View 2020 copay rates for VA and VA-approved health care.
- Does Umr Cover Emergency Room Visits
- Does Umr Cover Urgent Care
- Umr Urgent Care Copay Program
- Umr Care Management Fax Number
You can view the Glossary at www.umr.com or call 1-800-826-9781 to request a copy. Care Not available $500 Copay per visit $500 Copay per visit $500 Copay per visit Copay may be waived if. Urgent care Not available $75 Copay per visit $100 Copay per visit Not covered None. UMR: KENYON COLLEGE: 76-411216 001. Fetch ftp mac free download. $15 Copay per visit. Urgent care 20% Coinsurance 40% Coinsurance None.
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Does Umr Cover Emergency Room Visits
Effective January 1, 2020
Note: Some Veterans don't have to pay copays (they're 'exempt') due to their disability rating, income level, or special eligibility factors.
Urgent care copay rates
(Care for minor illnesses and injuries)
Does Umr Cover Urgent Care
There's no limit to how many times you can use urgent care. To be eligible for urgent care benefits, including through our network of approved community providers, you must:
- Be enrolled in the VA health care system, and
- Have received care from us within the past 24 months (2 years)
You won’t have to pay any copay for a visit where you’re only getting a flu shot, no matter your priority group.
Priority group | Copay amount for first 3 visits in each calendar year | Copay amount for each additional visit in the same year | |||
---|---|---|---|---|---|
Priority group | 1 to 5 | Copay amount for first 3 visits in each calendar year | $0 (no copay) | Copay amount for each additional visit in the same year | $30 |
Priority group | 6 | Copay amount for first 3 visits in each calendar year | If related to a condition that's covered by a special authority*: $0 (no copay) If not related to a condition covered by a special authority*: $30 each visit | Copay amount for each additional visit in the same year | $30 |
Priority group | 7 to 8 | Copay amount for first 3 visits in each calendar year | $30 | Copay amount for each additional visit in the same year | $30 |
* Special authorities include conditions related to combat service and exposures (like Agent Orange, active duty at Camp Lejeune, ionizing radiation, Project Shipboard Hazard and Defense (SHAD/Project 112), Southwest Asia Conditions) as well as military sexual trauma, and presumptions applicable to certain Veterans with psychosis and other mental illness. Java virtual machine 1.8 mac download.
Outpatient care copay rates
(Primary or specialty care that doesn't require an overnight stay)
If you have a service-connected disability rating of 10% or higher
You won't need to pay a copay for outpatient care.
If you don't have a service-connected disability rating of 10% or higher
You may need to pay a copay for outpatient care for conditions not related to your military service, at the rates listed below.
Type of outpatient care | Copay amount for each visit or test | ||
---|---|---|---|
Type of outpatient care | Primary care services (like a visit to your primary care doctor) | Copay amount for each visit or test | $15 |
Type of outpatient care | Specialty care services (like a visit to a hearing specialist, eye doctor, surgeon, or cardiologist) | Copay amount for each visit or test | $50 |
Type of outpatient care | Specialty tests (like an MRI or CT scan) | Copay amount for each visit or test | $50 |
Note: You won’t need to pay any copays for X-rays, lab tests, or preventive tests and services like health screenings or immunizations.
Inpatient care copay rates
(Care that requires you to stay one or more days in a hospital)
If you have a service-connected disability rating of 10% or higher
You won't need to pay a copay for inpatient care.
If you’re in priority group 7 or 8
You'll pay either our full copay rate or reduced copay rate. If you live in a high-cost area, you may qualify for a reduced inpatient copay rate no matter what priority group you're in. To find out if you qualify for a reduced inpatient copay rate, call us toll-free at 877-222-8387. We're here Monday through Friday, 8:00 a.m. to 8:00 p.m. ET.
Length of stay | Copay amount | ||
---|---|---|---|
Length of stay | First 90 days of care during a 365-day period | Copay amount | $281.60 copay + $2 charge per day |
Length of stay | Each additional 90 days of care during a 365-day period | Copay amount | $140.80 copay + $2 charge per day |
Note: You may be in priority group 7 and qualify for these rates if you don't meet eligibility requirements for priority groups 1 through 6, but you have a gross household income below our income limits for where you live and you agree to pay copays.
