UMR: Health Insurance Explained [2024]
UMR health insurance is an often misunderstood type of insurance. As a self-funded insurance plan, the insured employers will assume the financial burden borne by most healthcare-related costs. UMR is a third-party administrator.
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Brandon Frady
Licensed Insurance Agent
Brandon Frady has been a licensed insurance agent and insurance office manager since 2018. He has experience in ventures from retail to finance, working positions from cashier to management, but it wasn’t until Brandon started working in the insurance industry that he truly felt at home in his career. In his day-to-day interactions, he aims to live out his business philosophy in how he treats hi...
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UPDATED: Nov 27, 2023
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UPDATED: Nov 27, 2023
It’s all about you. We want to help you make the right coverage choices.
Advertiser Disclosure: We strive to help you make confident insurance decisions. Comparison shopping should be easy. We are not affiliated with any one insurance provider and cannot guarantee quotes from any single provider.
Our insurance industry partnerships don’t influence our content. Our opinions are our own. To compare quotes from many different insurance providers please enter your ZIP code above to use the free quote tool. The more quotes you compare, the more chances to save.
On This Page
- UMR stands for United Medical Resources and was founded in 1983
- UMR is not a health insurance provider per se, but should rather be viewed as a third-party administrator
- UMR is meant to give administrative assistance to a variety of health insurance plans that are self-funded
There are many types of health insurance coverage floating around out there, so it can be difficult to keep them all straight. UMR health insurance is an often misunderstood type of insurance.
As a self-funded insurance plan, the insured employers will assume the financial burden borne by most healthcare-related costs.
While it is true that some organizations will undoubtedly organize their own self-funded insurance plans, most will opt to make use of the third-party administrator that is United Medical Resources insurance.
It should also be noted that some companies that use a self-funded plan will have a stop-loss insurance policy designed to cover them for any medical treatment claims made over a set amount.
Self-funded health insurance plans are typically used when there is no employer contribution towards employee benefits or if the company does not wish to contribute toward its employees’ healthcare needs.
Third-party administrators provide services such as administration, billing, claim processing, etc. It does this on behalf of various insurers who offer group health policies. UMR insurance providers have hired the company to do this job
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Is UMR a UnitedHealthcare company?
Back in 2002, UnitedHealthcare bought Midwest Security Administration. This acquisition was the company’s first move into being a third-party administrator of healthcare-related insurance plans.
It was in 2005 that UnitedHealthcare actually expanded even further when it purchased United Medical resources. One other historical item of note is that UnitedHealthcare purchased Fiserv Health in 2008.
At this point, all three of the administrative arms of the company were combined under UMR. That is the way that it remains to this day.
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What is UMR insurance?
To understand UMR healthcare and its overall impact on the health insurance industry, it is helpful to know some of the following statistics.
- The main headquarters for UMR is in Cincinnati, but it also has local and regional offices across the country
- Currently, more than 3,000 people are employed with UMB
- Employees serve roughly 1,400 clients with self-funded health plans
- Clients include individual companies, state governments, and employer formed groups
- There are more than two million subscribers to UMR
- UMR medical insurance currently processes roughly 14 million claims every year
These statistics help to highlight the scope of UMR, but it is also helpful to get a picture of the range of services that the organization is able to provide via these self-funded insurance plans.
What services are offered?
When UMR is utilized, self-funded plans can be more comprehensively managed. These plans include not only medical insurance, but plans for disability, vision, and dental as well.
UMR effective works to tailor the services that it offers to the specific needs of each company that becomes its client including handling the claims process from start to finish, reporting issues, and cost control analysis.
Some clients will have several types of self-funded insurance plans under the UMR organization, while others will make use of just one or two.
For example, a company might offer a health insurance plan through an HMO, but self-fund its dental and vision insurance using UMB as its third-party administration.
UMR coverage includes the following:
- a host of pharmacy benefits
- programs aimed at wellness
- stop-loss coverage
It is also important to note that UMR provides its clients with certain discounts on in-network health services with UnitedHealthcare’s PPO Network is utilized. It also offers more than 100 other partner networks that employer insurance plans can utilize.
Is UMR a good place to work?
There are mixed reviews about working at UMR. Some employees have commented that the customer service jobs are difficult because you are dealing with medical issues and insurance claims and it’s a high-stress environment with lots of incoming calls from angry customers.
However, others have noted that the job offers flexible scheduling and a benefits plan that includes fertility benefits and mental health benefits.
There is an extensive training program to prepare you for a job at UMR, and several reviews noted that there were good opportunities for advancement.
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What are UMR’s policies and procedures?
In theory, UMR works like any other medical insurance company. The employer will provide a list of covered benefits to the employee, along with possible deductible and co-insurance requirements that need to be met.
In deference to an actual HMO plan, however, the employer will fund the plan on their own.
Any claims that are made against the policy will be paid out of this fund, and all of the expenses are organized by UMR.
It is a third party that governs the administration of the plan and ensures that each employee is adequately covered and receives the health care that they are entitled to.
