Can you get EOC?

[Dave020]

As far as I know, Lumenos has not been sold in California before the newest regulatory approvals 4/1 and 5/1. There are many California residents who have had Lumenos coverage in the past, usually through an out of state employer. Many I have spoken with that have had Lumenos is the past were very happy with the coverage.

You might check out www.lumenos.com and see if gives you any more detail although to me it is pretty much the same as the marketing brochures BCLH is putting out (actually they are Lumenos).


I've spoken with BCLH Lumenos and the constant answer I keep getting back is exactly as outlined in the brochure.

Dave

 

[Dave020]

I did find Lumenos group EOCs available and am still looking for the individual EOCs.

You can download the small group Lumenos EOC at

http://216.23.164.131/Forms/CarrierForms.aspx?carrierID=28&cTypeID=1

Dave

 

[Guest]

I did find Lumenos group EOCs available and am still looking for the individual EOCs.

You can download the small group Lumenos EOC at

http://216.23.164.131/Forms/CarrierForms.aspx?carrierID=28&cTypeID=1

Dave

Yes, this helps a lot. Good find, Dave.

Is it a good assumption that the IFP plans will be the same as the group plans? If not, what in your experience would be different?

I gave one of the HSA EOCs a quick skim and I don't see any deal-breakers. What I need to do next (or find someone who has done it) is a financial analysis to see if the increased prems pencil out to an HSA without the preventive care benefits. My guess is that they won't and that Lumenos will be a good deal, at least for younger people where the rates are lower.

Al

 

[Dave020]

I'd like to say the EOC should be similar for IFP, but until I see one I would not want to go out on that limb. I will query someone tomorrow and see what I can find out on IFP EOC. But I suspect they will be the same or at least very similar.

When I get time one thing I need to do is calculate the rate changes on Lumenos against the 5-year band changes on the traditional plans. Lumenos goes up every year, I am need to know if the yearly increases over a 5-year period a less, equal or greater than the bump to the next 5-year age band.

Dave
www.davefluker.com

 

[Guest]

Lumenos goes up every year

Yes, and therefore customers get a double-whammy... a rate increase on EVERY (not just 'fifth') birthday and then the 'standard' yearly across-the-board rate increase everyone in the plan gets (assuming there is one, and tell me a year that there hasn't been one with BC!)

The Lumenos rate chart is on the BC agent site. What I'm sort of surprised at is that some large GA .... maybe a Rodgers or Benefit Mall... hasn't done this analysis and published it for all their agents.

Is Lumenos also tier-rated? I didn't see any evidence of that in the rate chart but I didn't read it too closely.

The major analysis that has to be done is to compare the cost of the bundled Lumenos preventive care services against a cheaper but comperable plan that does not have them. That wll be difficult since we don't have access to negotiated rates.

The entire system is so anti-consumer, it makes me want want to scream. If (when) we get one-payor or universal coverage, no one (least of all I) will cry any tears for the carriers. I will cry about the crappy medical care we will get, but none for most of the large carriers I've worked with. There is one tiny local HMO that seems to have their act together... Western Health Advantage... but I've never written any of this plans because I'm simply not a believer in gatekeepers, and the other HMO hoop-jump-throughs consumers are made to do with those plans. The PPO pre-auth for hospitalization to me is onerous enough. I don't like some low-paid ex-nurse-aide working the phones for the carrier deciding if my doctor is correct in admitting me to the hospital.

They system is a mess. A total mess. That's what I communicate to my clients... and you should too... because you are not telling them anything they don't already know... and if you try to sugar-coat it, you're going to be held in the same contempt they hold their carriers in.

Word to the wise... and YMMV.

Al
www.insurancesolutions123.com

 

[Dave020]

Yes, and therefore customers get a double-whammy... a rate increase on EVERY (not just 'fifth') birthday and then the 'standard' yearly across-the-board rate increase everyone in the plan gets (assuming there is one, and tell me a year that there hasn't been one with BC!)

Assuming the rate increases are equal in value over the five year period, it may be easier for some clients to do it in smaller steps than the big whammy in the fifth year. Some carriers space out large rate increases over 6 month periods to make it easier on the subscriber. And, BC has actually dropped rates on HIPAA plans in certain areas in both of the last two years. All carriers are raising rates annually right now (if not more often see Health Net).

The Lumenos rate chart is on the BC agent site. What I'm sort of surprised at is that some large GA .... maybe a Rodgers or Benefit Mall... hasn't done this analysis and published it for all their agents.

Is Lumenos also tier-rated? I didn't see any evidence of that in the rate chart but I didn't read it too closely.

I don't see anything in the rate information to indicate anything other than the published rates, but I will ask tomorrow

The major analysis that has to be done is to compare the cost of the bundled Lumenos preventive care services against a cheaper but comperable plan that does not have them. That wll be difficult since we don't have access to negotiated rates.

