Mental wellness is essential to overall well-being. If your body is dropping hints that your mind needs some well-deserved care, it’s best to listen and act promptly. However, one concern for many people is the rising cost of therapy. Fortunately, United Medical Resources (UMR) has you covered.
UMR is part of the UnitedHealth group of companies. It’s the country’s largest third-party administrator (TPA) of self-funded insurance plans. UMR covers outpatient therapy services, though the extent varies by plan type. If your employer has provided you with this kind of insurance, then this article is for you. Read on to learn more about how UMR can help you pay for outpatient therapy.
Key takeaways
- UMR (United Medical Resources) is a third-party administrator (TPA), not a traditional insurer — your employer funds the plan and UMR processes the claims.
- UMR covers outpatient therapy, teletherapy, and behavioral health services including substance use treatment, though the specifics depend on your employer’s plan.
- Because every employer’s UMR plan is customized, your copay, deductible, and covered services may differ significantly from another UMR member’s — checking your own plan documents is essential.
- UMR uses UnitedHealthcare’s provider network, so in-network therapists are typically the same as UHC in-network providers.
Does UMR Insurance cover mental health services?
UMR is a TPA hired by your employer and technically not a health insurance company. Instead, it ensures that your healthcare claims are paid correctly. If you’re a UMR member, your employer shoulders the health care costs you don’t pay.
Having said that, UMR health insurance plans comply with the Affordable Care Act, which mandates including mental health services among the essential benefits. UMR covers therapist visits and addiction treatment services under its Behavioral Health Program. The company works with UnitedHealthcare and other providers to ensure you can access a wide range of affordable health services anywhere.
Did you know?
Self-funded employer health plans, like those administered by UMR, cover more than 100 million Americans, according to the Employee Benefit Research Institute. Unlike traditional insurance, your employer directly funds the health care costs, with UMR processing the claims. This means your mental health benefits are determined by your employer’s plan design, not by UMR itself — which is why two people with “UMR insurance” can have very different coverage.
Therapy covered By United Medical Resources insurance
UMR coverage depends on your insurance plan but generally includes behavioral diagnostic exams, talk therapy, and prescription drugs. A physician must authorize the services and confirm they’re medically necessary. The following are examples of mental health services that UMR covers:
- Diagnosis and treatment of autism spectrum disorders
- Biofeedback
- Gender affirmation therapy
- Bereavement counseling
- Diagnosis and treatment of sleep disorders
- Diagnosis and treatment of substance use disorders
Outpatient therapy may be provided by a qualified provider, such as a psychiatrist, psychologist, or a master’s level clinician. Further, UMR offers flexible in-network and out-of-network coverage, making access to many therapy providers affordable.
If you can’t see your therapist in person, you’ll be happy to know that UMR also covers teletherapy. The Teladoc site can conveniently connect you to your therapist via phone or video conferencing. However, online visits may not be available in some locations, so it’s best to check first before booking your appointment. You can also find a therapist who accepts UMR through the Grow Therapy website.
Therapy United Medical Resources insurance doesn’t cover
UMR doesn’t cover the following:
- Experimental, investigational, or unproven treatments and diagnostic exams
- Educational services provided by the government
- Counseling services that are medically unnecessary or not given by a qualified provider
For a more comprehensive list, read your plan’s General Exclusions section. You may also get in touch with customer service through the toll-free number on the back of your UMR member ID card.
How to check your United Medical Resources insurance coverage
There are several easy ways to verify the specific UMR benefits available to you. First, read the printed copy of the Medical Schedule of Benefits UMR has given you upon enrollment. Second, contact UMR customer service by calling the number on the back of your member ID card. Third, you may check online by following these steps:
- Go to the UMR website.
- Log in using your HealthSafe ID. You can register on the site if you don’t already have one.
- Follow the prompts.
- Once you’ve logged in, you’ll have access to information about your UMR health benefits.
Why does my UMR coverage look different from a coworker’s?
Because UMR is a third-party administrator rather than an insurer, your employer designs and funds your specific plan. Two employees at different companies — or even the same company in different plan tiers — can have very different mental health benefits, deductibles, and copays, even though both cards say “UMR.”
This is why the most reliable way to understand your coverage is to review your own Medical Schedule of Benefits or call the number on the back of your member ID card. General information about UMR plans gives you a framework, but your employer’s specific plan documents give you the actual numbers.
How much does therapy cost with UMR?
Therapy costs depend on various components. First, therapy providers charge differently. Many factors determine their rates, such as location and type of practice, services, and type and level of training received. For example, psychologists bill differently from licensed counselors, having different skill sets and responsibilities to patients.
After that, health insurance coverage varies with your plan type, location, and whether your provider is in-network or out-of-network. We explain below how these factors affect your therapy costs:
In-network vs. out-of-network providers and services
UMR has an organization of professionals under contract to provide healthcare services to insured members at a negotiated rate. In-network providers belong to this group, while out-of-network providers don’t. However, UMR doesn’t limit you to their in-network providers. You may also see out-of-network health professionals if you wish. However, insurance coverage for their services is usually less.
Note that UMR requires prior authorization for certain behavioral health services, especially if given out-of-network. Compliance ensures you avoid penalties. If you aren’t sure you need prior authorization for your therapy sessions, ask UMR customer service before booking your appointment.
Deductibles
A deductible is an amount you pay within a policy year before UMR starts paying for your health care costs. The rates depend on your type of insurance and whether or not your therapy provider is in-network. Having dependents also impacts your insurance expenses.
UMR plans are available in Bronze, Silver, Gold, and Platinum categories. Bronze plans have the lowest monthly premiums but provide the least coverage. Platinum plans have the highest monthly premiums but give more extensive coverage. UMR deductibles range from $250 to $5,000 per covered person and $500 to $10,000 per covered family.
Copays
Copays are fixed fees you pay at the time your therapy provider bills you. Some plans have copays, ranging from $20-30 per session, while others don’t require them at all. Copays don’t count toward deductibles but toward out-of-pocket maximums.
An out-of-pocket maximum is the most you’ll pay in a policy year for covered expenses. Copays and out-of-pocket maximums also vary by plan. Typically, plans with lower monthly premiums have higher copays and out-of-pocket maximums.
How to find a therapist who takes United Medical Resources insurance
Deciding to find a therapist is a courageous step toward your mental health journey. You can do this in different ways. First, you may call the number on your UMR ID card to reach customer service. Second, you may use the UMR search tool, which you can access here. It’ll help you narrow down UMR providers according to their areas of expertise, location, and others. Third, you can use Grow Therapy to find an in-network UMR provider in your area. You an even narrow this list down by specialty, among other filter options.
Final thoughts
UMR’s structure as a TPA means your coverage is more customized than most — and that’s worth understanding before your first session. The plan documents your employer provides, or a quick call to the number on your member ID card, will give you the clearest picture of your specific copay, deductible, and any prior authorization requirements.
If you’ve confirmed you have coverage and are ready to find a provider, Grow Therapy’s network includes therapists who accept UMR across a wide range of specialties. The cost estimator can show you your estimated session cost before you book anything.
