UMR / Data iSight Out of Network Issues

My daughter has been diagnosed with ASD and anxiety and requires speech, occupational and behavioral health therapy.

To keep her care consistent we see therapists that she has been seeing for the past three years or more. These therapists are out-of-network for UMR.

Our out-of-network family deductible is $6,000. We understand that we will be paying $6,000 out of pocket until the deductible is met after which we are supposed to be reimbursed at 50% of out of pocket cost for out-of-network providers.

We have been dutifully submitting claims. It seemed as if it was taking a very long time to meet our deductible based on what we had paid and submitted. When I started digging into things I realized that there was a “discount” applied to the majority of our out-of-network claims. To be clear we expected to and did pay the full amount claimed.

We contact UMR who then sent us to Data iSight. We then filed claims with Data iSight to try and have the correct amount applied to our deductible. This resulted in a “failed negotiation” with the provider (again we never expected to pay less than we did.) I was instructed by Data iSight to go back to UMR.

Does anyone have any insight into how to resolve. All I want is the correct amount I paid for services credited to my deductible so that I will be reimbursed appropriately once that deductible is hit.

This is to say nothing of the fact that UMR requires me to go through three levels of escalation to talk to a claims adjuster, frequently has me on hold for 45 minutes or more. Not to mention I had never heard of Data iSight before talking to UMR about 18 times.

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It feels borderline fraudulent to me and any help would be appreciated.