Medishare Review and My Personal User Experience

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Over the last few months I’ve had a few emails asking how I was enjoying Medi-Share.  I figured this would be an appropriate time to follow up and do another Medi-Share review.

Why Our Family Switched to Medi-Share

I wish I could share a deep theological reason for the switch.  However, though I like the fact that it is a Christian organization, that was not one of the major deciding factors.

The main reasons included:

1.  It was insurance that would work for us on the mission field and work for us when we moved to the States.  Our current international health insurance would have expired in April 2012, and we would not be eligible to renew it at that point because in order to renew it, we would need to plan on living overseas for six months of the next year.

2.  The price is competitive. When I compared the price of Medi-Share to traditional insurance plans, I could get a $1,250 family portion (think deductible) compared to a $5,000 individual deductible.

Medi-Share even had some more competitive maternity options.  If we were planning on having other children I don’t think we could find anything much better than Medi-Share.

3.  I was planning to be self employed.  I knew I’d be shopping for insurance (Medi-Share is not insurance) when I was living in the US.  Medi-Share seemed like a good option for us.

What I like about Medi-Share

As we were going through the application process, we had some very helpful people who quickly provided us with the information we needed.  We don’t often spend much time on hold, so phone calls are simple.

The price is right since we are a family of five with a self-employed head of household.  There is no way we could get the same coverage for a comprable price.

2 Disappointments with Medi-Share

1.  We Weren’t Eligible for Their Health Incentive

I know we shouldn’t count our chickens before they hatch, but we had anticipated being eligible for the health incentive that would have resulted in a 20% discount of our monthly payments.

I anticipated it because, other than regular checkups, I haven’t been to a doctor in … I honestly don’t know.  Other than delivering babies, my wife hasn’t been for nearly a decade.

However, there are a few metrics they use, and we don’t qualify.

2. There Have Been Frustrating Experiences

Here’s our first experience with Medi-Share:

One of our kids had a nasty looking abscess on his finger while we were in Houston on furlough.

We decide to take him to the doctor.

We checked the PHCS provider list, and our doctor was on the list.

After dragging the kid to the doctors office we found out that, even though they are part of the PHCS, they won’t do anything with Medi-Share.

My wife gets frustrated and doesn’t want to come home and look for another doctor and try to get another appointment.  I tell her that she should just see the doctor, and we’ll work out the coverage later.

Contact Medi-Share and they tell us the doctor should have worked with us, but just to go ahead and file paperwork.

We file all the information we get from doctor’s office, and Medi-Share gets back in touch saying they need more information.

Contact the doctors office to tell them what Medi-Share is looking for, and they tell us that everything they’ve already provided is all they provide.

Contact Medi-Share and they say they need the information.

Time Out – This is what I find extremely frustrating — being in the middle of two groups without any recourse to make either one or the other do what the other is asking for. 

Eventually, Medi-Share agrees to directly contact the doctor’s office to work things out.

This next move is completely my fault as I didn’t followup.  Next we get a collections notice (my first ever) from the doctor’s office because the bill hasn’t been paid.  I guess Medi-Share didn’t work things out.

The next step in the saga is to pay the bill myself and see if I can work things out with Medi-Share.  That’s where we are right now in the process.

By the way, the day before we were getting ready to fly back to PNG, our two year old developed a rash we thought should be checked out before flying internationally over three days.  To avoid all the hassle of dealing with Medi-Share, we simply paid cash for the appointment and decided not to file.

The hassle was not worth the return.

It’s sad to have an insurance alternative and decide it’s more hassle to use it, and decide to pay cash for doctor’s visits instead.

There seems to be a lot of confusion with medical providers who want to know what I mean when I say Medi-Share is ‘sort of’ insurance and ‘like’ insurance. The doctor’s office didn’t even want to entertain the idea of working with them.

I didn’t write this post because I have anything against Medi-Share, but since I do have a post on my site about it, I felt like it was fair to others that I followed-up based on my actual experiences.

Comments

  1. says

    Thanks for sharing that, Craig. Before our children grew up and moved out, we had Medi-Share, and we also found it a bit of a struggle to use. Because of the ceaseless and, in my opinion, outrageous annual increases in medical insurance premiums, I’ve thought about returning to Medi-Share. The savings, however, while substantial, do not offset the hassles.

    • bill heim says

      I drank the Christian Kool Aid pitch and basically got ripped off. The only thing they are good at is taking money from your account. In 3 months, and numerous emails and phone calls, We never even got ID Cards or a welcome back. The response is always the same, “we’ll call you back in 3 business days”. A judge in Kentucky shut them down and with good reason, they should be shut down in all 50 states. While “covered” my daughter broke her arm and we got zilch, not even an ID card. Buyer beware!!!!

  2. Kathy McMillan says

    Try Samaritan Ministries. It is somewhat the same concept except that you pay your “premium” to another member who has “filed a claim” with Samaritan. It was $285 per month for my husband and I. So, for example, if my husband broke his arm and the bill was $5000, we would negotiate a cash rate with the hospital and pay – or set up a payment plan. We would “file” with Samaritan. They would then direct the appropriate number of other people to pay their “share” directly to us. Disclaimer: we never actually had to file a claim so I can’t tell you how well it works BUT we did pay our shares every month so people are actually getting money.

  3. Teresa says

    I am sooo disappointed with Medishare. I wish I had never switched to them. They never seem to cover anything and always have an excuse why. I am wondering if they are really a Christian organization with the way they handle any medical bills. They make you call and call and call with absolutely no results. Save yourself a lot of headaches and use some other company.

  4. L. Jantzi says

    We appreciate you sharing your experience with MediShare. We were looking into it and really needed to hear about your experience and the that others posted because you took the time to post. Thank you.

  5. Kandace says

    Thanks so much for your post. I just today reached out to Medi-Share for initial info and the question topmost on my mind was whether this is a reimbursement plan that I would have to do the negotiating with the provider for. It is a terrible nightmare to be the middle man and I have spent hours doing so just for our FSA account. I can’t imagine having to do it for everything we use. It might work for someone with a non-working spouse who has hours per week to deal with this but just the fact that I would have to be the go-between puts me out of this game. Thanks!

    • says

      Kandace,
      The answer to your question really depends on your doctors office or hospital. If they are willing to ‘roll’ with the Medi-Share idea and approach then you shouldn’t ever need to get in the middle. But, sometimes life doesn’t work as planned …

  6. Karen says

    I am relieved to have found this review – thank you! What jumped out to me was the fact that you ended up paying the bill yourself…given our recent bill of over $300,000 (emergency flight and delivery of premature twins plus 1-month NICU stay) we would never be able to pay something like that then wait and hope things worked out financially! Guess we’ll keep shopping around…

    • says

      Karen,
      Let me clarify one thing in an effort to be sure I’m giving Medi-Share fair representation. If I had a $300,000 bill I’m sure it would be worth the hassle to file. I’ve heard good things about Medi-Share honoring legitimate requests. Please don’t feel as though they don’t pay out – it just might take extra time depending on the attitude/disposition of your medical team.

  7. Kaeli says

    Hi Craig,

    Thank you for your posts. I know I’m several months late in commenting but I’m hoping you’ll see my reply. I own my own business and my husband does not get health insurance through his work, so we know first hand how expensive individual policies are. I’ve recently been looking into Medi Share, and have spoken with a representative and felt very excited to have an alternative to health insurance. So I’ve been researching Medi Share and your posts are very, very much appreciated!

    The woman I spoke with just last month (September 2012) said that they are now a PPO Network and that this is a recent change. She said that your provider doesn’t even have to know you are a Medi Share member. They just know you’re part of a PPO. I’m wondering if they changed over to a PPO Network after your huge hassle? Your description of working with Medi Share makes me want to stay far, far away. The woman I spoke with made it seem much easier to deal with. So I’m wondering about the PPO status and this will definitely help with my decision.

    Thank you again!

