Sana Benefits

[powjunky]

Just curious if anyone had any experience working with them or looked deeper into Sana and willing to share? I have a small group 3 employees enrolled with local HMO carrier. Of course as everyone else they are frustrated with the renewals and perhaps tired of me presenting the same 3-5 alternatives every year.. Got an email today from the owner with quotes from Sana, saying I can be their broker on it. I understand they are level funded, there is not much info about the network on the consumer facing website. Meeting tomorrow with a client.
Much appreciated!

 

[Lee Vena]

Sorry do not know much about them. Sounds as if they are in the driver's seat, but at least they are willing to let you ride along and get some commission out of it. If I had to guess the network, it would be Cigna or PHCS.

 

[powjunky]

Ok, got more info... They offer All Access PPO for physicians by utilizing HealthSmart and Prime networks(never heard of them) and reference based pricing for hospitalization.
They will reach to a hospital to negotiate every time. Anyone had any experience with this or similar arrangement?

 

[Lee Vena]

this is nothing more than a self-funded plan utilizing a level-funded chassis. network appears to be large and ok, but nothing to write home about. reference based could be the achilles heel. BTW, I have been writing reference based for about 20 years. Key to understanding reference based is a few things. First, what is the reference they are using? It is usually Medicare + 150%. Second, will the provider even accept reference based? Many providers will not. Last, is balance billing protection for the member. Some plans leave the employee out on their own to challenge the balance billing, others will guarantee no balance billing impact on the employee but will pay it from the employer claim account.

 

[powjunky]

this is nothing more than a self-funded plan utilizing a level-funded chassis. network appears to be large and ok, but nothing to write home about. reference based could be the achilles heel. BTW, I have been writing reference based for about 20 years. Key to understanding reference based is a few things. First, what is the reference they are using? It is usually Medicare + 150%. Second, will the provider even accept reference based? Many providers will not. Last, is balance billing protection for the member. Some plans leave the employee out on their own to challenge the balance billing, others will guarantee no balance billing impact on the employee but will pay it from the employer claim account.

Thank You! Good point on balance billing. The person I spoke with couldn't tell me when I brought that up few weeks ago. I would need to confirm that. But here is from their website:
"providers typically accept our RBP without issue — balance billing occurs with less than 2% of all Sana claims.

When balance billing does occur, Sana has your employees’ backs. We know balance bills can be stressful and overwhelming, but rest assured, Sana will do everything we can to minimize what members have to do, and that they will never owe more than the patient responsibility outlined in their plan."

 

[Lee Vena]

Thank You! Good point on balance billing. The person I spoke with couldn't tell me when I brought that up few weeks ago. I would need to confirm that. But here is from their website:
"providers typically accept our RBP without issue — balance billing occurs with less than 2% of all Sana claims.

When balance billing does occur, Sana has your employees’ backs. We know balance bills can be stressful and overwhelming, but rest assured, Sana will do everything we can to minimize what members have to do, and that they will never owe more than the patient responsibility outlined in their plan."

That does sound good. My guess is that Sana will negotiate with the balance billing provider and then if they need to pay some/all of the amount they will cut a check from the employer claim account. One thing I did notice is the 2% of balance billing. This is very low, but since the plan pays for the balance amount it is not that big of a deal.