HealthShares offer a unique and beneficial alternative to traditional health insurance, providing individuals with a cost-effective and community-focused solution for managing healthcare expenses.
While HealthShares are built on a sense of mutual assistance, it is crucial for individual members to understand the intricate processes and guidelines to fully benefit from their participation in HealthShare programs. One of those processes is the payment of medical bills.
Although some HealthShares pay providers directly, others will request that members pay their medical bills upfront and then submit a request to be reimbursed.
Grasping the nuances of how different HealthShares manage medical bills can be a pivotal factor in determining which HealthShare program an individual might select.
Direct Payment vs. Reimbursement
Understanding the differences between HealthShares that directly pay providers and those requiring members to pay upfront and seek reimbursement is essential for managing financial expectations and healthcare experiences.
Each method has implications for cash flow, out-of-pocket expenses, and administrative tasks for members. Awareness helps members choose a HealthShare that aligns with their financial comfort and preferences for handling medical bills, ensuring a smoother and more predictable healthcare journey.
Direct Payment
HealthShares that pay medical providers directly when sharing eligible costs, streamline the medical expense process. However, members typically need to pay or meet their pre-share amount before HealthShares begin to pay providers directly.
This approach reduces the financial burden on members, simplifies billing, and often accelerates the payment process to healthcare providers. It can offer a seamless experience, allowing members to focus on their health rather than the logistics of bill payments and ensuring providers receive timely payments for services rendered—fostering a cooperative relationship between healthcare providers, members, and the HealthShare organization.
Some HealthShares differ in their approach to paying providers directly. For example, some HealthShares will negotiate prices on behalf of members to reduce the cost of medical bills before sharing and paying providers.
If HealthShares prefer to negotiate prices within a specific network, there may be some administrative delays if a member goes out-of-network. While most HealthShares allow members the freedom to choose a provider, some do have preferred provider networks, so it’s important for individuals to understand this before seeking medical care.
Reimbursement
HealthShares that use reimbursement as a method for handling members’ medical expenses typically require members to pay for their healthcare services upfront. After the services are rendered, members submit their medical bills, along with any necessary documentation, to the HealthShare for review.
Once verified and approved, the HealthShare reimburses the member for the eligible expenses, up to the limits specified in their guidelines and after they reach their pre-share amount. This method empowers members with greater flexibility in choosing providers. However, it also necessitates that members have the initial financial capability to cover their medical costs while awaiting reimbursement, which can vary in timing based on the HealthShare’s processing procedures.
The reimbursement method often involves more paperwork for members and can cause a financial strain if members have to wait longer periods of time to receive their reimbursement.
Due to the complexity involved, some HealthShares are using online portals and systems to enhance the management of members’ medical bills. These digital platforms allow members to upload bills, track the status of their sharing request, and access detailed guidelines on eligible expenses and reimbursement procedures.
This technological approach not only improves efficiency and transparency but also supports a more user-friendly experience, enabling members to manage their healthcare expenses more effectively and with greater convenience.
The reimbursement process can empower members to be more involved in their healthcare and financial planning. However, within the HealthShare industry, direct payment seems to be the preferred method of handling members’ medical expenses.
Understanding each HealthShare’s approach to medical bill management
While there are two main processes used to pay for members’ expenses, each HealthShare organization adopts a unique approach to managing and processing members’ medical bills, reflecting their distinct operational philosophies and the needs of their members.
For example, some HealthShares prefer to pay providers directly but will allow reimbursement in certain circumstances.
The following section offers a comprehensive overview of the specific processes employed by different HealthShares for handling members’ sharing requests and payments.
Altrua HealthShare
Members’ contributions are held in a member escrow account. In the case of Altrua, an escrow account is a secure account where members’ monthly contributions are pooled together.
When a member incurs medical expenses that are eligible under Altrua’s sharing guidelines, the sharing request is processed, and funds are then released from this escrow account directly to healthcare providers to pay for these services. It’s Altrua’s goal to have eligible needs shared within 30–45 days.
While Altrua prefers direct payment through the member escrow account, members can seek reimbursement if a provider doesn’t accept the Altrua HealthShare member ID card. In this case, members should ask their provider to apply a self-pay discount. Once a member’s pre-share amount is met and proper documentation is submitted, the member will be reimbursed.