    • says

      Kaeli,
      Thanks for the question. I think as long as we’ve been members Medi-Share has been part of a PPO. I guess part of the process is learning the lingo and learning the best way to identify yourself to medical people. One mistake we made was not learning enough about Medi-Share and how to use it. You sound like you’re doing more research so you’ll have better expectations.

      By the way, since we’ve been in Cheyenne for the last few months we’ve had three doctors visits. None of the three had any issues taking our Medi-Share card and processing thing through them.

      Let me know if you have any other questions.

      • Kaeli says

        Craig,

        Thanks for getting back to me! I’m so happy to hear you’ve had some good and easy experiences with Medi-Share. That’s encouraging!

        I was curious what you say at your doctor’s office when dealing with billing and they ask for your insurance card. Do you just present your Medi-Share card, not say anything and let them figure it out? Do you say, “I’m part of a PPO network”? It’s not necessary to mention Medi-Share’s name and explain what it is, correct? I’m just wondering how easy it is to deal with that aspect of it.

        Thanks again, Craig!

        • Todd Fuller says

          We have used doctors offices with Charlotte’s two major medical outfits: Novant and Carolinas Health Care System.

          When going to a doc – we present the Medi-Share card. Sometimes, we might get a funny look when they look at the front of the card, but, most of the time, they flip it over read for a few seconds, and see that PHCS logo. That usually ends the “concern.”

          If we detect any “doubts” we say that our health plan is called Medi-Share, they contract with the PPO called “PHCS.” Then we almost always get the “Oh, ok” if there were “doubts.”

          PHCS is owned by MultiPlan, which I think got bought by Kaiser Permanente. Translation: most providers have never heard of Medi-Share, but most providers have heard of PHCS.

          The PPO PHCS is “Private Healthcare System”

          • Todd Fuller says

            Correction: I just looked at our MS card. It is easy to think you remember how something looks… the PPO information (PHCS logo) is on the front of the card, not the back…. So to “fix” my last response…

            Most doctors offices just take our card at the first visit and make a copy, without pause or hesitation. 85%+ of all folks in NC on some sort of insurance or commercial health plan are on Blue Cross Blue Shield of NC, so the providers are used to seeing mostly just BCBSNC cards…

            I recall one or two new docs offices in the past asking about Medi-Share when we hand them our card the first time, but when we tell them MS is our health plan, they network through the PPO called PHCS – that shut downs any “concern” those one or two folks may have had.

      • Jim Virden says

        My wife and I are currently covered by my employer’s BCBSIL plan, but with this being the open enrollment period, I wanted to look at MS as well. She is the older, at 62, but we both have pre-existing conditions. Sounds to me, from what I’ve read, that MS is not for us.

        • Suzanne says

          I appreciate all of these comments. The new law is forcing me to change from perfectly good coverage to something twice as expensive with maternity that is unnecessary (and medically impossible!). MediShare appeals to me and your post raised concern that may sway others away from a good alternative that at least attempts to follow Christian ethics. All company’s can be a pain sometimes – and I think the way you presented your coverage (as some pointed out) may have been a factor. The advertisements/links for AARP on your site make me question your opinions as well. Please include AMAC links on your website as the conservative senior organization offering the same discounts to be fair. I still plan to go with MediShare and hope others will too.

          • says

            Suzanne,
            I do sell some advertising space on the website and different companies run ads in those spots. I don’t select the advertisers, but I do block out certain inappropriate categories. Thanks for visiting the blog.

  8. Todd Fuller says

    I have not seen dates for other posts so let me get that out of the way: 10/17/12

    My spouse and two year old daughter have been on Medi-Share 2.0 since April 1, 2010. Our son has been on Medi-Share 2.0 since birth in July 2012 (a “Medi-Share baby”). I became a Medi-Share 2.0 in August as it was only $5 more a month to add me as three family members classifies us as a “family” and monthly share amounts are based on the age of the oldest family member. I am the oldest, so my age bumped our family rate up a bit. I still retain my insurance through my work for me – Blue Cross Blue Shield of NC. But it is just crazy expensive to add family, $13,000 a year, to BCBS of NC group plan. And has gone up 25% a year for each of the last two years, except for the year coming up, rate stayed flat. When I was on my own individual plan with Humana Insurance, before my current job, Humana would raise my rates by about 8% to 20% each year. MS has risen our rates a very reasonable 3% each of the two years we have had a plan anniversary.

    MS re-contracts through the PPO, Private Healthcare System (PHCS), which is owned by MultiPlan which is basically owned by Kaiser Permanente. PHCS is one of the nation’s largest PPO’s, but, within each individual state, is not going to be the largest PPO within each respective state. I am a little surprised that the person above complained about some doc in TX not accepting MS. When you visit a doctor’s office, it is the PPO that the office usually looks at, as much as the health plan/insurance company itself, and PHCS/Multiplan does have a “name.”

    For example, in NC – Blue Cross Blue Shield of NC is the largest PPO, with about 7 million members. Blue Cross Blue Shield is NOT the same company as another state’s Blue Cross Blue Shield, say for example, BCBS of Indiana. Two totally different companies. Health insurers are not allowed to do business across state lines, but MS is b/c MS is not defined as “insurance” by regulation. MS is a health plan. BCBS of NC usually has bigger re-contracted pricing for medical bills (aka “discounts’) because of the weight they can throw around in the state with medical providers. PHCS re-contracted rates are not terrible, but they are not great. In one case, we had one docs group that was not in PHCS network at all, even though they service the largest hospital in Charlotte. More on that later.

    Also, I am a licensed NC Life, Medicare, LTC, Health, Accident & Sickness Agent. It is a health plan. My status as agent gives me a unique perspective to the complications of billing in healthcare and insurance, not just with Medi-Share or another non-insurance health plan. I am not appointed by any insurance company.

    Currently, my family and I are about a little more than halfway through our first big “test” with MS, as we had $31,200.70 (yes, that is to the penny, I am also a HS math teacher) of gross charges related to a normal, no complications, non-emergency (but deemed “of medical best practice”) C-section of our son in July 2012 through Carolinas Medical Center – part of Carolinas Healthcare System in Charlotte.

    So far, on the whole, bill processing is working reasonably well, albeit a bit slower than with insurance for when we had our daughter in 2009 – on Blue Cross Blue Shield of NC (BCBS of NC). However, as expected, we will likely “bust” our maternity limit, as Medi-Share had a maternity sharing limit for eligible maternity events up through births through July 31st. In the summer member vote, members voted to eliminate the maternity share limit, so limits went away for eligible births 8/1/12 or after. Unfortunately, we missed this by a few weeks. MS maternity limits were always way too low, and to make matters worse, were never adjusted upwards annually for inflation, even though medical costs have risen about 10% a year, more than triple normal inflation. The MS C-section maternity share limit was set in 2007. So in five years since, C-section total bills have gone up about 30-50%.

    Members vote to add eligible events twice a year, in the winter and the summer. MS member service reps are usually helpful, professional, and offer to pray with you. They even typically offer a call reference number for each issue, but if they don’t, and you ask, you usually get one anyway. The response to inquiries exists, and is usually prompt. I have only had two of my more than two to three dozen inquiries not returned; one, to a call to our bill auditor at MS, and the other, to the Guided Care Department that our bill auditor at MS works in, both remained unreturned as of this date, from a few weeks ago. Other than these two, all other calls/inquiries are promptly addressed.

    Since 4/1/10, the members voted to allow wellness checks for babies two years of age or younger to be eligible for sharing. So, as such, the one week, one month, and it looks like two month well check visits for our son are eligible, and have been already shared and paid, to another big local healthcare conglomerate; Novant. The addition of baby well checks for under age two, has been a pleasant surprise that was not a feature of MS when we first joined.