That is one area, also you'd have to include the co-insurance portion of the traditional plans since there is cost there to the consumer up to the OOPM. Since Lumenos deductible=OOPM, there is no co-insurance segment so that cost savings would also need to be factored in.

The entire system is so anti-consumer, it makes me want want to scream. If (when) we get one-payor or universal coverage, no one (least of all I) will cry any tears for the carriers. I will cry about the crappy medical care we will get, but none for most of the large carriers I've worked with.

You won't enroll WHA or buy Kaiser, but you want this?????

There is one tiny local HMO that seems to have their act together... Western Health Advantage... but I've never written any of this plans because I'm simply not a believer in gatekeepers, and the other HMO hoop-jump-throughs consumers are made to do with those plans.

I have several client groups with WHA, they are ok for a small regional medical group HMO. Weiss gives them bottom feeder ratings in his list of worst HMOs. Weiss is the most accurate rater out there. I believe they were last either E or D- but they are listed along with 5 other CA HMOs in his list of worst nationwide.

The PPO pre-auth for hospitalization to me is onerous enough. I don't like some low-paid ex-nurse-aide working the phones for the carrier deciding if my doctor is correct in admitting me to the hospital.

Why not find a FFS plan to sell instead, then you would never have to worry about preauth? Mega doesn't require it

Bear in mind HMO, PPO, EPO and POS plans are all a part of the "managed care" system. Hence the care has to be "managed" so they require preauth. Again, find FFS if you don't want to deal with it.

They system is a mess. A total mess. That's what I communicate to my clients... and you should too... because you are not telling them anything they don't already know... and if you try to sugar-coat it, you're going to be held in the same contempt they hold their carriers in.

I have a pretty large book of business and no one is dissastified with their health plan - not happy at rate increase time but actually like the coverage. I have had clients run up over $2 million in claims and it would have bankrupted them had they not had health insurance. I have had a client run up over 3.5 million, paid out a total of $6,000 OOPM and carrier handled the rest at NFR. And that client's life was saved.

The only complaints I ever get is on things like chiro, accupuncture, alternative medicine and out of network claims.

 

[Crabcake Johnny]

Ditto. Reading articles and books it would seem that a health insurance agent's phone would be ringing off the phone with clients getting "screwed" by these companies - especially after you have millions of premiums on the books. It's extremely rare that I get a call from a pissed off client and when I do it's normally a mis-billing issue that's relatively easy to correct. I'm not saying getting "screwed" doesn't occur. What I am saying is that it's reported disproportionally to how often it actually happens.

I personally have had more medical events then you can shake a stick at, my wife has a horrendous pregnancy and birth with major complications, family members have had major surgeries, one cancer and one of my best friends in battling his second year of non-Hodgkinds lymphoma. I'm still trying to find all these people who are getting screwed.

I believe Scott many times has posted his bill for the birth of his twins - very major bill. Screwed? Nope.

 

[Guest]

no one is dissastified with their health plan - not happy at rate increase time but actually like the coverage.

I hear bitching all the time about rate increases or deduct increases, claims not paid quickly (or at all), docs leaving networks, and about the general complexity of it all with co-pays, OOPM, etc.

Dave lives in a rural agricultural area (garlic, I think), I live in a fairly large metro area. That may account for the difference in 'tude'. Rural and small-town people tend to be more accepting of 'how things are' and are not the whiners and bitchers that people who live with the stress that urban areas have. This is just a 'gut feeling' based on my having lived in rural West Virginia for several years... as shown here (lots of people have liked this essay... I won a writing award for it.)

http://adams-blake.com/item.php?recordid=companyname&pagestyle=default

Al

 

[Crabcake Johnny]

Health insurance companies are after a fresh block of underwritten business. The effect of underwriting wears off as time goes by and people start getting sick and having accidents. Because of that, the goal is to ditch the entire block about once every 2 to 4 years. People with very low premiums can suffer past 5 years on the same plan but you're hard pressed to find someone with a family rate last longer then 5 years. The company wants them to either put in a supp app (re-underwrite) or simply cancel. This is the dirty game they play.

 

[J.R.]

Health insurance companies are after a fresh block of underwritten business. The effect of underwriting wears off as time goes by and people start getting sick and having accidents. Because of that, the goal is to ditch the entire block about once every 2 to 4 years. People with very low premiums can suffer past 5 years on the same plan but you're hard pressed to find someone with a family rate last longer then 5 years. The company wants them to either put in a supp app (re-underwrite) or simply cancel. This is the dirty game they play.

Besides Assurant, does anybody know if other companies allow clients to modify their plan at renewal time in their respective state??????