Case Studies: UMR: Health Insurance Explained
Case Study 1: John’s Experience with UMR Health Insurance
John, a 35-year-old software engineer, joined UMR health insurance, initially uncertain about its coverage. Through policy review and consultation, he gained clarity and understanding of the plan’s benefits. This case study showcases John’s experience and the advantages he discovered with UMR.
Case Study 2: Sarah’s Cost Savings with UMR Health Insurance
Sarah, a 42-year-old small business owner, faced significant healthcare expenses due to a chronic condition. Seeking a cost-effective solution, she switched to UMR health insurance. Through this case study, we delve into Sarah’s experience, examining the cost-saving measures and specialized programs offered by UMR that helped alleviate her financial burden.
Case Study 3: James’ Access to Comprehensive Care through UMR Health Insurance
James, a 50-year-old retiree, chose UMR health insurance for continued comprehensive coverage. This case study explores his experience, emphasizing the extensive network of healthcare providers and facilities available to UMR policyholders. With UMR, James found peace of mind in accessing the care he needed during his retirement.
Case Study 4: Maria’s Seamless Claims Process with UMR Health Insurance
Maria, a 28-year-old marketing executive, found relief from complex health insurance claims when she switched to UMR. This case study focuses on her experience, highlighting the streamlined claims process and prompt reimbursements that simplified her healthcare journey. With UMR, Maria enjoyed a user-friendly system that made her life easier.
Case Study 5: David’s Personalized Support from UMR Health Insurance
David, a 39-year-old sales manager, found personalized support and guidance with UMR health insurance. This case study highlights his experience, emphasizing the tailored resources and services provided by UMR. David’s healthcare decisions were positively impacted by the personalized assistance he received from UMR.
Case Study 6: Lisa’s Wellness Initiatives with UMR Health Insurance
Lisa, a 45-year-old teacher, was committed to leading a healthy lifestyle and wanted an insurance provider that supported her wellness goals. By selecting UMR health insurance, she gained access to various wellness programs and initiatives. This case study explores Lisa’s journey, highlighting the wellness benefits provided by UMR and their contribution to her overall well-being.
Case Study 7: Mark’s International Coverage with UMR Health Insurance
Mark, a 32-year-old international business consultant, found the ideal health insurance with UMR, offering comprehensive international coverage. This case study highlights Mark’s experience, emphasizing the advantages and flexibility he gained by choosing UMR for his global healthcare needs. UMR provided him with the necessary support and coverage for his international lifestyle.
Case Study 8: Emily’s Family-Focused Benefits with UMR Health Insurance
Emily, a 36-year-old working mother, found family-focused benefits with UMR health insurance. This case study explores her experience, highlighting UMR’s comprehensive coverage for pediatric care, maternity, and specialized services for children. The family-oriented benefits provided by UMR positively impacted Emily’s family’s well-being.
In Conclusion
Keep in mind that UMR is essentially a third-party administrator.
UMR is hired by an employer and its sole aim is to help ensure the claims made by the insured are paid correctly. This hiring is done in an effort to keep healthcare-related expenses to a minimum and enable the individual to focus on his or her own well-being.
It is important to remember that UMR is not a health insurance company by any stretch of the imagination. You cannot purchase any kind of medical plan directly from UMR.
The employer under this arrangement will agree to pay a certain portion of the health care costs that are not paid by the insured. Finally, remember that UMR is now a part of the UnitedHealthcare Company. This means it works closely together to create programs that benefit both parties involved.
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Frequently Asked Questions
What is UMR?
UMR stands for “United Medical Resources,” which is a third-party administrator (TPA) specializing in health insurance services. They work with employers and insurance carriers to manage various aspects of health insurance plans, such as claims processing, network management, and customer service.
How does UMR fit into the health insurance process?
UMR acts as a middleman between the employer or insurance carrier and the healthcare providers and policyholders. They handle tasks like claims processing, provider network management, customer service, and providing tools and resources for policyholders to manage their health benefits.
Do I purchase health insurance directly from UMR?
No, UMR is not an insurance company. They are a TPA that partners with insurance carriers and employers to administer health insurance plans. You would typically obtain health insurance coverage through your employer or an insurance carrier that works with UMR.
What services does UMR provide?
UMR offers a range of services related to health insurance administration, including claims processing, provider network management, customer service support, eligibility verification, pre-authorization for medical procedures, and online tools for policyholders to manage their benefits.
How does UMR handle claims processing?
When you receive medical services covered by your health insurance plan, the healthcare provider submits a claim to UMR for processing. UMR reviews the claim, verifies the coverage, and determines the payment amount based on the plan’s benefits and fee schedule. They then communicate the payment to the provider and the policyholder.
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Brandon Frady
Licensed Insurance Agent
Brandon Frady has been a licensed insurance agent and insurance office manager since 2018. He has experience in ventures from retail to finance, working positions from cashier to management, but it wasn’t until Brandon started working in the insurance industry that he truly felt at home in his career. In his day-to-day interactions, he aims to live out his business philosophy in how he treats hi...
Licensed Insurance Agent
Editorial Guidelines: We are a free online resource for anyone interested in learning more about auto insurance. Our goal is to be an objective, third-party resource for everything auto insurance related. We update our site regularly, and all content is reviewed by auto insurance experts.