For All that have Lumenos and are considering Lumenos healthcare, BEWARE! It wasn't until I had an unexpected illness, and claims were being processed, that I grew suspiscious about Lumenos. It was difficult enough being ill, muchless, have to deal with the unnecessary stress from Lumenos, especially from their agent's Ken Williamson and Kim Brunson.
I started questioning the payouts from what my Bridge included and what the payouts were when traditional 80/20 insurance kicked in. After I began complaining that something was wrong, Lumenos went back and found that they improperly took monies out of our HRA (health resource account) in 2005 for a "well woman's exam" when in fact this exam was supposedly to be paid for in full by Lumenos.
Out of curiosity, I traced the paper trail back and called the Doctor's office to see how the Doctor coded this procedure and it was filed and coded properly. I then found out after questioning Lumenos that they made an "error" on their end. As I recall being told "oh, we just made a error, maybe it wasn't read correctly". This so called "error" as I understood happened to many people and Lumenos said that they were "now" trying to resolve this.
Hmmm, I wonder why? But how interesting it is that had I not complained and grew suspicious in the beginning, I truly believe that they would not have refunded our HRA and would have kept this money. Their "error" caused many months of dealing with incompetence and "double talk" from Lumenos employees.
How can you get well when dealing with this? I finally had to threaten legal action before I started to get any real help and any resolution and got so frustrated that I told Mr. Williamson of Lumenos that we'll just settle this before a Dallas Judge. I was told to appeal these claims before they told me that they had an "error". So thirty days passed, and more, long after their required answer for my appeal. Then I asked since the 1st Appeal came back without satisfaction to me, what the procedure was for the "second" appeal so that I could proceed with litigation prospects.
Mr. Williamson of Lumenos said "oh, what you filed was not an appeal, it was clarification." Hmmm, even though I strictly e-mailed them "my appeal" more than thirty (30) days prior. Game playing with ill people. How sad! When your ill you have to deal with crumby agents that prolong providing information. I wanted to know if they had a legal counsel so I could proceed with a Bad Faith lawsuit and Mr. Williamson got scared and said he would give me their counsel's name and address here in Dallas. One minute he had it and the next he was saying he didn't, who knows, just sad!
I also had to question if I received my $50 e-checkup incentive for 2005. I thought it had been credited, but guess what, that was missing from my account also! Mr. Williamson said "Oh, were sorry." Sad!
My point is this, for all of you who have to unfortunately deal with Lumenos, you need to watch how they process your claims and what they take out of your HRA account. You need to make sure that Lumenos has not taken HRA dollars out for a "well woman's exam" that is supposedly paid for in full by Lumenos.
Go back and check your HRA account. You also need to be aware of your account getting proper credit for your e-checkups. Who knows how many millions of dollars they don't pay out when they are suppose to. Is this how they save money? They work for the employer, and obviously the insured. So watch them very carefully!
Regards
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