Health Share Ministries: Actual healthcare health share experiences?

[Need2knowWhy]

Hi,

 

Regarding the health share ministries alternative to ACA, who actually has experience with acquiring medical support throughout the USA (as an RVer) using such healthcare insurance alternative?

 

This is not a request for a link to an Internet health share ministry website.

 

Is there anyone that can actually speak to their own experience using an alternative such as this, including whether you were able to use your physician of choice, where medial provides actually accepting you as a patient outside their network, and what were the financial results you actually encountered?

 

Thanks!

Bill

[Ronbo]

My wife is on Christian Healthcare Ministries gold plan. She had to have some testing done. We paid up front. They reimbursed the amount prior to our cash discount so that even took care of our deductible. As she has to have continued annual testing, if it is coded right, they will cover it it with no deductible.

[Need2knowWhy]

Thanks for writing.... So the provider required you to pay up front the full amount before they would perform the labs? What would happen if you needed a CT or an MRI? Would you need to pay for that whole service up front to get the imaging done? After deductible, what percent would they reimburse for costs such as that?

 

Finally, were these tests she needed in your hometown community, or where you on the road, out of state?

 

Thanks again,

B

[Kirk W]

Glen West of these forums also uses on of the Health Share organizations. Perhaps he will join the thread shortly.

[GlennWest]

We have Liberty Healthshare. It has served us well. You can go to their website and find out all details. We had Texas Blue Cross ppl before. Very costly and that was 10k deductible. We got little out of it. Liberty has been good to us

[DuffMan]

When you say you have to pay up front - Which amount am I billed as a cash paying customer?

 

I just got my Humana statement: (totals for 2016)

Amount provider has billed: $18,315.72

Plan Discounts: $12,219.51

Benefit Exclusions: $ 1,139.51

Total Cost (Amount plan has approved) $ 4,956.94

Plan's share: $ 4,156.16

Your Share: $ 800.78

 

When I asked the clinic if I could pay cash and get a discount, the finance office refused saying that was a violation of their insurance contracts. I would be billed the full amount. (The $18K)

 

How do you handle this with a Healthcare Ministries reimbursement plan?

[GlennWest]

We don't pay up front. We give them our catd, they call, Liberty pays.

[Ronbo]

It was a biopsy. We paid up front but we have funds for that. We have been on the road for 2 years so have no pop. It was a center she had been at before though. Left and headed to California. Received a phone call to follow up,with oncology at our destination. Followed up and had several recommendations. Medication to another biopsy. Their biopsy was way overpriced at $29,000. Anything under $1000 you pay. Anything over that ask that they be allowed to negotiate. If it works out CHM will pay directly. We opted to not do any meds or another biopsy due to conversations with the team. We had the money but didn't feel it was really necessary. It helps that I was a provider before disability.

[Blues]

I don't use a healthcare sharing ministry, but I've recently looked into them. According to Christian Healthcare Ministries' website, the patient gets the bill and is responsible for negotiating a discount, and files a claim with CHM and then is reimbursed. Glen said he presents a card showing Liberty HealthShare membership; apparently it's handled like insurance. I'm glad he mentioned that because I read the entire 28-page "Official Liberty HealthShare Sharing Guidelines for 2016" and there was nothing about how the plan actually works. No mention of presenting a card to the doctor, a patient's duty to negotiate, whether you pay up front--except they do state that "each member is a self-pay patient," which conflicts with presenting a card to the doctor.

 

Christian Healthcare Ministries' site goes into great detail about the actual process, but is a little vague on some things. They will not pay for maternity care for an "unwed mother," but they don't define what that is. What if a woman was married at the time of conception but divorced or widowed at the time of delivery? That is the sort of thing that should be pinned down in a contract, but of course this isn't a contract. But it makes me wonder what other situations are similarly less than clear on the guidelines and could present an ugly surprise.

 

Since you mentioned using your physician of choice, I'll point out something that I found in the plan for Liberty HealthShare: A hysterectomy is eligible for sharing only if the woman receives a second opinion "from a physician approved by Liberty HealthShare."

 

I thought these healthcare sharing ministries were a situation where the ministry just manages the money coming in and going out, but that's not the case (even though the its guidelines state, "Liberty HealthShare serves only to facilitate this mutual sharing, directing member’s gifts to those who have eligible expenses"). For example, also from their guidelines:

Liberty HealthShare reserves the right, on behalf of its members, to determine what part of an expense for the care and treatment of an injury or illness is unfair or unreasonable, based on techniques, criteria and standards established or adopted by Liberty HealthShare.

It sounds like what insurance companies do for out-of-network coverage--they'll pay, but only to a certain amount that they determine is appropriate, and the patient is on the hook for the rest, and you don't know any of these numbers in advance.

I also assumed it was more hands-off as far as managing a member's care than it actually is. For example, there's a pre-notification requirement for hospital stays, and the Liberty HealthShare staff then follows the patient's progress and makes a recommendation as to the maximum days of stay, and additional days not recommended by the staff are not eligible for sharing.

[Zulu]

Make sure you read the info the health plan supplies.

For example, look up "pre-existing conditions" in Liberty Sharing Guidelines.

[GlennWest]

We had some health care services performed last year. Presented our card. We left. About a month later had a small bill from clinic. We called Liberty they said don't pay and they contacted clinic. We then got zero balance notice. The clinic and Liberty agreed on cost and they tried to get more from us. Liberty pay is 150% of medicare.

[Need2knowWhy]

Glen West, are the services you are discussing local services or are they out of state services received while on the road? When you say you "present the card" is that to anyplace out of state?

