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Initial Complaint
01/24/2025
Complaint Type:
Service or Repair Issues
Status:
Unanswered
The business failed to respond to the dispute.
In December Luminar cancelled my supplemental insurance . The reason they gave was none payment. This is not true. My premiums were a deduction from from my retirement Pennsylvania ( *****) . In July ***** stopped my direct deposit because my bank sold accounts and my number changed. In August and I immediately faxed over the new information and was told it could take 2 weeks to get it in the system. In September I did not get my retirement. So I contacted them again and faxed over the information again. During this time I was never told that because the direct deposit was messed up that HOP was not getting paid. Finally in October I started getting my retirement again. I was upset as that I didn't get my checks but no one told me that it impacted my insurance. This was PSERS incompetence. In November I got a notice that I owed 783 to HOP. That made no sense but I paid it on my cc and then put my cc information into the system so any other payments could just be deducted. I spoke to someone at ***** they told me it was deducted from December so I only owed 522. This is the amount that I paid on my CC and I have proof of that. I also have proof that my credit card was placed on the account for payment. I spoke to a someone at ******* and sent a email. They told me there was no way to know what they had received as of December 3. I also was told they just transitioned all this information so there system was behind. That is why my letters didn't arrive until November. I believed that all was good at that point. They were paid, the cc was not on file. Then this month I went into my account and it is closed. I wrote t them and they said I had to file a request for reinstatement. I did that but honestly how is this legal? The money was always available . My retirement didn't stop . I feel as though I am a victim of mismanagement and the system. I am 99 years old. I live with my daughter who is helping me with this mess but it is unfair.
Initial Complaint
12/18/2024
Complaint Type:
Product Issues
Status:
Unresolved
The business responded to the dispute but failed to make a good faith effort to resolve it.
Luminare Health, formerly known as Trustmark Health Benefits, has been extremely unreasonable in processing claims for the reimbursement of medical services covered by my policy with them. They have repeatedly delayed the processing of my claims and denied them without valid reasons, often allowing the deadlines to pass. Their stated reasons include that the medical documents have not been received (despite my submission through their own portal), that the format is incorrect, or that the documents need to come from my providerwhile providing an email address that is not working, among other issues. I have over $4500 in medical expenses that they should reimburse, yet they are continuously refusing to do so.
Business response
01/21/2025
On behalf of Luminare Health Benefits, Inc., please see the attached response for IL BBB Complaint ID ********.
Customer response
01/23/2025

Complaint: 22707145

I am rejecting this response because: their response neither addresses the accurate timeline of events nor provides a resolution to the issue.
To clarify, all necessary information, including the diagnosis codes, CPT codes, and supporting medical records, was submitted as part of the original claim on October 15, 2024. When additional information was requested, I promptly provided it, including personal health information and detailed doctors notes, on November 11, 2024, through multiple channels as instructed by your representatives.

Despite my compliance and efforts to expedite the process:
1. There was no request for additional information sent to the provider on November 6, 2024, as stated in your letter. This has been confirmed with my provider.
2. The issuance of an Explanation of Benefits (EOB) requesting further information was severely delayed until December 18, 2024, long after the claim submission and my repeated follow-ups.
3. Your team provided incorrect email addresses to send the requested documentation, causing unnecessary delays. I had to locate the correct email address on my own.

This pattern of mismanagement and delays is consistent with a strategy of delay, deny, and defend. Both my provider and I have gone above and beyond to supply the required documentation promptly, yet Luminare Health Benefits, Inc. has failed to process the claim in a timely and accurate manner.

The ongoing lack of resolution is unacceptable. I request that the claim (102024-143-06) should be finalized without further delay, with the full requested amount processed based on the documentation provided.

