Business Profile

Health and Wellness

Luminare Health Benefits, Inc.

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Complaints

This profile includes complaints for Luminare Health Benefits, Inc.'s headquarters and its corporate-owned locations. To view all corporate locations, see

Customer Complaints Summary

17 total complaints in the last 3 years.
15 complaints closed in the last 12 months.

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The complaint text that is displayed might not represent all complaints filed with BBB. Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business.

Initial Complaint
Date:08/08/2024
Type:Service or Repair Issues
Status:
ResolvedMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
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.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
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
Date: 08/26/2024
Hello -
On behalf of Luminare Health Benefits, Inc., please see the enclosed response.

Regards,
**************************;
Customer Answer
Date: 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
Date: 09/11/2024
see attachment
Customer Answer
Date: 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
Date:07/29/2024
Type:Service or Repair Issues
Status:
ResolvedMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
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.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
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
Date: 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 Answer
Date: 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
Date: 08/23/2024
Good afternoon:
On behalf of Luminare Health Benefits, Inc., please see the attached response.

Regards,
**************************;
Initial Complaint
Date:07/03/2024
Type:Service or Repair Issues
Status:
ResolvedMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
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.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
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
Date: 07/17/2024
Please see the attached response on behalf of Luminare Health Benefits, Inc.

Regards,
****** Phillips
Initial Complaint
Date:06/18/2024
Type:Billing Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
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.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
On April 08, 2024 I submitted a claim to Trustmark Health for reimbursement for a medical procedure I had. It wasn't until I called during the time I expected to receive my check (***** business days) that I was told that I needed to pay for the procedure in full before they would issue a check. I proceeded to the medical facility and paid for the procedure in full and uploaded the proof of payment. I was told that the time for review now reset back to ***** days for processing, which makes absolutely no sense because the claims department had yet to even look at my claim submission. The representative was extremely apologetic and I don't fault them because they don't make the rules, they just follow them. This is unacceptable by all means. With my claim not having been reviewed and having uploaded an artifact as proof of payment there's absolutely no reason for this untimely delay. I did not have the money to pay for the procedure which is why people get insurance, so they do not have to pay out of pocket. No one can tell me when it will be reviewed or how soon I will be reimbursed. There's no phone number for the claims department and I'm carrying a large bill and have no idea when I will be able to pay it. This is by far the WORST customer service I have ever experienced with an insurance provider. There were no clear instructions on paying for everything up front to have the claim reviewed and I only found out because time kept passing without a word from the company. This should be illegal!
Business Response
Date: 07/11/2024
see attachment
Customer Answer
Date: 07/11/2024

Complaint: 21868708

I am rejecting this response because: I have received no notification that this has been completed and resolved. Furthermore, when I first contacted Luminare to get a preliminary quote of what would be covered for this procedure, it was more in the range of 90% or so for the codes that were provided. The payment claim of half of the bill is way off from what I was originally quoted BEFORE moving forward with the procedure.

Sincerely,

******************
Customer Answer
Date: 08/01/2024

Complaint: 21868708

I am rejecting this response because: the information that Luminare Health provided is completely absurd and highlights their terrible job at record keeping and cross communication. I was notified almost a month after the claim had been submitted (only discovering this because I called) that I needed to pay the balance in full before it was to be processed. The attached documents (FirstClaimSubmission_ProofOfPayment and MS ***** ********* Documentation (5)) for proof of payment was sent on May 17th. On May 17th I sent over my receipt for payment in the amount of 4350 which was emailed to me by the ***************** Foot Visit - *****). The other $1000.00 proof of payment was also sent on the 17th (receipt from ***** Foot...).
I was also told AFTER submitting all of the invoices AND proof of payment that my original invoice from the Dr wasn't sufficient and they wanted a breakdown of the services as rendered by **************, which was sent on June 30th (MS ********* Documentation). This documents annotates that this was paid in full also, $6,500.00 signed by **************.
I've provided Luminare ALL of the requested documents starting when I initially had to contact them to figure out what the status of it was a little over a month after submitting my claim (Originally submitted April 08). ************ needs to do better with communication across their functional teams before denying a claim for said documents that they already have. In the portal for submitting a claim online, if my sent messages are checked, they will find every document needed to finally reimburse me for this procedure. I have more documents but am unable to upload more than 5 to this message.

Sincerely,

******************
Business Response
Date: 08/05/2024
On behalf of Luminare Health Benefits, Inc., please see the attached response for IL BBB Complaint ID: ********.