    For our $31K’s worth of gross charges for our son’s maternity event, all related bills have been processed and almost fully paid, except for two issues: the hospital facility charge for my spouse, which is by far and away the largest bill (mom’s facility charge is always largest bill, except if you have a big issue with baby, regardless of Medi-Share), and, the anesthesiologist’s professional fee. For the facility charge, which by itself is almost a $19,000 gross charge, it undergoing an automatic bill audit by MS. Any bill $15K or greater gets this done at MS. I agree with this, because, 90% of hospital bills have errors. The errors almost always favor the hospital, not the patient. And if bills are overpaid, insurance premiums rise. Bill audits take a few months, if not longer. When I had sought out a bill audit for our daughter’s maternity event, through a third party – our daughter was born when my wife had BCBSNC through a former employer, and completely unrelated to MS, my auditor found over $4,000 in hospital errors/oversights added in by Novant (daughter born at Presbyterian Matthews in Charlotte area in 2009 – part of Novant). BCBS of NC never caught this nor cared to catch it.

    Back to our current situation… the only other “issue” so far with our current maternity event which is with MS, was with Southeast Anesthesiology Consultants (SAC), the company that the anesthesiologist works for who did the anesthesia for the 1 hr 15 minute C section. Surprisingly, SAC was “out of network” for PHCS, even though at least one of their docs IS in PHCS network here in Charlotte, but outside the hospital, Carolinas Medical Center – Main. The hospital itself, all docs, urologist, pediatricians, etc. all are in PHCS network, except SAC. As a result, SAC charged whatever they want, with no PPO re-contracting of price, and MS, similar to what insurance would do, would not process 100% of the need for this specific bill, but did come close, to just over 90% paid by the membership.

    The issue with SAC is more to do with a broader issue of special doc groups signing exclusive contracts with big hospitals to “serve” patients in that hospital, then ducking signing contracts with most patients’ PPOs so they can charge whatever rates they want without having to honor a re-contracted price. In our state, SAC does have a contract with BCBS of NC, but they pretty much have to, since BCBSNC has 7 million members in the state, you can’t duck 7 million potential customers/patients.

    I will try to report back later with more followup details. Overall, the experience with MS has been reasonable – it will be downright great if we had our son a few weeks later and made it to the removal of the maternity share limits, and if PHCS had more “weight” to throw around in our state so specialty docs like SAC couldn’t duck the PHCS network. But, getting insurance in NC with maternity benefits on the individual market is impossible, only BCBS of NC offers it. Or, if we would have added my family to my group health plan which is through BCBS of NC, we would paying huge bucks, much of that would be going to lifestyle habits we don’t support: babies out of wedlock, drinking, smoking, etc.

    … All for now.

    • says

      Todd,
      Thanks so much for your fantastic comment. I think the information you’ve added will really help people make a wise choice when considering Medi-Share.

      • Beckky Barnett says

        Thank you for this information!!! I am helping my Father-in-Law with possibly switching this over for his small, family-run company & have been really praying for more feedback before filling the entire family in on the changes that we might do. A Godsend, thank you! And thank you, Jesus.

    • Todd Fuller says

      A couple of other things that I forgot to mention that are helpful: Medi-Share members can track their bills, monthly share amounts, additional donations made known as “Extra Blessings”, and make prayer and praise requests via the member website. Also, Medi-Share issues an EOS (Explanation of Sharing) for each medical bill, showing medical CPT codes, any discounting, what amounts were paid by the member share exchange, etc., similar to what an EOB (Explanation of Billing) looks like that is issued by a health insurance company.

    • Kaeli says

      Thank you, Todd, for that fabulous comment. It was so helpful and I feel much better about (possibly) proceeding with Medi-Share. The price quoted for my husband and I is about $250/month, as opposed to $500/month for individual health insurance premiums through BCBS in Oregon. We are both in our 20′s and if that’s how expensive it is now, we can’t fathom how much we’ll be paying as we get older and possibly add to our family. So 50% savings seems worth any small hassles of using Medi-Share, although I don’t want to end up in a situation like Craig’s initial story!

      We also hope to be having children on Medi-Share (if we proceed with MS, which is looking likely), so your story of your son’s delivery was very relevant to me. I was curious how maternity coverage worked! As you wrap up your “maternity event”, I would love to hear how things worked out in the end and if you have any more good (or negative) things to say about MS.

      Thanks again!

      • Todd Fuller says

        10-30-12

        Kaeli

        I will be glad to, and I intend to post more details as we “wind down” our maternity event with Medi-Share.

        You may also contact me directly by email at: tfuller52@aol.com any time. I am also a licensed, North Carolina, life, accident, health, Medicare, and Long-Term Care insurance agent since 2009, but not appointed by any insurance company. So this means, I have not made, nor intend to make a dime off any health plan or insurance company at this time. I am a HS math teacher. MS is not insurance, as “insurance” is defined by law in any state, but I find my insurance agent training helps me understand the complexities of the medical billing world.

        For our maternity event with MS, the last provider bill to get processed is the huge, hospital (facility) charge for mom. Since that is over $15K, that undergoes an automatic bill audit (validation) done by MS. Most people don’t realize, that medical bill audits are essential (90% of hospital bills have errors or “oversights), and, that bill audits take a long time (many weeks). Most big insurance companies do not do bill audits. They just rely on the laws of large numbers, process the bills, and pay according to your plan. Then, at year end, if they find they have spent more, raise your rates the next year.

        On our MS account online, when we checked my wife’s facility charge, this bill status just moved from “blank” meaning we were still awaiting medical records/docs MS requested from the hospital through us, used to validate their charges, to, “Bill eligible to share” which means this bill has been approved and will be paid, at least in part, by the MS members share exchange of dollars.

        But, we can’t see what the results of the audit have done to this bill on our online account. We may have to call in again to MS. However, two prior calls to the MS auditor or that person’s dept, remain unreturned as of today, going back to September – unusual, these are the only two calls to MS that were not returned in the three years we have been on MS. I also requested detailed billing of my wife’s hospital stay directly from the provider, and already found one “oversight.” The hospital billed my wife almost 3 hours of sitting in the recovery room, when after 65 minutes, the recovery room nurse told us that she would have been moved to her daily room on the maternity room floor, but all rooms were full. But the hospital had no problems billing us $15.90 per MINUTE of recovery room time, just to wait an extra nearly 2 hours in the recovery room, while my wife waited for a room to open up on the maternity ward floor. I sent a letter to the hospital and a copy of it the MS bill auditor a few weeks ago. As of today, we have not heard any results of the letter as well.

        One thing that will help you and your husband TREMENDOUSLY is that there is now, no longer any maternity sharing limits for eligible pregnancies (basically: some adoptions or child conceived in wedlock by adult, married Medi-Share members) with Medi-Share. Out of wedlock babies are one of many cost drivers with traditional insurance rates.

        With the Summer 2012 Medi-Share member vote, the members overwhelming voted to get rid of the hideously low, and getting lower every year (no adjustment for inflation) – former maternity limits – one for vaginal births and one for C-sections. The limits were removed effective for births on or after August 1, 2012. This will be the lion’s share of our hassles (example: recovery room fees above – wouldn’t have to worry about this without limits because we would be over our annual household portion anyway); as we have to try to deal directly with the provider to hopefully get amounts reduced that are over the limit.

        You will still have to hassle with the anesthesiologist’s outfit, if you have an epidural or C-section, because anesthesiology companies more and more, are trying to sign contracts with big hospitals to be the exclusive provider of anesthesia needs for the hospital; but then in turn duck signing contracts with most patients’ PPO’s/HMO’s/etc so that they can charge whatever they want. It is probable you will not have an anesthesiologist in-network in the hospital, although that same anesthesiologist could very well be in-network outside the doors of the hospital. If a provider is “out of network” MS, like most other insurance companies, will not quite pay the full amount; instead, only an amount deemed “usual and customary” which is always lower than the self-dictated rate the anesthesiologist wants.