 

Rondo, you mentioned "if it works out CHM pays directly". What does "if it works out" mean?

 

I'm not concerned about maternity stuff and issues with pre-existing condition just would see normal with insurance companies of old. It would be a loosing battle being responsible to negotiate with a hospital on one's own. I have to look at the link to Liberty from Zulu, but to me the big question is after whatever the deductible is - even say it's 10,000 per year, what then does the plan actually pay? Getting 50% coverage is pretty inadequate to me since I would expect at least catastrophic coverage. There should be a cap.

[GlennWest]

Local, we have no such thing. Our domicile is Huntsville TX. We seen doctors/clinics etc in Baton Rogue, La, Winnie TX. Raleigh NC, Houston. Never seen one in Huntsville. Liberty doesn't care what doctor, clinic, network, state. You decide that. We have a yearly "non share" amount. It is 1k. Think deductible. Liberty pays the rest. Non christian services are not paid, abortions, sex change, drug rehab. And as member you get to vote on changes you want made. As for a catastrophic illnesses, pays up to 1 million per incident.

[Blues]

As for a catastrophic illnesses, pays up to 1 million per incident.

 

I looked at the guidelines and didn't see anything about $1 million. There is something in the Guardians Group section (which is separate coverage) about covering expenses above $125,000 (which implies there's a cap of $125,000 under the regular plan), but I don't see anything about $1,000,000.

 

 

I'm not concerned about maternity stuff and issues with pre-existing condition just would see normal with insurance companies of old.

 

I'm not sure what you're saying. Under the ACA, pre-existing conditions are no longer in play. When you mention pre-existing conditions, most people think of someone who has cancer not being able to buy health insurance. Which was bad. But it was more insidious than that.

 

If you got cancer a few years into your plan, the insurance company could comb through your application and your medical history to see if you had left anything out, even inadvertently. If they found that you had been treated for a bum knee a few years ago, and you had forgotten to include that in your medical history when you applied, they could cancel your policy retroactively, not pay for your cancer treatment (even though it's unrelated to your knee), and make you pay back any amounts they had paid on your behalf for the entire time you (thought you) were covered. They can't do that any more.

 

THAT is why people should give a big cheer to the ACA, and that is why "sharing" plans that have pre-existing condition clauses should be looked at very carefully.

 

And it doesn't even have to be pre-existing: Altrua HealthShare has a provision that cancer isn't covered until a member's one-year anniversary, even if it wasn't diagnosed until after the member was enrolled.

 

Of interest to RVers is that one also has a provision that injuries resulting from camping are shared to a maximum of $5,000, although the limit is raised to "$25,000 if the member submits an additional $300.00 annual contribution per participant."

 

The guidelines also define the annual limit and lifetime limit, but they don't say what they are. The ACA prohibits insurance companies from imposing either annual or lifetime limits on coverage.

 

Since HealthSharing Ministries are unregulated, you can't "assume" anything about what will be reimbursed, so a very careful reading of the guidelines is important (but may not tell you everything, like in the "annual limit" example above).

[GlennWest]

The top program with Liberty include Guardians. That where 1 million comes in.

[Ronbo]

If the provider agrees to receive payment directly from CHM they will pay directly.

[Need2knowWhy]

I've only briefly inspected two health sharing ministries, and I have the impression these are oriented towards the evangelical community, and that's fine with me. I think what I am looking for is a "plan" that has firmer statements on what healthcare needs are supported. The wording is somewhat vague about what is actually provided, and appears to be a sort of mission outreach.

 

I don't know that these are suitable for me; for while I meet all the guidelines for lifestyle, I really don't want someone wondering if I go to church enough for example. This missions are not intended for someone like me, for although I whole heartedly support the beliefs of the individuals involved, my belief system is more nebulous then the intended market these ministries intend to reach. Heck if I had greater financial means I'd be glad to contribute for no other reason then to assist their coop efforts - so to speak. But I don't think these structures are meant for me. It would be unethical for me to utilized these programs without fully endorsing the scope of their intentions I believe.

[Blues]

The top program with Liberty include Guardians. That where 1 million comes in.

 

I found the information about Guardians in the guidelines, but there was no mention of any cap, much less a cap of a specified amount. Where would that information be found?

[GlennWest]

Liberty complete option. First listed. Plainly states 1 million per incident

[Kirk W]

They will not pay for maternity care for an "unwed mother," but they don't define what that is. What if a woman was married at the time of conception but divorced or widowed at the time of delivery? That is the sort of thing that should be pinned down in a contract, but of course this isn't a contract.

While the younger members of the Escapees my still need to concern themselves with that issue, I'd suspect that most of us have reached a point in life where the maternity clause isn't a high priority....

[whj469]

There is no free ride! You get what you pay for. I have bought medical insurance for over 350

employees for over twenty years. I am the CEO of a company and no one will sell you medical insurance that they lose money on,

share program or health insurance company. If you have to pay up front, $ 67,000 for a pacemaker, how would that work?

[GlennWest]

We don't pay up front, period.

[Blues]

While the younger members of the Escapees my still need to concern themselves with that issue, I'd suspect that most of us have reached a point in life where the maternity clause isn't a high priority....

 

The people in these threads who are having to scramble for health insurance are under 65, though.

 

 

Liberty complete option. First listed. Plainly states 1 million per incident

 

I finally found it. I had to poke around the website to get to it; I assumed the Guidelines would cover all the the specifics.

[Kirk W]

The people in these threads who are having to scramble for health insurance are under 65, though.

True, but we ceased to need pregnancy coverage well before we reached Medicare age! We were permanently fixed well before age 65. Also, the comment was intended as a joke.