Regards,
**************************;
Customer Answer
Date: 08/06/2024

Complaint: 21868708

I am rejecting this response because:
"Mr. Stills response to Luminare Health Benefits Inc.s, letter dated July 31, 2024, indicates that he was
informed by a **************** Representative a month after claim 071024-041-01 was submitted that Mr.
Still needed to pay the balance in full before the claim could be processed. Our claims team has reviewed
all recorded calls between Luminare Health Benefits, Inc. and Mr. ****** and has confirmed that Mr. ************ not advised that he would be required to pay the balance in full before the claim could be processed."
This is completely untrue, as you can see the attached document which annotates the entire conversation with myself and Luminare (****************). If they had not told me that full payment was required, I wouldn't have paid the balance and uploaded the proof of payment in full. Please see Luminare Artifacts attachment.
"As mentioned in Luminare Health Benefits, Inc.s letter dated July 31, 2024, claim 071024-041-01 was sent
for medical review on July 22, 2024. An operative note/report was requested from the provider. Medical
records were received on July 24, 2024, but the operative note/report was not included. Claim 071024-041-
01 has been denied with the following explanation: Documentation provided does not support payment."
************** was never contacted, as he just confirmed and said that if they needed any additional information they would gladly provide it but they have not heard from Luminare. The operative report was included in the itemization report that was requested from Luminare and sent through the portal (reference Artifacts attachment). Also, how does the documentation provided not support payment?
This is by far a mishandling of this case and too many loopholes in the process. All documentation has been provided that was requested by this company. I should not now be subjected to an appeal because of their disorganization. Requesting that this claim be updated and paid, ASAP, and if there is something else that is needed, the provider's information is listed and should be contacted immediately. Also, I'd greatly appreciate someone actually getting on the phone with me from the claims department because there is clearly a HUGE disconnect between the Health Benefits **************** and claims department. If this cannot be remedied immediately I will be contacting my lawyer and let the courts handle the appeal process which will not only show that this claim should have been paid but will incur additional cost.

Sincerely,

******************
Initial Complaint
Date:05/07/2024
Type:Service or Repair Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
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.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
Luminare Health has got to be one of the worst benefits administrators Ive ever worked with. Their customer page seems to have been designed in 1992 and hasnt received an update since (except when they rebranded and changed the logos, but their emails still have the old Trustmark branding). Their phone system is horrid and requires you to state your information no less than 5 times before it will let you move past that. **************** is slow and has no clue whats going on up there. Claims take ***** days to process and you dont know the status of any of it since the portal doesnt update. They also dont publish the ***** day policy anywhere as its only an internal policy. Ive been attempting to get claims processed for almost 2 weeks now and have zero movement on them from what I can tell. Tried to contact customer service, but they are unable to provide any information.
Business Response
Date: 05/21/2024
Attached please find the Company's response to Mr. ****** complaint, ID #********.
Customer Answer
Date: 05/21/2024

Complaint: 21680282

I am rejecting this response because: This reply summarizes the issues at Luminare Health. I have replied to their email with the date the claim was submitted in THEIR system.

Sincerely,

******* Sites
Business Response
Date: 05/29/2024
Response letter is attached. Thank you.
Customer Answer
Date: 05/30/2024

Complaint: 21680282

I am rejecting this response because: Luminare health attached the same response with zero edits or anything from the last reply. I replied to **** via email per the last letter and had to send a followup email to get a basic reply. **** was magically able to locate the claim that has now been siting for over 30 days. Here is a copy of their reply on 5/23 after I sent the email on 5/21 with no reply until the followup: "Mr. *********** have received your email and am checking with our Claims Team on your request below. Thank you for providing additional information including the provider name and claim amount. I have also received a formal follow up from the IL BBB and will respond to that inquiry within the requested time frame.
Thank you."

Sincerely,

******* Sites
Business Response
Date: 06/07/2024
Attached is a copy of the Company's response letter dated June 7, 2024.
Initial Complaint
Date:02/09/2024
Type:Service or Repair Issues
Status:
UnresolvedMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
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.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
Trustmark (now branded Luminare Health) seem to think its okay to not uphold their own policies. Ive been on a Trustmark plan for several years now. Ive also made the same few claims every month, due to certain weekly healthcare. I have had incredibly varying results from the same claim, over and over again. Different prices, different excuses. Sometimes, after theyve confirmed theyve received a claim, it has not been added to my account after months. Most recently this happened to a claim I made in November. It is not that it has been deniedit has just not been attached to my account. (And that is even though I received a confirmation, called two months later and was told to resend it, and now its been another month) Is this a joke?I also have claims that, for no reason, they apply different policies to, month to month. Most recently I was charged for co-insurance even though I had met my out-of-pocket maximum over six months previously. And (again) this was a claim I had made monthly, without co-insurance.The fact that I cannot follow-up on a claim that appears to have disappeared, until over two months later, and after following up, am told to continue to wait another month-6 weeks is ridiculous. If the claim doesnt appear in ***** days, I should be able to follow up after ***** days.*** considered leaving my job because the health insurance is so impossible to deal with.
Business Response
Date: 02/27/2024
Luminare Health Benefits, Inc. (formerly known as Trustmark Health Benefits, ***** is in receipt of the 2/12/24 letter from the IL Better Business Bureau regarding the complaint from *********************. We are still researching ****************** inquiry and require additional time in which to respond. We are requesting an extension to March 5, 2024. I can be reached at ************ or *********************************************************** should you have any questions.
Thank you.
***************************, Senior Director - Compliance
Luminare Health Benefits, Inc.
Customer Answer
Date: 03/06/2024

Complaint: 21244567

I am rejecting this response because: the business asked for an extension until Mar 5 to reply, but still did not reply. (Today is March 6.)

Sincerely,

*********************

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Luminare Health Benefits, Inc.

Luminare Health Benefits, Inc.

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Luminare Health Benefits, Inc. is NOT a BBB Accredited Business.