        Hence, the anesthesiologist will attempt to keep balance billing you, which is legal, because they have no contract with any PPO/HMO.. or anything to honor. This issue goes far beyond MS; it is something political and requires calls to your state’s Attorneys Generals office. About the only way to ensure that small providers like anesthesiologists are “in-network,” and therefore, have to honor contracted rates, is to: either get a great job with a great health insurance plan that uses your state’s largest network (for example: Blue Cross/Blue Shield of NC here in NC) – a small provider will be stupid to duck a huge network like BCBS of NC b/c they have 7 million members, and/or, have enough tax-paying citizens call their respective state’s Attorney General office to complain.

        About the only other issue we have had so far, is a pathology provider, servicing the hospital, kept trying to bill us, because they didn’t realize that we are part of a PPO with MS (PHCS), and that contract with the PPOs says that they typical, automated bloodwork done on the newborn is included in the global (all-in-one) charge – but they were trying to bill us separately. We have gotten that provider error fixed. They were the only provider of many that missed the fact that Medi-Share is linked to PHCS.

        Also, MS has a program called “Extra Blessings” (late fees, donations) which helps pay for amounts over the maternity limit. However, according to last year’s financial audit of MS; there was only about $255K in Extra Blessings, but, over $1 million in medical bills eligible for Extra Blessings.

        On the other hand, that same audit revealed that MS’s member pool of cash available to pay eligible member needs, after admin expenses were paid, was around $21 million, as I recall. I’d have to look that number up again off the audit on their website, but I think that is reasonably close.

        All for now,
        Todd

  9. mary jo says

    Are you still medi share members we are so not sure what to do but the price of traditional is outrageous and being a stay at home mom and homeschooling and a self employed spousewe need to look into other options wondering if the other ministries would be better but I like the no hassle of filing your own paperwork and having to be self pay.

    • Todd Fuller says

      Mary Jo

      Yes, my family and I still are. Feel free to contact me about Medi-Share if you want using the contact information in my above posts.

  10. Kathryn Dunn says

    Kate Dunn

    I have just joined MS, coverage effective 12/1/12. My husband, myself and our two year old son have purchased the $2500 plan. My question is this:
    Is it $2500 max out of pocket for my cost in medical bills or the entire family?

    Thank you! So glad I found this conversation.

  11. Todd Fuller says

    Yes, for all MS members under the same household member number; the annual household portion (AHP) – similar to an insurance “deductible” is shared by all members for the year under that membership number.

    If you hit the AHP like what has happened this year for my family, as a result of an eligible need – an eligible birth, then a followup eligible need for another family member does not have to meet an additional AHP. I pray that we don’t have to hit our AHP again or use very much of it in following years like our first two years on MS.

  12. Dj says

    So glad we found this conversation! We have recently fallen into the position of having to find our own medical coverage and have been looking into MediShare after hearing about it for years on Christian radio. The whole “plan” really sounds appealing, our only concern is the “pre-existing” clause. So, if I’ve had my thyroid removed….is it only my synthroid that would not be covered? Will other possible future diagnosis be somehow tied to the thyroid by some unknown CPT/ICD9 list?? Or, my husband has high blood pressure. Would any future cardiac diagnosis not be covered?
    Thanks so much for everyone’s comments on this! Medi Share sounds exactly like what we’ve been looking for…just want to hear others experiences and wondering about the questions we may not know we have!

    • says

      Dj,
      Thanks for the comment. I actually have another post on Medishare that will post in the next couple of weeks.
      As for the ‘pre-existing’ clause you’d need to apply or contact them to discover the exact implications of that coverage. If you’re not applying through an organization my experience has been that without open enrollment most insurance companies will include exceptions for certain pre-existing conditions.
      Medi-share does have certain health categories where they charge an extra $60 per month. High blood pressure is listed as one of those conditions. Again you’ll need to call to see at what point there would be an extra monthly charge. It will be covered if you disclose it and they don’t do any sort of pre-existing condition.
      Medi-share does screen applicants so there is not guarantee of acceptance. The only what to know if you’ll be accepted and the exact terms would be to apply.

  13. says

    I found your site while searching for reviews of Medi-Share by actual members – or past members. I had posted about our extremely positive experiences with Samaritan Ministries, and a reader on my blog asked how it compared to Medi-Share. Apparently, it doesn’t compare well at all. :)
    We have had several bills paid by Samaritan members. It’s extremely easy and has gone off without a hitch every time, and we can use any medical provider we want, even unlicensed/uncertified midwives if we choose.
    It’s also cheaper than Medi-Share; you might want to look into it for your family. We only pay $355/month for our family, with a generous referral credit that can also help offset monthly shares. You can see some of my own posts about our family’s experiences and how it works here: Samaritan Ministries

    • Todd Fuller says

      “It’s [Samaritan's Ministries] is also cheaper than Medi-Share….”

      While I am sure Samaritan’s is a good program, my family of 4 (two adults and two kids) pays $289 a month for Medi-Share 2.0. We are now in our 4th year. That includes $2 a month for the America’s Christian Credit Union (ACCU fee – b/c bills are shared out of a share exchange coordinated through ACCU; funds not held by Medi-Share itself). That $289 also includes contributing $5 per month for the “Extra Blessings” program; a program of about $450K per year in funds, that pay’s for certain needs that are not eligible for sharing within the MS program, using late fees and contributions.

      MS 2.0′s monthly share amount is based on the oldest member of the household. That’s me at 39. While we do get a 15% discount for qualifying for the Health Incentive, even if you remove that incentive our monthly share amount will be $326.60.

      I was looking at the Samaritan’s Ministries program a few days ago, and did I read that only bills up to $200K are eligible unless you add on another program at additional cost?

      While $200K seems like a lot, one car accident and a few weeks in the hospital could easily challenge that limit. Additionally, I don’t believe that Samaritan’s uses a PPO or other network, I could be wrong. If that is the case, there is no mechanism to buffer outrageous hospital charges, because there are no contracted prices the hospitals have to give if a person is “self-pay.”

      While most hospitals do provide a “self-pay” discount off their own chargemaster prices, the self-pay discount may or may not be less than the contract price negotiated by the PPO and the hospital.

      Also, does Samaritan’s have an annual household portion or something similar that the member must contribute first each year towards medical bills above which the members contribute?

      • says

        Todd,
        I also looked into Samaritan Ministries recently. From what I could tell they aren’t exactly an apples to apples comparison so I person shouldn’t blindly just look at the share amounts. Thanks for helping to highlight the differences. Thanks also for adding a lot value to these posts about Medi Share.

  14. Judy K says

    Thanks everyone for your input on MediShare. I’m looking into it because the only way I can get my healthcare insurance premium down to reasonable is to raise my deductible to $10,000.00. I’m 55 and have no health problems (except I take thyroid meds which are cheaper to pay cash for than the insurance copay) so I pay for insurance I don’t use, and barring a catastrophic injury, would not ever reach that deductible.

    You all talk about “eligible” services. Anywhere I can look at a list of those?

  15. Tom Burgess says

    Wow, sure am happy to find this blog. Thanks to everybody for taking the time to post.
    Have been considering medishare as my BCBS rates are going thru the roof with no sight of stopping. Spoke with a very friendly and professional associate from MS who said my wife and I can get coverage for both of us for about the price BCBS is raising me alone too ($314). I’m self-employed and my wife’s work doesn’t provide ins. benefits. I was however deeply concerned about all the disclaimers of MS not being health insurance and there being no guarantee of coverage and was confused about the “share” process, but from reading your posts it appears they have been very diligent about covering claims and that “sharing” equates to paying valid claims from other members fees “share amounts” as a rule and not that is a question of some individual deciding to share with you or not. I’m pretty close to deciding to go with MS at this point feeling that I can rely on them.

  16. Kimberly says

    I am going to post my CURRENT, yet-to-be-resolved experience with MediShare and a denial for a condition MediShare claims was “related to a pre-existing condition.” I will follow with an update so those of you who exploring MediShare as an option can get a fair review.

