Humana Maternity Coverage

Discussion in 'Health Insurance and Ancillary Benefits' started by BKrocko, Aug 22, 2007.

  1. BKrocko
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    BKrocko Well-Known Member

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    I went to a Humana product training session and also to the full carrier product roll out. The same information was presented at both pertaining to maternity coverage. They say that although the maternity coverage is not in-force until 12 mths after issue, if a person become pregnant prior to that, and the doctor(s) agree to do "global billing", they will cover it so long as the bill is submitted after the 12 mth period. The dates of treatment are not considered - only the billing date.

    That means that if a woman gets pregnant after the first 3 mths on the policy, and the doc agrees to hold the billing (global billing) until her maternity coverage becomes effective, everything is good with Humana.

    I thought it sounded strange at the first meeting so I stood up at the official roll out and asked it in front of about 50 other agents/brokers (over a microphone I might add). The same answer was given!!!!

    I then asked where I could find that policy in writing - they answered that it is not in writing but it is the way Humana has decided to handle those situations. I said that I could not tell any clients/prospects that policy because my policy is "if it's not in writing, it's not true". I then asked if I could call into the Humana service center with the client on the phone and ask the same question and expect the same answer - they said yes. I figure if it's going to be said, let them say it, not me.

    I have also called into the service center since then (no client on line) and asked it - to their credit, I have always been given the same answer.

    I think Humana has weak maternity coverage - there are only a few carriers that offer it in CO though. Just curious if any of you have heard about this before - may be something you can use in your neck of the woods. If you are going to the roll out, you may want to ask it yourself. Of course, all states are different so it may be a moot point.
     
  2. TXINSURANCE
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    TXINSURANCE Well-Known Member

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    I feel lucky in TX we have a 30 day wait on maternity.

    I think the 12 month wait is very clear and here is how I understand it:

    Any bills, services, claims within 12 months relating to maternity under 12 months - DENIED, not covered.

    After 12 months - COVERED.

    I find it VERY hard to believe that DATE OF SERVICE will not be factored in and I would not be relaying that to my clients at all... That scares me.
     
  3. somarco
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    somarco Well-Known Member

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    BX does the same here .. . at least that is what they say in training classes. I have never seen it in writing. They say all maternity related claims submitted after 12 months will be paid.

    Humana has not officially rolled out their new product line yet. Can't say. All I can get at this point is plan summaries.

    I agree. I find it hard to believe they will not check dates of service. Seems to me they could also be forced into paying other claims that were incurred before coverage kicked in as long as they were not billed until after the effective date of coverage.

    I think that is a dangerous position for a carrier to be. The same can be said for an agent who uses that as part of their pitch.
     
  4. BKrocko
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    BKrocko Well-Known Member

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    Agreed.....and just to make it clear, I have never mentioned it to a prospect. I think it is a dangerous way to present the product - Humana (and BX) could open themselves up to some serious liabilities. That is why I asked if the service center could be utilized, but when the [email protected]#! hits the fan, the agent will be left out to dry.

    Kris and I both met with the RSM for Humana as well and she did not deviate from their position. I have to wonder, how many doc's would be willing to hold off on billing?

    What could they be thinking? Glad to hear that someone else has heard of this before though.
     
  5. TXINSURANCE
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    TXINSURANCE Well-Known Member

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    When push comes to shove they are going to go by the policy wording only or when they get too many pre dated / post dated claims and changes their internal policy.

    I would sell it same as pre-ex with no credible coverage - no benefit until you have been a member for 12 months which is truly what the contract states.

    I can see them changing their position when the claims start rolling in.
     
  6. jrsa
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    jrsa New Member

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    I was just wondering if anyone has any experience with this global billing...how has it worked, are dr's on board with it?

    I am a consumer looking for info. I called Humana directly and this is the info they gave me over the phone when asked. I am getting ready to call my Dr. to confirm.

    I am stuck between a rock and a hard place for maternity here in GA. We make too much to qualify for medicare so I need some insurance, but don't want to wait a yr to get pg.
    thanks for any help ;)
     
  7. STIBROKER
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    STIBROKER Super Moderator Moderator

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    Maternity Health Insurance Texas

    If you are pregnant and do not have Health Insurance there is a Insurance plan that will cover you. The new Texas Pre Existing Condition Health Insurance plan is your answer. If you qualify for this insurance this is your answer. This is not a discount plan but full fledged Health Insurance. So if you need coverage send me a message from this site or call 512-260-0856 and lets talk.





    well you have to look at having kids as like buying a car......do you have a insurance policy that pays for a new car when you want one......
     
    Last edited: Nov 12, 2011
  8. somarco
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    somarco Well-Known Member

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    JRSA -

    Humana discontinued maternity about a month ago. Global billing is a game. Give me a call if you want to discuss options.

    404-252-5859
     
  9. jrsa
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    jrsa New Member

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    Yes, I am currently in the application process, awaiting my acceptance letter so I am in under the deadline. I am just rethinking if it will be worth it. I called the Dr and they said there will be at least $2000 in other charges not billed through global billing. Not to mention the $1000 deductible and $300/month premium and 40% co-inurance. Payments at that point almost equal billed charges :nah:
     
  10. STIBROKER
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    STIBROKER Super Moderator Moderator

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    but thats not were the risk is....if the baby is a premie then the baby is add to the health plan..(whether they cover maternity or not ) ..thats what the insurance company's is afraid of.....and in most case's maternity is a wash....take it from a man who had twins at a $250,000 tab.........
     
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