Length of stay | Copay amount | ||
---|---|---|---|
Length of stay | First 90 days of care during a 365-day period | Copay amount | $1,408 copay + $10 charge per day |
Length of stay | Each additional 90 days of care during a 365-day period | Copay amount | $704 copay + $10 charge per day |
Note: You may be in priority group 8 and qualify for these rates if you don't meet eligibility requirements for priority groups 1 through 6, and you have a gross household income above our income limits for where you live, agree to pay copays, and meet other specific enrollment and service-connected eligibility criteria.
Medication copay rates
If you’re in priority group 1
You won’t pay a copay for any medications.
Note: You may be in priority group 1 if we've rated your service-connected disability at 50% or more disabling, if we've determined that you can't work because of your service-connected disability (called unemployable), or if you've received the Medal of Honor.
If you’re in priority groups 2 through 8
You'll pay a copay for:
- Medications your health care provider prescribes to treat non-service-connected conditions, and
- Over-the-counter medications (like aspirin, cough syrup, or vitamins) that you get from a VA pharmacy. You may want to consider buying your over-the-counter medications on your own.
Note: The cost for any medications you receive while staying in a VA or other approved hospital or health facility are covered by your inpatient care copay.
The amount you’ll pay for these medications will depend on the “tier” of the medication and the amount of medication you’re getting, which we determine by days of supply. Once you’ve paid $700 in medication copays within a calendar year (January 1 to December 31), you won’t have to pay any more that year—even if you still get more medications. This is called a copay cap.
Outpatient medication tier | 1-30 day supply | 31-60 day supply | 61-90 day supply | ||||
---|---|---|---|---|---|---|---|
Outpatient medication tier | Tier 1 (preferred generic prescription medicines) | 1-30 day supply | $5 | 31-60 day supply | $10 | 61-90 day supply | $15 |
Outpatient medication tier | Tier 2 (non-preferred generic prescription medicines and some over-the-counter medicines) | 1-30 day supply | $8 | 31-60 day supply | $16 | 61-90 day supply | $24 |
Outpatient medication tier | Tier 3 (brand-name prescription medicines) | 1-30 day supply | $11 | 31-60 day supply | $22 | 61-90 day supply | $33 |
If you have a service-connected rating of 40% or less and your income falls at or below the national income limits for receiving free medications, you may want to provide your income information to us to determine if you qualify for free medications.
Geriatric and extended care copay rates
You won't need to pay a copay for geriatric care (also called elder care) or extended care (also called long-term care) for the first 21 days of care in a 12-month period. Starting on the 22nd day of care, we'll base your copays on 2 factors:
- The level of care you're receiving, and
- The financial information you provide on your Application for Extended Care Services (VA Form 10-10EC).
Level of care | Types of care included | Copay amount for each day of care | |||
---|---|---|---|---|---|
Level of care | Inpatient care | Types of care included |
| Copay amount for each day of care | Up to $97 |
Level of care | Outpatient care | Types of care included |
| Copay amount for each day of care | Up to $15 |
Level of care | Domiciliary care for homeless Veterans | Types of care included |
| Copay amount for each day of care | Up to $5 |
Services that don't require a copay
You won't need to pay a copay for any of the services listed below, no matter what your disability rating is or what priority group you're in.
- Laboratory (lab) tests
- Electrocardiograms (EKGs or ECGs) to check for heart disease or other heart problems
- VA health initiatives that are open to the public (like health fairs)
Other information you may need
Pay your copay bill
Find out how to pay your copay bill—and what to do if you disagree with the charges or are having trouble making payments.
Your health care costs
Learn how we assess and verify your income to help determine if you're eligible for VA health care and whether you'll need to pay copays for certain types of care, tests, and medications.
Copayments for maternity care (PDF)
We cover maternity care for eligible Veterans through arrangements with community providers. Download this fact sheet to find out more about copays.