    Some reviewers have criticized the negative reviews, particularly those complaining about being denied for pre-existing conditions. Such reviewers claim these upset individuals “should have known” pre-existing conditions would be declined. However, a careful reading of many of the complaints will show these individuals are NOT complaining that their pre-existing conditions were denied; they are complaining because MediShare seems to deny claims, citing “related to pre-existing condition,” when their new condition was in fact not related. Of course MediShare should deny claims when they are legitimately related to a pre-existing condition – or the premiums (“monthly shares”) would skyrocket. However, if someone receives a new diagnosis of melanoma, it would not be fair (or ethical) for MediShare to deny treatment for my new condition based on a routine dermatology check-up two years ago, or a mole removal five years ago, or acne diagnosis ten years ago. But the question is, COULD they? After all, they are “not insurance” and have a right not to cover anything. They tell you that right on their web site. My husband worries about that – he has had moles removed in the past as a preventative measure. None of the moles were cancerous. So what if, God forbid, he was diagnosed with melanoma? Would MediShare decline any treatment claiming it is “related to a pre-existing condition?” My latest experience will undoubtedly help to answer that question for me.

    Let me share my latest experience with MediShare: I have been to the doctor in the past for gluten-intolerance, which means I cannot eat gluten. Upon applying, MediShare informed me that they won’t cover treatments related to this condition, which I completely understand. Recently I went to the doctor for stomach issues. I was diagnosed with SIBO (Small Intestinal Bacterial Overgrowth), a new condition completely unrelated to celiac disease. MediShare denied my doctor visit, claiming it was “related to a pre-existing condition.” I was stunned and called them for an explanation. They told me to go through the appeals process. I informed my doctor, and he too was surprised it was declined in the first place. He wrote MediShare a letter clarifying that SIBO was a NEW diagnoses unrelated to any pre-existing condition. I will keep you posted after it goes through the appeals process.

    • says

      Kimberly,
      Please do report back with how your situation is handled. Since your situation is currently being processed through an appeal I’d encourage people recognize that your situation is to final and thus ultimately at this point Medi-Share must receive the benefit of the doubt.

    • Todd Fuller says

      Hi KIMBERLY,

      How long have you and your husband been Medi-Share members?

      Yes, please post back any developments here as well like Craig said. You are doing the right thing by getting the doctor to type a written letter stating your need is not related to a pre-existing condition.

      We have been members since April 1st, 2010. On the whole we find MS a good program, and have had one major need related to the birth of our son, and before the old maternity limit eliminated. But, as you are experiencing, we have had two medical needs that MS heavily “scrutinized.” Fortunately, both did get resolved and neither was expensive. In addition, I had a friend and his family in Illinois join MS b/c of me, but had a very similar situation to what you talked to about with melanoma. More on that later.

      First for our two scrutinized needs; both scripts. One was written as a pain medication right after my wife’s C section last July, written by a certified midwife in our OBGYN practice. MS initially did not accept it stating a midwife wrote the script and not a doc. Also, the OBGYN clinic is part of a large practice that uses only certified midwives, all working directly under docs. Once we got the practice to send MS the midwive’s certification, the script was approved and paid by the members, within about a month of paying for the script.

      The second, was a script written for our son; same one born in July 2012, during a November well-visit to his pediatrician. MS initially did not accept this for sharing, stating that the script, even though it was written by a board certified doctor (his pediatrician), that it was written during a so-called “well visit.” Apparently, MS operates on the principal that no scripts “should” be written during a “well visit.” At the time, our son was still experiencing a leaky eye, which is common for newborns. It has since cleared up thankfully. But the doc at the time prescribed some medicative drops to prevent any infection. After we had the provider fax over the doctor’s ordering notes for the script, this re-opened the script for review at MS. Unfortunately, there were several unusual delays that did occur, that did not with the pain script, that slowed down this script getting approved. But it eventually did. We just got the reimbursement check last week.

      Those are the only two medical needs that we have had that had initial, unexpected rejections for approval for sharing.

      … Switching gears to my friend in Illinois that I referred to MS. Within months after becoming MS members, they had two frustrating experiences as he shared with me. The first: his wife came down with some type of skin condition that required a hospital to remove some skin; I think it was called basic cell something-or-another that was deemed pre-cancerous. She did have a pre-existing skin condition that was put on the MS signup paperwork. My friend claims that they received a verbal pre-approval from MS for the treatment, which is why they were surprised at the rejection for sharing. I asked if they wrote down the time/date/who they talked to for the pre-approval and they don’t have it. The other, while cooking one day with her mom, their daughter cut herself, fainted and fell, cracking her tooth. It required an expensive root canal. Dental is not eligible for sharing, but dental related to trauma is. MS likely just got a claim for a root canal, with no other info. Initially they were not approved, and were planning on having the doctor send in notes stating the canal was related to fall, not just an ordinary dental procedure. I have not heard anything since. I know in the months following, my friend’s employer got much better health insurance and at a much lower cost to the employee, through BCBS of Illinois so they went on BCBS of Illinois.

  17. dfmerrifoy says

    Based on numerous variables, I’m not convinced that MS would be the best choice for a senior citizen. For instance, most elders take lots of medicines (which I can’t tell if medication is covered); they have chronic, long-term, preexisting, costly conditions; their illnesses tend to be sudden and costly; and having to “wheel and deal” with slick insurance companies and then end up paying out a huge amount of their costs anyway does not sound like a great way to spend one’s retirement. Or have I missed something?

  18. Todd Fuller says

    Dfmerrifoy: Seniors are generally not eligible for Medi-Share as they are presumed to be on Medicare. I think Christian Care Ministry has another option for seniors that I think is called Senior Assist.

    About prescriptions; this was a big issue for me when I signed up my family four years ago. The guidelines of Medi-Share 2.0 stated then that prescriptions for eligible needs were eligible for sharing for up to 6 months. Before signing up, I was told that this meant for “maintenance meds” for treating things like high blood pressure, not for things like “cancer treatment meds.” And I was not told but just some normal Medi-Share clerk, I was told this by a guy named Tom Taylor, who in 2009, was higher up the food chain of MS on the west coast.

    As everyone knows, while coming down with something like pancreatic cancer or acute myloid leukemia is rare (our family has had friends that have passed away from both); if that does happen, medication to treat these rare conditions can be atmospherically expensive, and of much longer duration than just six months. Since 2009, the MS 2.0 guidelines have been clarified to state that the 6 month limit rule may not apply for the treatment of cancer.

  19. Patty says

    10/1/13

    Thank you, Todd and Craig, for your extensive comments. I am not sure if this discussion is still going but I really enjoyed reading it. I live in PA and I am a stay at home mom of two young boys. My husband is self employed. We pay about $500/month with Highmark and that is with no maternity coverage (we canceled the maternity after the birth of our second son to defray costs) and a $5000 deductible and I believe we pay 20% of all bills. I am so frustrated with what’s going on right now with the healthcare laws and just got a notice today from Highmark that says our coverage will no longer be available to us after December 2014. I have heard of Medishare for many years on the Christian radio station. We are close to making the leap but I need to understand exactly how it works. So we pay the family share (like a deductible) of say, $5000, and then that is it for the year and all of our expenses are completely covered, assuming we continue to pay our monthly premiums? I am just wondering if there is any share of 90/10 or 80/20. Also, I have had two c-sections due to a pelvic condition and if I would have another pregnancy (not planning but could happen!) I am wondering if the entire cost of c-section would be covered. I understand there were some complications/questions, Todd, with your anesthesiologist, but overall it is covered? Vaginal birth is not an option for us so this is a big question for me.
    Thanks for all of the info! It is a breath of fresh air to think that this could actually be an option for us and we could stay well informed and I feel more in charge of our health bills. It feels empowering!

  20. Todd Fuller says

    “So we pay the family share (like a deductible) of say, $5000, and then that is it for the year and all of our expenses are completely covered, assuming we continue to pay our monthly premiums?”

