Iowa Wellmark: 40% Increase, One Patient Costing them $12 Million/year

May 13, 2016

  1. dgoldenz
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    dgoldenz Moderator Moderator

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    Wellmark plans 38% to 43% increases for some customers

    "She said about 10 percentage points of the increase stem from the costs of a single, extremely complicated patient who is receiving $1 million per month worth of care for a severe genetic disorder."

    That is just crazy....never heard of anything nearly that high.
     
    dgoldenz, May 13, 2016
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  2. Yagents
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    Yagents Guru

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    In the beginning, people said the lifting of the annual/lifetime maximums would only have a 1-2% increase in rates. Another fallacy......

    My BX rep said they have "MANY" people that have already blown thru their OLD $5 million old lifetime caps under PRE-ACA plans
     
    Yagents, May 13, 2016
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  3. Ann H
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    Ann H Guru

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    This is surprising to me. I was one of the people who said that the unlimited maximum would make minimal difference in rates. Obviously, I was wrong. I have heard from reps that the number of transplants spiked after Obamacare. I have also heard that the utilization levels on ACA-compliant IFP are much higher than similar ACA-compliant group plans, and certainly higher than the gfathered/gmothered IFP plans.
     
    Ann H, May 13, 2016
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  4. RayNY
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    RayNY Guru

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    Situations like this make me question, "what's a human life worth"?

    IMO, your life is worth whatever you're willing to pay for it. If you can't afford to pay for it, your worth to society is equal to your contribution.

    I'd assume someone with a genetic disorder that requires a million dollars a month in medical costs isn't contributing much to society, which begs the question of whether society is responsible for paying to keep this person alive.
     
    RayNY, May 13, 2016
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  5. Yagents
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    Yagents Guru

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    Ray, Pose that great question to Trump, I'm sure he'll retweet it and start another media frenzy. (or a national discussion)

    Ann, I think carriers and industry articles were saying the same thing.
     
    Yagents, May 13, 2016
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  6. kgmom219
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    kgmom219 What's Next?

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    I think the move to unlimited on group made minimal difference in rates.

    Its the move to unlimited on Indy, when previously people who "needed" insurance were denied coverage, that has caused the spike on the Indy side. Remember, most high risk pools had a $1 million max, so that kicked them off the transplant list, too.

    My understanding is that the carriers (and providers) knew the transplant spike wpuld occur and the reinsurance was supposed to offset it. But we all know how that went.....
     
    kgmom219, May 13, 2016
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  7. AllenChicago
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    AllenChicago Guru

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    The UNICARE company increased their lifetime cap from $5 million to $7 million as a marketing ploy. The next year, they suddenly reset it back to $5 million, and then went bankrupt about 9 months later. I think this was 2008.

    $1 Million a month in medical care is amazing. And you have to believe that the insurance company worked really hard to negotiate it down to that figure. Wow.
     
  8. Yagents
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    Yagents Guru

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    The high claim people probably can't work any longer and are forced into individual after group or cobra expires
     
    Yagents, May 13, 2016
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  9. Josh
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    Josh Retired Agent, Current List Broker

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    My 14 month old daughter has a rare genetic disorder that's running about $40,000/month. She's due for brain surgery in 13 days.
     
    Josh, May 14, 2016
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  10. Norwayguy
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    Norwayguy I have spent way too much time here.

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    Sorry to hear that Josh as a parent I feel for you.
     
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