If no resolution is provided within a reasonable timeframe, I will have no choice but to escalate this matter further. This will include filing a complaint with state regulatory agencies and exploring other avenues of recourse, in addition to this BBB complaint.
Thank you for your attention to this matter. I expect a prompt and satisfactory resolution.
Sincerely,
******** ****
Initial Complaint
12/08/2024
Complaint Type:
Order Issues
Status:
Answered
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
THEY HAVE NOT HELPED ME FILL OUT A CLAIM FORM FOR BILLS PAID WHEN WE HAVE AN HRA WITH THEM FOR A FEW THOUSAND DOLLARS WHICH THEY GET TO KEEP IF THE FORMS ARE NOT FILLED OUT....SEE MORE DETAILS BELOW
Business response
01/31/2025
On behalf of Luminare Health Benefits, **** please see the attached response
Customer response
01/31/2025

Complaint: 22656985

I am rejecting this response because:

The School District told us that Luminare Helath told them the account was 'all used up'
Luminare Health told me "there is nothing left" and that "the account has been closed."

Now they tell you there is still money in it-----but we have stopped collecting and saving the paperworrk to file claims for the payments.....AND THIS IS WHAT I BELEIVE THEY WANT ....SO THEY CAN KEEP THE MONEY....BUT TO FALSELY INFORM US AND THE **** THAT OUR ACCOUNT WAS CLOSED DOWN, OR CLOSED, OR EXPIRED, EMPTY.....AND THEN TO WRITE TO YOU THAT THERE IS ~$ ****** IN IT SHOULD BE A CRIME.
In my opinion, and as I am literally dying in a few months, it should be noted that cruel and unusually vile attempts to steal our money will be soomething I will not get to tomorrow....but I will see this rectified for my poor wife or again literally die trying. Luminare Health may do well to consider acknowledging their errors or erase or misplace their phone records and othe material relevant to this......matter.

Sincerely,

****** ********
Business response
02/19/2025
On behalf of Luminare Health Benefits, Inc., please see the attached follow-up response.

Thank you,
****** Phillips
Customer response
02/21/2025

Complaint: 22656985

I am rejecting this response because: THEY NEED TO TURN OVER ALL TRANSCRIPTS OF RECORDED CALLS
THEY JUST SAID ON THE 18TH THAT IT WAS $0.00 AND MY WIFE AND I WE WERE ON THE PHONE TOGETHER
THEY ALSO SAID THERE WAS A PROBLEM AND THE ACCOUNT NEEDED AN AUDIT---
THIS WAS TUESDAY 2/18/25 AT 2:45 pm FOR 26 MIN AND 47S

Sincerely,

****** ********
Initial Complaint
12/02/2024
Complaint Type:
Billing Issues
Status:
Unresolved
The business responded to the dispute but failed to make a good faith effort to resolve it.
I submitted my first superbill for reimbursement on 5/22. I was told by several Luminare customer service representatives (hereinafter ******* and by my company's broker that out of network reimbursement was available at a rate of 70%.I submitted my bill and received $54 back on a $2,281 bill. I was told by two separate **** that the reason was because I didn't have a letter of medical necessity. I got a letter of medical necessity and resubmitted.After waiting for about two months for a decision, I was told that Luminare would not be reimbursing me again. I have had numerous (probably 30+) phone calls with **** telling me different things: that it's right, that it's wrong, that they've submitted for reprocessing. Finally, I've been told that I can submit an appeal.I received an automated message that the appeal would be decided in 30 calendar days. It has not been.I think Luminare's argument is that the charges exceed the reasonable and customary amount charged for the services ("R&C"). The R&C that Luminare determined is $65.34. As detailed in my appeal, this is not reasonable or customary for any service provider, let alone a provider who has the credentials to advise on **************** recovery, which is the service that I need. In fact, the R&C for the services I require is probably somewhere between $200 and $300.
Business response
01/09/2025
On behalf of Luminare Health Benefits, Inc., please see the attached response for Complaint ID ********.

Thank you,
****** ********
Sr. Regulatory Licensing and Complaints Analyst
Customer response
01/09/2025

Complaint: 22628132
I had several Luminare representatives / agents (including my plan broker) confirm to me that I would receive 70% coverage.
I am rejecting this response because Luminare has stated to me (December 16, 2024 at approximately 5:30pm) that it is at Luminare's discretion to pay out my claim.
I called Luminare after receiving this response (December 9, 2025 at approximately 7:50pm), and the agent advised me that the appeal was denied because the charges exceed reasonable and customary charges as determined by anthem. Luminare has yet to provide me with a calculation of reasonable and customary charges for this service. Further, the agent did not make any statements about the provider being a New Jersey-based provider. Moreover, I have not received an explanation as to why a New Jersey provider would be an issue.
Please advise.
Sincerely,

