Lifewise Health Plan of Washington, which is replacing Kaiser Permanente in the San Juan Islands, will not use auto-adjudication to process air transport claims from islanders. Kaiser Permanente used algorithms to process claims and automatically denied dozens of islanders' air transportation claims.
San Juan County Public Hospital District #1 board and staff listen to Lifewise representatives October 16, 2019. Sharon Kivisto
Representatives from Lifewise Insurance said, "If they [claims] are going to get denied, we'll stop and have a physician take a look."
Lifewise contracts with an Emergency physician who lives in the islands who does reviews of emergency transport.
Three representatives from Lifewise spent a couple of days in the islands this week meeting with EMS Chiefs, PIMC staff, Orcas Island, Lopez Island medical providers and more. At the Public Hospital District special meeting October 16, they answered questions from the hospital district commissioners.
Policy holders who had Kaiser through the Affordable Care Act Exchanges will be "mapped" to a plan at the same medal level (bronze, silver, gold) provided by Lifewise in late October/early November. The premiums should be a bit lower according to the Lifewise representatives. If policy holders want to seek a different plan, after they've been mapped, they can visit www.wahbexchange.org/ to select a one.
Lifewise has been providing employer-based health insurance to islanders so they do have experience in the islands.