Key points:
- Member escrow account
- Providers are paid directly with funds from the member’s escrow account
- Needs shared within 30-45 days
For more information on how Altrua uses the member escrow account, click here. To learn more on the reimbursement process, click here.
Christian Healthcare Ministries
Christian Healthcare Ministries (CHM) generally encourages its members to act as self-pay patients when seeking medical care and then submit their bills to CHM for sharing among its members. However, it encourages members not to pay for medical bills at the time of service, and instead ask providers to bill the member and set up a payment plan if needed until CHM completes the sharing process.
After bills are received and processed, CHM then shares the eligible expenses, by either reimbursing the member for out-of-pocket expenses, or in some cases, paying the provider directly if the member has not yet paid the bill.
Medical bills are required to be submitted within six months of the date of service. Most medical bills are shared within 90-105 days.
Key points:
- Allows both direct provider payment and reimbursement
- Encourages members to present as self-pay patients when seeking medical care
- Bills shared within 90-105 days
To learn more about CHM’s sharing process, click here.
Impact Health Sharing
Members pay a monthly share, and Impact will then match those funds with another member’s eligible medical expenses. When seeking medical care, members are encouraged to present their member ID card with Impact’s billing information. As part of members’ agreement with Impact, members will have to pay a provider fee at each visit. This fee is not part of the costs that are shared.
There are two options on how members’ medical bills are paid. Some providers will bill Impact directly, and Impact will coordinate the bills with them. A member’s pre-share amount must be met first before costs are shared.
The second option is if a provider requires payment in advance. In this case, members are encouraged to proceed with payment and submit bills and receipts to Impact. Members are also encouraged to ask for self-pay discounts to reduce out-of-pocket expenses.
Eligible medical bills are then applied toward a member’s pre-share amount, or if that has already been met, the bill will be reimbursed.
Key points:
- Members should present member ID card with Impact’s billing information at appointment
- Members are encouraged to ask for self-pay discounts
- Allows for both direct provider payment and reimbursement
To learn more about Impact’s sharing process, click here.
Liberty HealthShare
Liberty uses an online platform called “ShareBox,” where members can directly share contributions to other members. Members can also see how other members have contributed toward their medical expenses. This method is different compared to most HealthShares that deposit funds into a company bank account.
Members are asked to pay a monthly share amount to their online member account , which will be shared with another member who has medical bills. Giving monthly is how members remain eligible to have their bills shared with the community.
Key points:
- Member-to-member sharing through ShareBox
- Pre-notification required for some services
- Needs processed in 30-45 days
To learn more about Liberty’s process, click here.
Medi-Share
Medi-Share works on behalf of its members to negotiate discounts and will pay providers directly. Members are asked to pay a provider fee that’s listed on the front of the member ID card when seeking medical services. If the pre-share amount is not met, the provider may bill the member for an additional amount after the bill is processed.
In addition to their individual and family program, Medi-Share also offers a program for individuals 65 and older called Medi-Share 65+, where Medicare must be billed first before eligible costs are shared.
There are certain circumstances (listed below) where members may need to submit a request to be reimbursed with either of their programs.
- If an out-of-network provider refuses to submit a bill to Medi-Share
- If an out-of-network provider requires upfront payment
- If a member had to pay upfront for expenses relating to prescriptions, adoption, death, or medical bills incurred outside the US.
Members can check the status of their bill by logging into the member center.
Key points:
- Medi-Share negotiates prices on behalf of members
- Members should present member ID card at appointment
- Medi-Share Complete: Providers bill Medi-Share directly
- Medi-Share 65+: Medicare is billed before costs are shared
To learn more about Medi-Share’s payment process, click here.
OneShare Health
OneShare prefers members stay in-network when seeking medical services. For medical expenses to be considered eligible for sharing, pre-notification is required for certain services.
Members are not required to see a provider within their network but could end up with an additional sharing responsibility if the provider is out-of-network. After the member’s pre-share amount is met, OneShare will work with providers directly for payment.
However, if a provider requests payment on the day of service, members are encouraged to ask for a self-pay discount and then fill out an Expense Sharing Request Form to be reimbursed.
Key points:
- Pre-notification required for certain medical services
- Members could have an additional cost if the provider is out-of-network
- Direct provider payment preferred, but reimbursement allowed
To learn more about OneShare Health’s programs and sharing process, click here.
