Medically reviewed by Kevin Wandler, MD, Chief Medical Advisor
UMR is a UnitedHealthcare company that administers health plans for employers who pay their own employees’ medical claims, an arrangement known as a self-funded plan. If your insurance card says UMR, your employer designed the benefits, and UMR processes claims, answers member questions and coordinates reviews on your employer’s behalf.
Promises Dallas-Fort Worth is in network with UnitedHealthcare, and UMR is included in that contract. Because UMR plans are built employer by employer, though, your coverage for addiction or mental health treatment may look quite different from that of someone who carries a UMR card from another company.
How UMR Relates to Our In-Network Contract
UMR is part of the UnitedHealthcare family, and our UnitedHealthcare agreement lists UMR among the plans it includes. Many UMR plans use a UnitedHealthcare provider network, which is why UMR members can often access in-network benefits at our Lewisville facility.
There’s one wrinkle to watch for. Some employers pair UMR’s administrative services with a different provider network. Look at the front and back of your card for a network name or logo. A UnitedHealthcare network is a good sign. If you see a different network, verification will clarify which benefits and rates apply to you.
Understanding a Self-Funded Plan
With a self-funded plan, your employer, rather than an insurance company, carries the financial risk for claims. Your benefits are described in a plan document and a summary plan description, often called the SPD. That document spells out what the plan covers for substance use and mental health care, which services need prior authorization, and how to appeal a decision you disagree with.
Most private-employer self-funded plans are governed by federal law instead of Texas insurance regulations. Federal mental health parity rules apply to many of these plans, which generally means limits on behavioral health care can’t be more restrictive than limits on comparable medical care.
What a UMR Plan May Cover
Subject to your plan’s terms, medical necessity and prior authorization, a UMR plan may include benefits for:
- Medical detox, which provides medically supervised withdrawal management
- Residential treatment for addiction, mental health conditions or both
- A partial hospitalization program (PHP) held in person at our Lewisville campus
- A virtual intensive outpatient program (IOP) available online to adults anywhere in Texas
Behavioral health services for UMR members are often managed through Optum, another company in the UnitedHealthcare family. If your card lists a separate number for mental health or substance use care, that’s likely where prior authorization requests are handled.
How to Verify UMR Benefits
- Gather your card and note the group number, member ID and any network name printed on it.
- Call the member services or behavioral health number on your card. Ask whether Promises Dallas-Fort Worth is in network, how much you owe before coverage begins, and which levels of care require prior authorization.
- Ask your human resources department for the summary plan description if you’d like to read the exact plan language.
- Or skip the calls and let our admissions team run a free, confidential verification for you.
Frequently Asked Questions
Will my employer know I asked about rehab benefits?
Verifying benefits is a confidential process. Federal privacy rules limit how a group health plan can share your health information with your employer, and plans generally can’t share it for use in employment decisions.
Why is my UMR plan different from a friend’s UMR plan?
Each employer chooses its own deductible, coinsurance, network and covered services. UMR administers the plan, but your employer’s plan document defines it.
Can I use my UMR plan for virtual care?
Many plans include telehealth benefits for behavioral health. When you verify, ask specifically about coverage for a virtual IOP, since some plans treat virtual and in-person services differently.
Take the Next Step
If you have questions about your UMR coverage, our team can help sort through them. Visit our insurance options page, contact Promises Dallas-Fort Worth online, or call (469) 546-9303 to speak with admissions any time of day or night.