A UMR card usually means your employer writes the rules.
UMR turns up on self-funded employer plans. On a self-funded plan the employer pays the claims out of its own money and hires an administrator to process them, which means the employer's plan document, not a carrier policy, decides what the benefit is. That document is the thing we read.
Shift is out of network on UMR-administered plans.
We are not part of any commercial carrier network. On a self-funded plan the out-of-network terms can be more generous than on a fully insured one, or tighter. There is no way to know without reading the plan, so we read it and give you the number before your first appointment.
What we can say about your plan before we read it.
Covered by many PPO plans. We check your benefits first.
We do not waive cost shares, we do not tell you a number we have not verified, and we do not promise a result. We read your plan, we tell you what it pays toward intensive outpatient care, and you decide after that.
What your plan sets, and what we do about it.
The numbers are not on this page on purpose. Yours are specific to your plan and your plan year, and we pull them with you.
What your plan document sets
- An allowed amount for each kind of visit or day of care.
- A deductible you meet before the plan starts paying its share.
- A coinsurance split that applies after the deductible.
- An out-of-pocket maximum for the plan year.
- An authorization step for intensive outpatient care.
What we do
- Call the behavioral health number on the back of your card and pull the out-of-network figures for the level of care you need.
- Turn those figures into the dollar cost of a week of treatment and give you that number in writing.
- Open the authorization and stay on the case through review and renewal.
- Bill the plan directly, so you are not fronting the claim and chasing a reimbursement.
Ask your employer for the summary plan description.
It is the plan document in readable form and your employer has to give it to you. The behavioral health section is where the out-of-network allowed amount, the authorization requirement and the annual limits for intensive outpatient care are written down.
Send the behavioral health pages
We read them with you, point at the out-of-network language, and turn it into the cost of a week of intensive outpatient care. You do not need to interpret it yourself.
Check your benefits If the card also carries a carrier logoCheck which network the plan rents
Self-funded plans often rent a carrier network while the employer keeps the risk. The card can carry both names. Send us both and we work out which line to call.
UnitedHealthcareUMR and self-funded plans, answered plainly.
What does self-funded actually mean for me?
Your employer pays the claims from its own funds and pays an administrator to process them. For you the card looks the same, but the rules come from your employer's plan document rather than from a carrier's standard policy.
Is Shift in the UMR network?
No. We are out of network on every commercial plan, UMR-administered plans included. The out-of-network section of your plan document is what decides your cost, and we read it first.
Can my employer see that I used this benefit?
We do not report anything to an employer. We also cannot control what a plan's own claims or utilization reporting shows a plan sponsor, and we will not claim otherwise. Substance use treatment records carry the stricter protection of 42 CFR Part 2, which limits what we may disclose and to whom.
Who deals with the authorization?
We do. We open it, send the clinical documentation, and stay with it through review and renewal.
Send the UMR card, and the plan document if you have it.
Member ID and group number are enough to start. The behavioral health pages of the summary plan description make the answer faster and more exact. We come back with the out-of-network figures and the weekly cost of intensive outpatient care.
If you or someone you are with is in immediate danger, call or text 988 (the Suicide and Crisis Lifeline) or call 911. Shift Support Network is an outpatient program and is not an emergency service.
Not the card you hold.
Shift also publishes a page for UnitedHealthcare, Aetna, Cigna, Anthem and Elevance, Blue Shield of California, Carelon, Magellan, Kaiser and union and Taft-Hartley funds.
Background reading: how out-of-network works, out-of-network for IOP and PHP in plain English, and the program itself.