I'm an honest to goodness seasoned executive in the health insurance industry, with long-term experience with multiple Top-5 health insurers. I accepted a HealthMarkets offer to join their team under the premise of building a credible managed care organization that would market and deliver industry standard benefit plans (PPO, EPO, POS). I voluntarily left HealthMarkets (and returned to another Top-5 healthplan) after only 18-months, due to their overt unwillingness and dismissive attitude toward creating products/plans that offered true value to their members.
I've had the unfortunate opportunity to work among all of the HealthMarkets senior leadership team, including their recent COO and CEO and while I delivered tangible managed care savings, HealthMarkets is unwilling to direct these saving into their benefit plans and ultimately to the member/consumer.
It is utterly apparent and obvious that HealthMarkets is not and will not accept any MEDICAL EXPENSE RISK, and rather underwrites and prices their products to a DOLLAR-FOR-DOLLAR payout at best.
This is best demonstrated by the simple example that HealthMarkets directs their members to a specific network of hospitals and physicians (PPO) in order to reduce medical expenses for themselves and their members - this is a good thing and is what nearly all healthplans do. HealthMarkets saves MILLIONS OF DOLLARS by doing this every year. However, even the cost to HealthMarkets for using these PPO provider networks is passed onto their members as part of their monthly premium. As if this is not bad enough, not only does HealthMarkets pass this cost onto their members, but they have the nerve to mark it up and actually create an additional revenue stream from it.
If you are an uninsured individual, perhaps self employed and seeking individual coverage, do yourself a big favor and put your monthly premium back in the bank and perhaps seek a HSA for yourself.
HealthMarkets coverage is not going to help you, even in catastrophic medical situations.
0 comments