******** ****
Initial Complaint
09/26/2024
Complaint Type:
Order Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
On 7/15/24, my orthodontist **** ****************** called my insurance company (Luminare Health) to find out my coverage for me, as I was unsure of it and I was interested in getting invisalign. My ortho advised me they spoke with my insurance company. I was told the Treatment Fee for invisalign would be a total $1,995.00. I was advised that insurance confirmed that I was approved and that they would cover $997.50, while I would cover the other $997.50. Being told insurance approved this led me to decide to go through with this treatment. Two months later, on 9/10/24. My ortho called me to advise my insurance denied coverage for my invisalign and I was now obligated to pay the remaining $997.50. I called my insurance company spoke to one representative that told me they specifically told my ortho I was NOT covered and only dependents up to age 18 was covered. My ortho says this is a lie and that my insurance did in fact state I was covered. I called my insurance again and a different representative stated they did not tell my ortho specifics of my coverage and was very vague about my coverage. If true, this means my insurance did not tell the correct information and mislead my ortho on what was covered. I requested the recorded phone call from my insurance to determine what was actually said. I made this request on 9/10/24 and was told a supervisor would be calling me back soon. On 9/25/24 I still had not received a call from a supervisor. I called my insurance who stated they have not looked into the recorded call yet, the supervisor I talked to stated she would put the request in and call me back by the end of day. I did not receive a call back. I called again today 9/26/24 and was told they still have not looked into the recorded phone call and it would be 72hrs until I would hear back regarding it. I complained. I shouldn't have to pay another $997.50 for someone else's mistake. This has been going on for over 2 weeks and my insurance has done nothing about it.
Business response
10/22/2024
Good morning:
On behalf of Luminare Health Benefits, Inc., please find the attached response for IL BBB Complaint ID ********.

Regards,
****** Phillips
Initial Complaint
09/18/2024
Complaint Type:
Service or Repair Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
Luminare health *************** system has failed to provide access to the patient portal. In my case the Portal (which in the past has been an important tool to managing our health care),has not functioned in the last month and a half. I have spoken to customer service **** and their supervisors ad nauseum without result. It was a great system when it worked, but now I am without this important tool that is a promoted benefit of my health plan, Thank You
Customer response
09/21/2024

Better Business Bureau:

The Business has addressed my concerns outside of addressing the BBB in reference to complaint ID ********. My issue is resolved and my complaint can be closed.

Sincerely,

*** *****
Initial Complaint
08/27/2024
Complaint Type:
Product Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
2/14/2024 I received surgery to remove breast implants. Luminare Health with Cigna covers the removal of the implant if the is at a ***** level that requires removal. I filled shortly after the surgery to be reimbursed for the implant removal. I have been very responsive and turned in all the information that they have been asking for. Every time I turned in another document they would proceed to do a 30 day review. I have called and asked for this to be raised up the review process and they said they would but would never follow thru. It has now been over 6 months of this back and forth. I have given them everything they have asked for. They have now asked for my email address (which I gave them) to send me another document and I have yet to received the email.
Business response
09/25/2024
see attachment
Initial Complaint
08/08/2024
Complaint Type:
Service or Repair Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
Clean timely claim submitted- # ************* EOB generated 1/19/2024- showing check issued to member address- with no check number.February call to luminaire health with member and member services, needing check reissued Ref:********** Call with member services 6-20-24- said claim was paid to the provider by "echo" a temporary credit card, which was never received. Ref# ********** 7/16/2024 payment not sent, called and representative says payment now sent to the subscriber, not the provider. Ref# I-21935812 no new EOB reissued- no representative able to assist in closing this case.please give us a call- my email is on this complaint as well.
Business response
08/26/2024
Hello -
On behalf of Luminare Health Benefits, Inc., please see the enclosed response.

