What The Hell Does Utilization Mean

[SamIam]

I wrote this client up in July with BCBS of IL and this month their getting a rate increase of $70.00 on the computer it list the reason why as utilization. This is the first time I've ever seen it. Utilization is what for a rate increase.

 

[Crabcake Johnny]

Re: What The Hell Does Utilzation Mean

How often services are used.

 

[Josh]

Re: What The Hell Does Utilzation Mean

How often services are used.

More specifically, the dollar amount of claims. If your groups have "high utilization", that means they're amount of claims is high relative to the amount of premiums they're paying. Even if a group only had one claim, but it was a $250k hospital stay and it was a small group, that would still be considered high utilization.

 

[SamIam]

Re: What The Hell Does Utilzation Mean

This was an individual policy that was written 5 months ago. One wellness check up is all they used.

 

[somarco]

Re: What The Hell Does Utilzation Mean

That is odd. I am under the impression that all states prohibit carriers from singling out an individual for high claim utilization and surcharging the premium.

 

[VolAgent]

Re: What The Hell Does Utilzation Mean

That is odd. I am under the impression that all states prohibit carriers from singling out an individual for high claim utilization and surcharging the premium.

Perhaps it meant the pool had high utilization?

 

[Josh]

Re: What The Hell Does Utilzation Mean

Perhaps it meant the pool had high utilization?

There's a missing piece of the puzzle. Maybe it was an association type "group" plan.

 

[pahealthquotes]

Re: What The Hell Does Utilzation Mean

individuals cant be singled out for rate increases.. sounds fishy

 

[ins.dave]

Re: What The Hell Does Utilzation Mean

Yeah, talk about yer reform ... that's b.s.
just like when someone's rates go up because of claim activity in that zip code ... WTF is that about?

 

[JAngelson79]

Re: What The Hell Does Utilzation Mean

I wrote this client up in July with BCBS of IL and this month their getting a rate increase of $70.00 on the computer it list the reason why as utilization. This is the first time I've ever seen it. Utilization is what for a rate increase.

In Ohio Anthem BCBS counts wellness as claims utilization and thus uses it to calculate rate increases on all individual plans and pools. They give you free wellness as in the Lumenos Plans and now all plans but they dong you for it - usually at renewal time. Somethings off because it's newer policy though...