    Basically, yes. However, well visits (except for infants under two) are not applied to the annual family share amount, and your medical needs must be deemed eligible for sharing, according to the Medi-Share 2.0 Member Guidelines. Generally, medical needs are, unless the need involved some sort of pre-existing condition, then it may not in whole or in part.

    “I am just wondering if there is any share of 90/10 or 80/20.”

    Not really. A family meets the annual family share amount or they don’t in a given year. If they do meet it, then generally all eligible needs past that point that year are paid for by the members.

    “Also, I have had two c-sections due to a pelvic condition and if I would have another pregnancy (not planning but could happen!) I am wondering if the entire cost of c-section would be covered.”

    Generally speaking yes, once the annual family share amount is met, and, if you got pregnant after you were approved and became a Medi-Share member, and the child was that of you and your husband. The husband does not need to be a member. The good thing now, is that the members voted to get rid of the pesky Maternity Limit that existed until August 1, 2012. If our son was born just a few weeks later, we would not have gone over the limit (which was too low), and I wouldn’t have had to scrutinize medical bills so hard and make calls to have providers adjust errors in bills.

    “I understand there were some complications/questions, Todd, with your anesthesiologist, but overall it is covered?”

    The issue of anesthesiology has little to do with Medi-Share and more to do with the broader problem of specialized practices signing contracts with big hospitals to be the only provider of that specialty in the hospital, then the specialty turning around and ducking signing contracts with patients’ healthcare network for service ONLY IN THE HOSPITAL. This way they don’t have to negotiate prices with the networks before-hand. Many states’ Attorney Generals have pushed laws or have considered laws banning this practice. A partial workaround is that insurance companies reimburse specialty bills at a higher “out-of-network” rate. Medi-Share does a similar thing. Only huge insurance companies in a particular state can make the specialty practices join their network, because who would duck a huge network, say in NC, Blue Cross Blue Shield of NC, that has 7 million members? But most smaller insurance companies don’t have that leverage. MS reimbursed our anesthesiologist at 90%. Then, we griped to the hospital and to the parent company of the anesthesiologist of this practice of “going out of network only inside the walls of the hospital” and they have not balance billed us the remain 10% or so (about $200) that they were demanding.

    • Todd Fuller says

      Kimberly, one thing I messed up on above, the well-visits for baby’s under two, I believe are eligible for up to $750 in sharing, once the annual household portion is met (which it will be met when one has an eligible birth in most cases).

  21. says

    Medi-share is indeed a unique program for providing assistance with medical care, but unlike health insurance programs this route uses blatant discrimination to prevent certain individuals from benefiting from its service. Mychristiancare.org specifically points out that only those engaging in sexual intercourse within a “Christian” marriage are allowed to join. This immediately eliminates gay, lesbian, and transgender individuals from enrolling in Medi-share. The program also places limits on services it covers based upon religious beliefs and states specifically that abortions will not be covered under any circumstance.

    To be clear, Medi-share is not an insurance program. Medi-share operates as a non-profit group and while members pay into a group fund each month, the money is never Medi-share’s money. Furthermore, Medi-share is not required to pay any bill, nor keep cash reserves on hand.REF::http://www.newsonhealthcare.com/how-does-medishare-work/

  22. Todd Fuller says

    All great points Ken, but, I’d call it trying to live and honor a Christ-like lifestyle, versus blatant discrimination.

    Those are all great things to me that our member dollars are not being used to pay for things such as taking innocent life.

    …. As for the the money never being Medi-Share’s money, MS not being required [presumably by law, I think you are inferring], nor keep cash reserves are all true, but if either one were true than it would be insurance as defined by law.

  23. Samm Brown says

    My wife and I are currently looking into medishare. A couple of questions

    1. When you go see a doctor in network, is there a copay (If yes, what is it?)

    2. If not, are you responsible to pay the full bill and then submit for sharing

    3. What do you do about prescriptions? My wife takes wellbrutin.

    • says

      Samm,
      1. There is no copay, you pay the full amount until you’ve reached your family share amount
      2. Yes.
      3. If I remember correctly you are eligible to get some minimal discounted medications through a third party service. It’s not anything significant. I’d contact Medi-Share directly and ask this question.

  24. Todd Fuller says

    Samm,

    A couple of points about #2 and #3:

    2) You can still have the provider submit the bill for sharing, regardless. Medi-Share will determine if the bill is eligible for sharing per the MS 2.0 Guidelines and then determine the member responsibility amount after any potential PHCS (PPO) discounting.

    If you know 100% that the bill is not eligible for sharing, for example, if you are going in for a well visit, I’d negotiate a cash (self-pay) rate with the provider that you pay on the spot, and, with the lab that the doctor uses. These self-pay discounts are typically far larger than any PHCS discount that might be provided to a well-visit, or, labwork associated with a well-visit.

    3. Scripts: If the associated need is eligible for sharing, then the cost of the script is added as part of your annual household portion. You fill out a form and mail it in to have it added to your AHP, after you use a discount card. If the script is not part of a need eligible for sharing, you can still use the discount cards. We have two script discount cards; “ScriptSave” and “NeedyMeds” and have the pharmacist check and see which one provides a larger discount.

  25. Pam says

    I just wanted to add my two cents about Medishare. I greatly dislike it! The monthly rate for me and my one son started out to be almost 500 dollars and the last two months, with the Manna share, has jumped to around 580 dollars! When I called to voice my distress over this, I was told it was because the amounts that needed shared had exceeded the current sharing so everyone’s share went up.
    I had to sign up for the Health Coaching as well, which I found totally useless and not worth the extra money they were charging me for it, and I had no choice of being “coached” and charged extra! All it amounted to was twice monthly phone calls with a very nice young lady asking me if I had lost weight and how I was eating, exercising etc., yet, they don’t cover the costs of lab tests, radiology tests, and yearly exams which are a requirement for someone my age!
    The one time I have had to use them for an emergency the first email and letter I got was to inform me that I needed to contact the hospital where I was admitted to apply for some type of aid so they would save their cost of covering me! I told them that due to my last year’s income, I was not eligible for any type of financial aid and that the reason I was even on Medishare was because I lost my insurance when I got divorced and did not work for an employer that provided insurance. I told them to please go ahead and process the claims they were receiving from my hospitalization. They said they would.
    The next problem I encountered from them was that with every charge they received from my medical problems was that I received an email stating I needed to sign a release of information and send it back to them or they would cancel the claim processing! In every situation where I have needed any type of medical care, I have signed consent for the provider to share any and all medical records with my medical coverage provider so I did not understand why I needed to sign any additional consent. I signed it, but it just seemed like it was yet another stumbling block they were throwing my way to keep from paying my medical bills.
    I recently looked at the medical bills they are processing and am seeing that they are not going to share a great deal of those bills! Where they think I am going to get the money to pay those bills is beyond me! Yet, every month they sure take money out of my account to pay someone else’s bill! I never participated in the “extra blessings” because I could hardly afford the regular bill, forget having enough to give extra!
    I am terminating my membership with Medishare effective November. I am tired of throwing good money after bad. The last time I spoke to my health coach I told her I would be terminating my membership and why. They sent me a survey that asked me several questions, one of which was if I was going to complete “my goals” with them. I was honest and answered no since I wasn’t going to be on the program after November 1st. About two days after that conversation I received a letter from the MS Health Coaching stating the they determined that I was no longer eligible for their membership because I did not meet the terms of their agreement which was to follow what the health coach was recommending I do in regards to weight loss and body size reduction. If MS is a “Christian Organization” then they shouldn’t kick someone off of their program because they aren’t the size their program deems appropriate! That’s why people can’t get commercial insurance is because they don’t meet the standards!
    I would not recommend this program to anyone. They are way too expensive and, in my opinion, way to hard to work with in regards to paying claims. I feel that the commercials that talk about how “all my husbands medical bills were shared” is totally false advertising. They make it sound like all you have to do is sign up and all your medical bills worries will be over, and that could not be further from the truth. Because of “Medishare” I don’t know how I am going to pay the medical bills they are leaving me with. I am just hoping that they will pay the whole hospital stay at least.
    Again, this is my experience with Medishare. Maybe those with perfect health, body weight and body size have had better experiences with them.