Affordable Self-Pay Pricing
We have an affordable self-pay tier system that allows you to pay just for what you need. Most patients benefit from a tier system as it is the minimum charge for all that you may need for your level of visit. This payment option may also appeal to insured patients with high deductible plans, where one may end up paying for more of their medical services out of pocket. Our office accepts payments by cash, checks, and Visa, MasterCard, American Express and Discover credit cards. To see the list of visit tiers and pricing, please click below. *EFFECTIVE SEPTEMBER 2020
Insurances We Accept
For your protection, you must present a VALID ID every visit. Co-payments and/or deductibles must be paid at the time of service. Below is a list of the main insurance carriers we are currently contracted with:
- AARP
- Aetna
- Assurant Health
- Beech Street
- Benefit Administrators
- Blue Cross Blue Shield
- Magnolia Local Plus
- DO NOT ACCEPT: Magnolia Local
- CIGNA
- Coventry
- First Health
- GEHA
- Gilsbar
- Great West
- Humana
- Kaiser Permanente
- Mail Handlers
- Medicare (Part B)
- Medicaid
- United Health Care Community Plan
- Healthy Blue
- AmeriHealth Caritas of Louisiana
- Aetna Better Health
- Humana Health Benefit Plan of Louisiana
- NALC
- Office of Group Benefits
- Peoples Health
- PHCS
- Pinnacle
- PPO
- Seafarers
- Tricare
- Total Broker Benefits
- UMR
- United Healthcare
- Vantage
- Workers Compensation*If we cannot verify your insurance or we do not accept it or it is not listed above: We can still see you as a self-pay patient and we will give you all records of your visit for you to submit to your insurance for reimbursement. If your insurance is not listed above, you would be considered “out of network” by your insurance. You may incur a higher copay or coverage amount. We recommend you provide your insurance company with a copy of all paperwork from your visit. In addition, we are always happy to research and potentially join networks of insurances we do not currently list above. Please call our clinic and see if and how we can work with your insurance today!
*PLEASE NOTE: If you visit one of our clinics to seek medical attention and you are referred out to the EMERGENCY ROOM, you may still be responsible for the cost of your visit as medical advice is not free. If you are experiencing a life-threatening emergency, please call 911 or go to your nearest emergency room.*
How can I be prepared for the cost of my visit?
We recommend that you contact your insurance company prior to visiting any of our clinics to verify coverage of the specific service you are seeking, as well as any co-pays, co-insurance or deductibles. Confirming this information in advance will help you avoid unforeseen charges.
How do I verify my insurance plan?
If you do not know how to verify your insurance, we recommend you call the number listed on the back of your card. If you are having trouble or you are trying to verify and your insurance office is closed, please call our clinic at either 504-393-2273 (Gretna), 985-359-2273 (LaPlace), or 504-370-2273 (Mid-City) and we can further assist you. If for some reason, we cannot verify, you can still be seen at our clinic. You will be required to pay either an office visit or 70% of your visit. Once we can verify your insurance (usually during normal business hours), you will either get a refund from us (if applicable) or we will give you all the necessary paperwork for you to file with your insurance company for reimbursement based on your insurance plan. We always recommend seeking medical attention when needed, especially after-hours or weekends when your insurance company may be closed.
Umr Urgent Care Copay Program
My insurance will not cover me at The Urgent Care clinics. What can I do?
If The Urgent Care is not in-network with your insurance company, please ask your insurance company to add The Urgent Care as a participating healthcare provider.
- We cannot waive co-pays, deductibles, or set up payment plans.
- Call the member service information phone number on the back of your insurance card so you understand your coverage and benefits.
- Inform your insurance company that you’re planning to visit one of The Urgent Care clinics. Again, confirm your benefits & coverage for the specific service you are seeking.
- HMO members, please confirm your plan’s rules to access The Urgent Care. Your out-of-pocket payment will be higher if you do not adhere to your plan’s rules.
What information do I need to bring with me to The Urgent Care?
Please bring a photo ID and ALL of your insurance cards. If you have any prior X-rays or lab work that will assist us in your treatment, please bring those as well. In addition, provide us with a list of medications and nutrition supplements you are currently taking and the dosages of each.
Umr Care Management Fax Number
If you need help verifying insurance or would like to see if we accept your insurance plan,
please call our billing department (504) 393-2775.