BALANCE BILLING
Balance Billing can occur when the provider or facility charges a member for an amount greater than the required cost of the healthcare service(s) provided.
WHAT SHOULD I DO IF I RECEIVE A BALANCE BILL?
How Do I Know If I'm Being Charged Too Much?
After receiving medical care, you will get an Explanation of Benefits (EOB) from your plan administrator specifying what you owe for services. If you receive a bill for more than this amount, immediately contact UMR. UMR will work with ELAP to open a case for your invoice.
If you are ever overcharged for your care, UMR will send a notification letter informing you that they are reducing payment and to lookout for any balance bills in the mail.
UMR works with ELAP to ensure the following resources:
- Member Service Advocates to assist you throughout the balance billing process. The Advocate will work closely with you as they work to resolve the balance billing issue. All we ask is cooperation and patience as the Advocate takes the lead on working through the process.
- An expert team to assist members with all billing issues. You will be requested to sign and return a HIPAA form for medical records release and a signed Attorney-Client Representation Agreement. If you receive a balance bill, please contact UMR immediately at 1-800-972-3025.
MEMBER SERVICE ADVOCATES
Will Anyone Help Me Through This Process?
Once UMR receives your bill, you and your family are assigned a personal Member Services Advocate who will provide you with support every step of the way. After you provide written permission to have UMR advocate on your behalf, their team begins working to resolve the claim with your healthcare provider.
Your dedicated Advocate is your main line of support, continually monitoring the progress of your account while proactively keeping you up to date.
Have a question? Call or email your Advocate at any time. You’ll get a response within 24 hours.
If it sounds easy, it’s because it is. If you receive any billing correspondence in the mail, send it to UMR right away. Your Advocate will take it from there, keeping you in the loop throughout the process.
Additionally, you also have the ability to find providers and determine the right care for you using Care Navigation. This makes it easy for you to find providers that fit your needs and work well with your benefits. See additional information in the link below.