    • says

      Pam,
      I’m sorry for your negative experience. I wanted to clarify a few things with you for the value of all the readers. I feel like we need more information so that people can have some context in considering your feedback.
      1. What was your family share when you said you’re rate for you and your son was $500? That seems higher than the share prices I’ve seen online for two people.
      2. What do they charge for Health Coaching? I had the impression it was free.
      3. You said that Medishare is “not going to share a great deal of those bills”. Can you clarify why that is? Do you think they have an legitimate reasons?
      5. You state that Medi-Share removed your coverage because you didn’t meet terms of an agreement. Can you expand on what they required you to sign? If you didn’t meet the terms of the agreement, what would you suggest would have been a better course of action?
      Honestly, it seems like your feedback is missing some important context. Please help our readers to understand the situation so we can make a fair assessment of Medi Share. You’ve definitely make some serious accusations, but what did they do contrary to what they committed to do?

  26. Todd Fuller says

    Pam,

    I am sorry to hear your concerns, but I piggyback off Craig; further details will be helpful.

    To Craig’s first point I just checked, the highest monthly share, assuming one is 50 years old and with two on the plan (monthly shares are based on the oldest family member) is $522, and that is with the lowest possible annual household portion of $1,250.

    The “….Health Partner Program – In some cases certain health conditions (like high cholesterol, excess weight, or diabetes) qualify applicants for our mandatory Health Partner program, which includes an additional $80 per month fee….”

    From here: http://mychristiancare.org/medi-share-pricing-tool.aspx

    So, if you are 50 with a second family member who is younger, and a Health Partner, your maximum monthly share will be $602, and that also assumes you want the lowest Annual Household Portion of $1,250 which is the combined highest amount per year in eligible medical bills your twosome will pay.

    … Something else you alluded to… about having to sign forms….

    You might be referring to one of two things… or both:

    If you do qualify for Medicaid, then…. you qualify. This saves the Medi-Share members money, and helps keep rates low. In fact, if you fill out the forms (and they are short) and qualify for Medicaid, you can end up with a 10% share credit according to what Medi-Share has told us. MS asks members to do this to waste member dollars on a need Medicaid might pick up anyway.

    The second thing; if you do have an eligible medical need, and any single bill from a provider is over $25,000 (used to be over $15K), then, Medi-Share automatically conducts a Bill Validation (audit). They ask you to sign a couple of forms (took us about 10 minutes for the birth of our son). Then, they pull the Medical Records and compare with the detailed bill. Since 90% of all hospital bills have some sort of error or oversight and usually in the hospital’s favor, then catching the error(s) also saves the members money.

    Most insurance companies do not do this. They just simply process the claim according to the terms of their contract they hold with the provider, then, at year’s end, total up all the claims paid, and raise rates accordingly. When my first child was born four years ago, before we went on Medi-Share, I had a third party conduct an audit of the hospital bill that was mostly paid by Blue Cross Blue Shield of NC, our insurer at that time. The third party audit caught over $3,300 worth of overcharges on just a $15K bill for a normal hospital delivery, no complications. In the end, I didn’t save anything b/c it was over our deductible, and unfortunately for the auditor they didn’t make anything, b/c that one got only 25% of any monies the patient recovered. But the auditor saved BCBS of NC $3,300, and hence, in turn, we did our part to keep pressure down on a BCBSNC rate increase that year. I still paid the auditor a little bit anyway since she did an excellent job.

    Many people do not understand the complexities of hospital billing, so being patient on waiting for a bill audit to complete is not easy. It can easily take 6-12 weeks. Typically, the hospital will not bill until the bill audit is complete.

    Regardless if my response is on to something, I do look forward to hearing more details Pam, thanks.

  27. Pam says

    Addressing of questions: My monthly share started out at 495.00 with a 2500 dollar deductible, and that is with an 80 dollar Health Coaching Fee every month. It went up to $502 the next month, $507 the next month and the last month it was $567 just for the Medical Share. This did not include the Manna going from 10 dollars to 15 dollars so my last bill that I had to pay was $582!
    I looked over the bills that weren’t shared and they are extensive. I intend to call Monday to find out why they are not being shared. Most of the statements say that medical information was not received! I sent a copy of all the bills in question to Medishare for them to submit for payment and stated in the email that they have my permission to request any and all medical records that pertain to the bill. Providers know that they will not get paid if they do not submit the medical records for review. Insurance companies know THEY have to request those records, and Medishare SHOULD know the same thing. They either haven’t requested the information or they haven’t yet received it. I am going to find out and inquire as to why these bills were not shared.
    I do not believe they cover lab work at all, which is absurd to me, especially when they “require” blood work for the Health Coaching. It’s not cheap to go the doctor just so they can order a blood test and then you have to pay for the lab work on top of that!
    Anyway, I will post again when I find out why they have marked a lot of the charges as not being shared. Again, this is just my opinion, but the fact that the sharing exceeded the number of payments made by members begs the question of whether other members are getting fed up by all the red tape and are leaving to find other means of paying medical bills.

    Pam

    • Todd Fuller says

      Pam,

      I am sorry to hear your frustration. I will like to hear more hard specifics when you get them.

      It is hard to follow much of your post. There are lots of pronouns, like “they” and it is difficult to make sense of certain things.

      First, you seem to be mixing in parts in your last post of three different and distinct programs with Christian Care Ministry: Medi-Share (medical bill sharing), Manna (a separate disability program), and Health Coaching (Health Partnership program for Medi-Share participants who have demonstrated specified, lifestyle health-risk factors and are required to participate in the Health Partnership program in order to continue their Medi-Share participation).

      –”My monthly share started out at 495.00 with a 2500 dollar deductible, and that is with an 80 dollar Health Coaching Fee every month. It went up to $502 the next month, $507 the next month and the last month it was $567 just for the Medical Share.”

      Pam, what is your birth month? This is the month in which everyone’s plan share goes up, due to a birthday of the oldest member. For example, for us, I am the oldest member on our plan, so every July, we expect to receive a bump up in our share starting August 1st. Each of the last three years, our increase has been about 3%.

      Did you change program options, in Medi-Share, Manna, the Restore/Health Coach, or any combination of the above programs? For example, with Manna, which we are not participants, the more income you want supplemented in the event of a disability the more you pay, I believe it is $12 per month for each $2,200 of income a Manna member potentially wants reimbursed.

      –”I sent a copy of all the bills in question to Medi-share for them to submit for payment and stated in the email that they have my permission to request any and all medical records that pertain to the bill. Providers know that they will not get paid if they do not submit the medical records for review.”

      A provider has to have your permission to release Medical Records to a third party including Medi-Share or an insurance company. Generally, an email does not count as permission. Medi-Share has a one page form that, in the event of a hospital bill greater than $25,000, Medi-Share sends to you asking you to sign a copy and mail a copy to the provider and the other copy to Medi-Share, so that MS can receive Medical Records and detailed billing on your behalf in order to audit the medical bill for accuracy. This ensures that bills are not being overpaid. Of course, this paragraph above assumes that the bill is eligible for sharing. The form is easy to complete and took us less than 15 minutes.

      In other words, you are requesting to the Provider your own Medical Records and Detailed Billing be sent to Medi-Share, and MS makes it relatively easy with a short form.

      –”Providers know that they will not get paid if they do not submit the medical records for review.”

      It is generally true that once a Provider receives written correspondence from either you, or your health plan, they have to respond. Generally, Providers do so, and settle the issue, before in turn billing you or your Health Plan. However, this can take weeks, if not months.