Samaritan Ministries
Samaritan members send their monthly shares directly to other members with medical needs through an online member portal. A member is notified each month with the name and sharing information of another member with a medical need. The member then sends their monthly share to the member in need and is encouraged to pray for them.
For members who have a medical need, they’re encouraged to start the sharing process online or call a Samaritan member advocate. Once bills and other required documents are submitted, Samaritan notifies other members of the need.
Members will then use the shares they receive from other members to pay their medical providers. Members generally start receiving shares from other members 60-90 days from the time their bills were submitted.
Key points:
- Member-to-member sharing
- Members who have a medical need should start the sharing process by contacting Samaritan
- Bills shared within 60-90 days
To learn more about Samaritan’s programs and sharing process, click here.
Sedera
Members are encouraged to inform their providers they are self-pay patients at the time of a medical service. Providers then bill members directly, and members submit their medical bills through the online need submission process.
With Sedera, members pay their bills directly with their own funds, up to their pre-share amount. Sedera encourages members to not pay more than their annual pre-share amount. Once that amount is met, Sedera reviews the medical need and helps share community funds to pay for the medical need.
Key points:
- Members are encouraged to present as self-pay patients
- Members submit bills through online submission process
- Members are reimbursed for expenses once their pre-share amount is met
To learn more about Sedera’s sharing process and how medical bills are paid, click here.
Solidarity HealthShare
When members seek medical care, they should present their member ID card. Medical bills are submitted to Solidarity, and then bills are negotiated on behalf of members to ensure the lowest possible cost.
If a provider chooses not to participate in HealthShare options and requires payment, members should ask for a self-pay discount, pay their bill, and then submit receipts to Solidarity for reimbursement. If members haven’t met their annual pre-share amount, they are required to pay before sharing begins.
Solidarity also uses a ShareBox. If a member has met their annual pre-share amount, Solidarity will pull funds from other members’ ShareBox accounts to pay for eligible medical expenses.
Key points:
- Members should present their member ID card at appointments
- Allows for both direct provider payment and reimbursement
- Bills are negotiated on behalf of members
- Uses ShareBox to facilitate payment for members’ eligible medical expenses
To learn more about Solidarity’s sharing process, click here.
United Refuah HealthShare
United Refuah manages members’ medical bills by sharing 80% of eligible medical costs after members meet their annual pre-share amount, and then members are responsible for paying the remaining 20% until an annual co-share responsibility is met.
After contributing for the first two months, members will be assigned an individual Refuah ShareFund account that securely holds their monthly contributions. Members can share funds directly with other members from this account. By paying their monthly share amount, members remain eligible for their needs to be shared with other active members.
Key points:
- Member-to-member sharing through ShareFund
- United Refuah shares in 80% of eligible medical costs
- 20% annual member co-share responsibility
- Average share processing time is 30 days
To learn more about United Refuah’s sharing process, click here.
Zion HealthShare
Zion HealthShare works to coordinate payments directly with providers. Members are encouraged to contact Zion before receiving medical care and then present themselves as self-pay patients.
Members pay a pre-share amount per need before their medical expenses become eligible for sharing; however, members won’t pay more than three pre-share amounts per year.
Once members have a medical need, they pay their pre-share amount and then submit a sharing request. Members then must submit itemized medical bills within six months of receiving the medical service. Zion will then use funds from the sharing community to pay eligible medical expenses.
If a provider requires payment upfront, a member can submit receipts for reimbursement.
Key points:
- Members encouraged to present as self-pay patients
- Prefer patients contact Zion HealthShare before receiving medical care
- Allows both direct provider payment and reimbursement
To learn more about Zion’s sharing process, click here.
Key considerations beyond bill payment in choosing a HealthShare
When researching HealthShares, it’s crucial for individuals to consider not just how bills are paid but also other nuances such as waiting periods for certain conditions, limitations on sharing for pre-existing conditions, annual and lifetime sharing caps, and whether the HealthShare has preferred provider networks that impact cost-sharing.
Awareness of these factors, alongside understanding each HealthShare’s unique approach to medical bill management, will enable individuals to choose a program that aligns closely with their healthcare needs and financial circumstances.
