UMR

Have coverage through my wife's work so it's not Obamacare but it might as well be because they don't pay. Called twice asking why they aren't paying my doctors bills.

I am $243 away from my out of pocket limit and deductible, yet I received bills from in network providers for ~$600 and another for ~$950. The first lady I talked to at least seemed intelligent and said we are waiting for all the bills to come in. So I call the providers and ask them to resubmit. A month later I'm still getting the bills so I call again and get a mumbling kid that apparently doesn't know what deductible means or that $600 and $950 is bigger than $243.

Reminded me a lot of the movie Idiocracy. His theory was I have to pay whatever the provider charges and they don't pay anything until that is more than the deductible.

So I ask him if I get a bill for $1M and I'm $243 off my deductible I have to pay $1 million? He is befuddled and tries to put me on hold for a 2nd time at which point I am so pissed I just hung up.

I have been battling with UMR for over a year, and the experience has been nothing short of infuriating. Despite having submitted all the necessary documentation, including irrefutable proof via screenshots and fax confirmations, my claim remains unresolved. UMR continues to deny my claim, citing missing documents, even though I have provided every piece of evidence they requested. The situation is further aggravated by the fact that I have already hit my deductible and maxed out my out-of-pocket expenses, yet UMR persists in claiming that I owe patient co-payments for services that should be fully covered.

One of the most egregious aspects of this ordeal is UMR's faulty communication. The fax number provided on their website for claims submissions is invalid. When my healthcare provider attempted to fax the supporting documents, they were informed that the number does not work. This deliberate misinformation appears designed to ensure that crucial documents never reach the appropriate department, thereby stalling the claims process. Eventually, my provider found an alternative way to submit the documents, but they still do not respond.

Every time I call UMR, I am forced to retell my entire story to a new representative, who then promises that my claim is in progress or under review and that an escalation email has been sent. However, as soon as I hang up, nothing changes. The repetition of these empty assurances is not only exhausting but also demonstrates a complete lack of accountability and coordination within UMR's customer service.

Attached is a detailed breakdown that reveals a glaring disconnect between the services provided and the benefits I am entitled to. Despite meeting all my financial obligations under the policy, UMR continues to misclassify these charges and delay proper payment.

UMR's deceptive tactics exploit the goodwill and trust of their customers. As someone who has lived on three different continents, I have never encountered a health insurance system as disorganized and unresponsive as UMR's. I am posting this review on the Better Business Bureau website to warn others about the unacceptable delays, inconsistent communication, and apparent intentional misdirection employed by UMR. Potential customers deserve transparency, prompt service, and genuine care—qualities that UMR has sorely failed to demonstrate.

Where to start? They were telling providers my youngest, who has severe medical problems, was not on my plan, which is fraud.

They automatically took her off my plan because she had secondary insurance (which is usually for low-income and disabled individuals). Since this insurance did not have an automated verification system, they took her off my insurance without notifying me or making any attempt to verify with the other insurance. I called three times and got nowhere, kept saying it would get fixed, but it never did until I contacted the head of HR for the major company I work for; then, amazingly, it got fixed. Also, they are playing games with durable medical equipment and medically-assisted equipment for my daughter.

Unfortunately, it's the denial and appeals game, which is ridiculous. The plan clearly states that physician-prescribed medical equipment that is medically necessary is covered. I can never get a straight answer from anyone when I call; I get transferred or hung up on. They would save money and work better if they had a straightforward system and customer service.

It feels like one big scam.

They have practices that anyone with two brain cells can see are completely discriminatory in nature, especially against those with disabilities, particularly children. But they hide behind their lawyers and political friends to 'save money' while committing fraud and not living up to their end of the contract to the consumer.

We paid over $1,200 to UMR COBRA in March, under the impressionbased on what their materials and representatives led us to believethat coverage would begin once they received our payment. What wasnt made clear at all was that any payments would be applied retroactively to cover a prior period (in our case, December), which we did not need, use, or intend to cover.

To actually obtain coverage for April, we would have had to pay for four months of premiums, most of which would have applied to a time period where we were not even using their services.

Thats over a thousand dollars wasted.

We called and spoke to a representative who admitted this is common practice, and advised us to send a signed letter requesting a refund for the coverage we didnt use. We did exactly thatonly to be met with a flat-out denial.

This may very well be a common practice for them, but that doesnt make it any less shady or deceptive, especially when we were clearly led to believe that coverage would begin upon receipt of payment in March.

Why would anyone in their right mind pay $1,200 in March to begin coverage in December of the previous year? It makes no logical or ethical sense, and there was no transparency about this process up front.

We feel misled, manipulated, and taken advantage of.

Their vague communication, misleading policies, and refusal to make things right raise serious concerns about the ethics of how they operate.

I would strongly warn anyone considering UMR COBRA to stay far away. Their practices are not only confusing but feel intentionally deceptiveand it wouldnt surprise me if theyre eventually hit with a class action lawsuit for these kinds of unethical business practices.

It hs taken my primary dental office including myself to get EOBs. From

November 2024 through April 2025, no EOB was sent to my primary dentist.

The dentist received credit by direct deposit, but no information sent to office for them to give me credit. We worked days that get information. Four times we ask for EOB and was told they would fax that day. Never happened.

Ask to speak to a Manager and was told 3 times

They would have manager to call within 2 days. There again no phone calls.

So guess who was getting payment, the Dentist, definitely not the Patient. So I am fed up and searching for dental insurance.

Through my employer, I have full (and somewhat decent) coverage, including some wellness benefits. Last year, I bundled and submitted my receipts for reimbursement, using the website submission feature.

I didn't hear anything for a ridiculous amount of time, and after calling customer service, the answer was to resubmit the claims, and they would eventually be entered into the system. Eventually, I was reimbursed, but it took several calls, lots of transfers between agents; basically, it was a huge waste of time. Fast forward to the end of 2024, I submitted (via the web portal) a set of 4 receipts for reimbursement. Surprisingly, it has taken at least 5 calls and nearly a month of waiting only to find out that the claims were just submitted and may take another 30 calendar days to process.

Again, the answer was to resubmit the claims (counterproductive, I think, since the system is already beyond the ability to deal with whatever was already submitted), no matter than I have a confirmation number for the original submission. Two or three agents told me to just resubmit, to call back, to call a different number, etc.

It will take them at least another month to process the claims, and even then, I'm doubtful that it will be done correctly. After last year, I'm not sure why I expected less of a runaround.