Tess has a bunch of amazing specialists working to help her. She went to the hospital in Boston a few times this year. She had hip surgery, got scoped by a GI doc, and took tests with an audiologist and an adaptive communication specialist. Here in Maine, she saw a physical therapist and visited her pediatrician half a dozen times.

Thing is, most of these specialists aren’t getting paid. Our insurance company, United Healthcare, has an administrator called UMR, and their policies are designed to keep them from paying Tess’s doctors, or at least to delay those payments for as long as possible. I’m on the phone and emailing UMR pretty often. I’ve written about this before, here and here.

Tess_doctors_office

The biggest problem I have with UMR’s no-pay policy is this pretense they’ve invented, one that says they aren’t sure whether our family has secretly gotten new health insurance coverage from somewhere else. Until they know for sure whether we have other insurance, they say, they won’t pay a dime to any of Tess’s doctors.

Well, I’ve told them. I called their 800 number, once in August and then again a month later. Both times I said nope, nothing’s changed and you’re still our primary insurance. Both times they apologized and said all claims would be reprocessed. But here we are in mid-October, still getting medical bills for services that Tess received in July. In spite of my calls, UMR is still saying the same thing:  they deny all claims because they need other insurance information.

This week I’d had enough. I emailed the president of UMR, a man named Jay Anliker, and asked to meet with him personally. Apparently I’m not the only one having difficulties with UMR not paying doctors for the work they’ve done. There’s a whole county of employees in and around Indianapolis who have also had enough, which I mention in my message.

Here’s what my email said:
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Dear Jay,
I’m writing to schedule a meeting with you.

For years now I’ve had a lot of problems getting UMR to pay claims, mostly for my daughter, Theresa “Tess” Bigelow, age 4, DOB XX-XX-XX. Our member ID is XXXXXX, and it’s under my wife’s name, XXXXXXXXX, who’s employed by XXXXXXXXXXX.

Since my wife started her job in August 2010, I’ve called your 800 number a whole lot, and also written letters to claims services. I know UMR changed its website recently to try to make it easier for customers like my family, but we’re still having trouble. Depending on who I talk to when I call your 800 number, UMR’s computers either have a bunch of information about my family and my communications with you, or none at all. Go ahead–look me up.

I read somewhere that employees of Hamilton County, Indiana were having issues recently with UMR regarding claims, and so you met personally with Steve Dillinger, the county commissioner, to try to work things out. (Here’s the article where I read about your meeting.) So let’s you and I do the same. If you’re really serious about helping customers, meet with me. I live in Maine, and I’m a stay-at-home dad to my two kids, so do you think you could come here? I’m free most weekday mornings, and we could meet here at my house. You can reach me on my cell: (207) XXX-XXXX.

I’ll look forward to a personal response from you. Let me know when you want to meet, and I’ll send you my address. Thanks!

Best,

Bo Bigelow