Facing the uncertainty of mental health coverage through your employer’s UMR-administered self-funded plan can feel overwhelming. Rest assured, clarity is within reach. Call us 24/7 for a free UMR benefits review.
Understanding UMR and Self-Funded Plans
UMR is a third-party administrator (TPA), distinct from traditional insurance companies like UnitedHealthcare. Instead of directly funding your claims, UMR manages administrative tasks such as processing claims and utilization reviews. Your employer, also known as the plan sponsor, actually funds the claims from their own budget. To protect themselves from excessively high claims, employers often purchase stop-loss insurance, which helps manage their financial risk if individual claims surpass a predetermined threshold.
Our Experience With UMR Plans
At Lenape Wellness Center, we have extensive experience helping clients navigate UMR-administered plans. Approximately 70% of our UMR cases are approved even when we’re out-of-network, thanks to our expertise in securing gap exceptions. A gap exception allows you to access specialized services like ours when suitable care isn’t available in-network.
We assist you and your employer throughout the approval process, providing transparent billing and clear communication every step of the way.
Step-by-Step Authorization With UMR
Navigating authorization for residential mental health treatment can seem complex, but we simplify the process into clear steps:
- Verify Your Summary Plan Description: We start by reviewing your specific plan to understand your benefits thoroughly.
- Collect Clinical Packet: Our clinical team compiles necessary documents, including treatment history, medical diagnoses, and justification for residential care.
- Submit to UMR Nurse Reviewer: We submit all required paperwork to UMR for initial review.
- Employer Final Approval: After UMR’s initial approval, your employer makes the final authorization decision.
Timelines You Can Expect
UMR provides clear timelines for authorization decisions:
- Routine reviews typically take about five business days.
- Expedited reviews (for urgent cases) are generally completed within 48 hours.
- Additionally, we can arrange peer-to-peer discussions if UMR requires more information or clarification.
What Residential Care Costs With UMR
Your exact costs will depend on your specific UMR plan details, but typical financial responsibilities include a deductible ranging from $0 to $2,000 and coinsurance between 20% and 40%.
Most UMR-administered self-funded plans also specify an annual out-of-pocket maximum, limiting your total spending. Successfully obtaining a gap exception can significantly reduce your coinsurance costs, making residential care at Lenape Wellness Center more affordable. We’ll help confirm your deductible status and any amounts already met during the plan year.
Why Self-Funded Members Choose Us
Self-funded members consistently choose Lenape Wellness Center because we offer a unique blend of evidence-based and holistic therapies, personalized to your specific needs. Our tranquil facility, nestled within a serene golf-course setting, promotes true relaxation and healing.
With our dedicated UMR liaison, you never have to navigate coverage complexities alone. Our transparent billing ensures there are no hidden surprises, providing clarity and peace of mind from admission through discharge.
How to Begin Your Admission
We’ve streamlined our admission process to ease your transition into care:
- Contact Us: Reach out to begin your free UMR benefits check.
- Benefits Verification: Our team promptly verifies your specific plan details.
- Employer Coordination: We’ll manage communications with your employer and UMR to facilitate coverage approval.
- Prepare for Arrival: We’ll help you understand what to pack and what to expect.
- Welcome to Lenape: Upon arrival, you’ll immediately feel supported and cared for.
Call us 24/7 or email admissions@lenapewellness.com to start your journey today.
Stories of Hope
“After searching through several mental health facilities, we’re so thankful we found Lenape Wellness Center. The care here was compassionate, professional, and truly focused on long-term healing. They supported our family every step of the way.”
Map and Directions to Our Campus
We’re located at:
950 Golf Course Rd, Ford City, PA 16226.
Our campus is easily accessible, situated on scenic grounds ideal for recovery and reflection.
Ready to Take the First Step?
Take the first step towards lasting wellness today. Contact us anytime or visit our online contact form at https://lenapewellness.com/contact-us/ to begin your path toward healing.