Regards,
**************************;
Customer response
08/28/2024

Complaint: 22114615

Please see the attached eob copy (this is all we've been able to obtain after multiple calls)
Demographics,
and the Member ID card-

please particularly refer to most recent call ref# ***********
and feel free to contact us if you require more information

Sincerely,

***************************
Business response
09/11/2024
see attachment
Customer response
09/11/2024

Better Business Bureau:
I have reviewed the response made by the business in reference to complaint ID ********,
Tenatively- we appreciate this response, and in good faith will close our complaint.
I have sent the patient a commensurate statement matching with the check they should receive- however we requested, and in the first place ********* was willing to reimburse the provider directly. This delay was a creation by *********, and was only rectified under scrutiny from the BBB

If this payment does not arrive again and close this case- we will reopen a complaint and refer it back to this one- still unresolved.

Restricting medical care, and reluctantly issuing payment is the entire business model- on the margins itmanifests in all sorts of different iterations.

I want to be clear how absurdly improbable it is to lose multiple checks in the mail-
and highlight the fact that temporary credit card payments sent through fax are secure, inexpensive, and timely.

Sincerely,

***************************
Initial Complaint
07/29/2024
Complaint Type:
Service or Repair Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
I have an insurance card from my employer where I see that Luminare Health is my administrator of the ***** medical plan. I have a member ID which is solely Luminare Health member ID. I contacted ********************************************* several times by calls and portal messages when discovered that the list of service providers in the Network on the website they provided was incorrect. They said that they have no control over the website, only ***** has control. Ok, in this case, I provided them with the Providers' Names (Clinics) I was interested in and asked Luminare Health to contact ***** to provide me with the correct information because ***** is not going to talk to me since their medical plan is completely administrated by Luminare Health. Luminare Health refused to do so saying that they could not. I asked them to provide me with ***** phone number where I would be able to check this information myself.They refused to do so saying that they could not. I asked to talk to the supervisor since there was no help from **************** No one called or messaged me.
Business response
08/13/2024
On behalf of Luminare Health Benefits, Inc., please see the attached response for IL BBB Complaint IL 22060499.

Regards,
*****************************
Sr. Regulatory Licensing and Complaints Analyst
Customer response
08/14/2024

Complaint: 22060499

I am rejecting this response because:
Your response is incorrect. I have the account on the ********************************************* portal. And if you take a look on messages I received from **************** you will see the following:
"If the providers office has indicated their contract with Aetna has ended, you would need to go by what their office is indicating".
"Penn Oral and Maxillofacial Surgery is out of the network.

Jefferson Oral & Maxillofacial Surgery is out of the network.

Pennsylvania Oral and Maxillofacial Surgery is out of the network.

Oral & Maxillofacial Surgery providers (tied to the State University Clinics) - unable to locate with info provided. "

This information is entirely incorrect as it turned out after ***** (a representative from Luminare Health), who called me after this complaint.
She did what needs to be done: emailed Aetna to figure out this information for me. I think your customer service should do it always on the customer request otherwise we' ll be always misled by provider (who initially refused to take my insurance saying that it's out of the network) and your company.

Sincerely,

*****************************
Business response
08/23/2024
Good afternoon:
On behalf of Luminare Health Benefits, Inc., please see the attached response.

Regards,
**************************;
Initial Complaint
07/03/2024
Complaint Type:
Service or Repair Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
I gave birth on April 28th (*********************** ******) and I reported it to my private insurance Luminare, on May 3rd I had a medical appointment and since it was not updated, I paid myself and sent the claim to the insurance, they have denied my claim repeatedly due to lack of documents and I send them and return and receive denial, delays in the process and the last denial was because they do not run the claim using the name and API of the doctor who treats my baby, justifying that the clinic is called Holistic Pediatrics and is not in their network when ************************* is in the network and the **** **********, I found this doctor through the website and its providers, only they try to run the claims and everything through their clinic and that is why each consultation I have problems the same as with this claim, they are not correctly handling my claims etc.I called them a lot times but only I can speak with customer service and is the same taking notes and nothing happen, the last call was 07/03/2024 (Lavirna) was the person that took a notes , I asked to speak with a supervisor and she toll me no body is available and took a notes. They don't take customers seriously.
Business response
07/17/2024
Please see the attached response on behalf of Luminare Health Benefits, Inc.

Regards,
****** Phillips

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