Land Of Lincoln

[steven2244]

I talked to one of their guys - said they have addressed the RAP (Radiology etc) out of net problem. Will be paid at in net rates for stuff like surgery

There apparently was also an issue of forcing people to use mail order meds - no longer

I asked the 5 test cases I put in 1/1/15 - no complaints. Just a billing error that was the hosp's fault - was corrected

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I hope they make it - PHCS is a decent network

 

[AllenChicago]

Thank-you for that valuable info Steven! I'm looking forward to seeing the 2016 LOLH brochures and SOBs. Hopefully the company materials will say that Out-of-Network providers who treat you in an In-Network facility are treated as being In-Network for Deductible-OOP purposes.

A pre-ObamaCare insurer named Independence Holding Company used to have this in their brochures. They called it the "Forced Provider" benefit. It helped us tremendously with sales of IHC health insurance pre-2010. Radiologists and Anesthesiologists operating outside of PPO networks became a big problem in the Chicago area after 2007.

 

[steven2244]

A retired radiologist friend told me that, in situations like surgery, their bill gets packaged with the hospital's.

In essence, if the hosp is in-net, so are the RAP people.
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Back to BCBS IL, the main thing is they have too high a market share - are shouldering too much

That and going out too cheap at the start of ACA led to them having to drop the larger network 'PPO', adverse selection will get ya' every time!

I hope UHC & Aetna also pick up some people to spread the risk. Those PPO's are pretty good.

The main thing we're missing from BCBS's big one are established psych therapists, who have been spoiled getting $125/session and don't want to go backwards. PHCS pays $60.

I hope many younger ones sign up for the other networks to build their practices.

On the Indiv side, we're way outnumbered by Grp members, are not that important. We're what, 8, 9% of the market?

 

[AllenChicago]

A retired radiologist friend told me that, in situations like surgery, their bill gets packaged with the hospital's. In essence, if the hosp is in-net, so are the RAP people.

Perhaps that's the way it used to be back when your Radiologist friend was working. The out-of-network complaints really ramped up afterwards, it seems.

 

[steven2244]

LoL is also bundling the RAP group in with the hospital bill per conversation yesterday

I haven't had an RAP bill complaint for about 7 - 8 yrs - was BCBSIL HMO Grp., anesthesiologist.

As they say, "We'll see!"

I do advise surgical candidates to:

-Pre-cert with confirmation

-Ask the office mgr if they have any RAP people involved to be in their network. Can't hurt to have that in the file. Should help a negotiation with the finance office

That chat is also a good educational piece. No one knows how this stuff works

 

[AllenChicago]

October 7, 2015

If I'm reading the updated chart at this website correctly, Land of Lincoln Health is burning through money faster than it's coming in. A lot of Co-ops are.

Link: https://www.washingtonpost.com/nati...bc98-6d36-11e5-9bfe-e59f5e244f92_graphic.html

Thoughts???

ac

 

[Pancur]

Supposing their rate increase is below 10%, their premium should be better then Blue Cross. And from my calculations Blue Cross should have better rates then Aetna, UHC, Coventry and Humana.
Now knowing that Land of Lincoln can go out of business anytime in 2016 how I'm supposed to insured my clients with them? On the other hand if similar plan premiums differ $100 a month or more I think many people without knowing it will get into their hands.
I am already filling the excitement. I'm looking forward to February.

 

[AllenChicago]

I didn't know you were not in the Illinois market, Pancur. Last I heard, you were in Alabama. Did you move up this way to enjoy our frigid, snowy winters? Welcome!

-Allen

 

[Pancur]

I've always lived in IL and enjoyed the snow :-). In my settings I have IL but for some reason on posts it shows Alabama flag. Do you know how to change it?

 

[AllenChicago]

I've always lived in IL and enjoyed the snow :-). In my settings I have IL but for some reason on posts it shows Alabama flag. Do you know how to change it?

Try going to "User CP" then "Edit Options". At the bottom of the page, change to another state...save..logoff..log back on..change it back to Illinois, save it..and you should be OK.