      –”Insurance companies know THEY have to request those records, and Medishare SHOULD know the same thing. They either haven’t requested the information or they haven’t yet received it. I am going to find out and inquire as to why these bills were not shared.”

      This is where I get fuzzy. Insurance companies do not typically request Detailing Billing and Medical Records in order to audit a charge. Typically, an insurance company will just process and pay a charge based on the terms of their contract they hold with the network and the provider. The insurer might exclude a Provider charge b/c their contract might state that certain charges are disallowed, but generally, the insurer does not audit. The upside? This makes it relatively quick for an insurer to pay a bill. The downside? The insurance company often overpays the claim b/c they are not digging in to the bill line item, by line item. The insurer relies on the law of large numbers; meaning millions of subscribers paying lots of monthly premiums. The other downside? Premiums go up at year end for insurance company subscribers because, in part, insurance companies have essentially overpaid on many of the bills in which they have paid. Medi-Share’s philosophy is different. MS tries to ensure that large bills (over $25K) are accurate in all respects, before paying the bill, in order to be a good steward of the members’ dollars.

      –”I do not believe they cover lab work at all, which is absurd to me, especially when they “require” blood work for the Health Coaching. It’s not cheap to go the doctor just so they can order a blood test and then you have to pay for the lab work on top of that!”

      Lab work related to a wellness visit is not eligible for sharing, however, it may still be discounted through their PPO, Private Health Care System (PHCS/Multiplan). However, if lab work is not related to a well visit, for example, a pregnancy verification test, or blood work related to an acute medical need, it may be eligible for sharing. Specific to the Health Coach, our experiences in Medi-Share can’t speak to that; my understanding is that some members are accepted to Medi-Share as members “on condition” that they adjust certain lifestyle habits that generally now or in the near future are detrimental to health.

      –”Anyway, I will post again when I find out why they have marked a lot of the charges as not being shared. Again, this is just my opinion, but the fact that the sharing exceeded the number of payments made by members begs the question of whether other members are getting fed up by all the red tape and are leaving to find other means of paying medical bills.”

      I am not clear on what you mean by the ‘sharing exceeded the number of payments made by members.’ Generally, if a need is eligible for sharing, the MS members pay it once the member meets their annual household portion, which in your case seems like it is currently $2,500. I think the one notable except is Outpatient Therapy, which is generally limited to 20 visits. But, even then, if more Outpatient Therapy visits are needed, the Provider can write a letter stating why more are needed to Medi-Share.

      As far as the red tape, when my wife had a C-section, maternity, and all of the bills related to maternity, generally the extra “red tape” was minimal. However, I am coming to appreciate the relative thoroughness as a result. Said another way, if this thoroughness was not there, I wonder how much higher our monthly share amounts will have been raised each year, over and above the modest 3% per year. My understanding is that insurance companies have been hiking rates about 9% a year, and that was before, the mandates of the Affordable Care Act started affecting insurance premiums.

      Pam, it will be interesting to hear of more details when you get them. I prayed for you this morning, and look forward to an eventual good resolution and future great health for you and your son.

  28. Pam says

    Todd, I thank you for your prayers.

    At this point, I am beside my self with distress over this issue. Now they are asking for medical record from that past 3 years from my family doctor! This is to review them to see if there were any pre-existing conditions related to my acute event last summer, in JULY! I know that I didn’t act very Christ like when speaking to the young lady, but quite frankly, the medical bills so far are well over $50,000 dollars from my chest pain episode last summer and they are JUST NOW asking for those medical records that, I hope, doesn’t contain anything they can use to prove my acute episode of chest pain was somehow related to some pre-existing condition. I don’t believe they will as I haven’t been treated for any chest pain related condition in the past three years, but I am not confident they will not come up with something in that medical record that they can use to deny the claims for this ACUTE event! I told her that if they had needed those records, why didn’t they ask for them when I signed up for Medishare? I had to fill out an application that stated all of my medical history so why now are they asking for the medical records from my family doctor? All she kept saying was that it was to determine if there were any pre-existing conditions. Well, shouldn’t they have already figured that out what kind of medical history I had when they agreed to cover me?!?! It just appears to me that they can’t come up with a legitimate reason to deny the hospital stay so are now turning to the past three years of medical history to see if they can come up with a reason to deny the claim. I told her that if they did decide to deny the claim, that I would have to declare bankruptcy as I had no means to pay upward of $50,000 dollars in medical bills and thank you very much! As I said, I was not very nice, verging on hysterical but I couldn’t help it. She isn’t the one who is going to be stressing out when all those providers start hounding me for the money if Medishare doesn’t pay my claim!

    As for Manna, I am under the assumption that it is mandatory that you pay that and has never been based on my income. If that were the case, it should have gone down as I have had a drastic reduction in my income since I became a member of Medishare. My statements say that 2 months of non sharing will result in termination so I take that to mean it is mandatory.

    I don’t know about all insurance companies but the one I worked for did. I was a review nurse and routinely reviewed prior authorization requests which required medical records review to determine eligibility of the request. I also reviewed current hospital stays which required medical records for review to determine eligibility. I also NEVER had to request the member to sign any additional forms so their medical records would be sent to me.

    As for the increase, I spoke to a gentleman regarding this and he told me that the reason the cost went up was because the requests for medical sharing exceeded the amount they had coming in from member sharing. He didn’t say it had anything to do with my birthday.

    Yes, I know this post is a little fractured and disorganized but that is how upset I am. This is why I would never tell anyone to sign up with Medishare unless they are in perfect physical condition and perfect health. Then and only then might they be able to get their medical bills covered without hassle but that is only if they have no type of past medical history whatsoever that would cause Medishare to have to pay the claim by not allowing them to find any reason to deny it.

    Upset, yes. Very! I wish I had never heard of Medishare. They have taken over $2000 of MY money this past 4 months and I am really afraid that I will see no benefit of wasting that money. I’m glad there are members out there who benefitted by MY contribution!

    My advice: find some other type of coverage. Anything would be better than this Christian Sharing Organization! Just my two cents.

  29. Todd Fuller says

    Hi Pam

    How long have you been a Medi-Share member?

    It sounds like, based on your response, that you have been a member for less than three years.

    I am not sure of the exact reasons/methodology Medi-Share uses to qualify a bill as eligible, but the Member Guidelines are quite clear, and can be seen here: https://mychristiancare.org/Members/Medi-Share/Medi-Share_2_0/Guidelines.aspx#VIF

    It looks like your situation may fall in to clause F, “Pre-Existing Medical Conditions or Related Conditions.”

    I’ll paste much of it here:

    “….Medical bills for diagnosis or treatment for a non-congenital, pre-existing medical condition, defined as signs/symptoms, diagnosis, treatment, or medication for a condition prior to membership, will be eligible for sharing as follows:

    • The condition is eligible for sharing up to $100,000 per Member per calendar year if:

    o the Member has been sharing faithfully for 12 consecutive months, and
    o the medical records state the diagnosis/condition has gone 36 consecutive months without signs/symptoms, treatment, or medication.

    • The condition is eligible for sharing up to $500,000 per Member per calendar year if:

    o the Member has been sharing faithfully for 60 consecutive months, and
    o the medical records state that the diagnosis/condition has gone 60 consecutive months, without signs/symptoms, treatment, or medication.

    • High Blood Pressure:
    o Ongoing evaluation or treatment of high blood pressure/hypertension or cholesterol that is diagnosed prior to membership is ineligible for sharing.
    o High blood pressure or cholesterol that is controlled through medication or lifestyle will not be considered a pre-existing medical condition for purposes of determining eligibility for future vascular events….”

    My guess is that since Medi-Share is a Christian organization, the premise is that folks are being honest when they apply for potential membership listing information, pre-existing conditions, etc. and it may be too impractical, and expensive to try to research all possible medical records for all potential applicants. But, now that a need has become real, the guidelines kick in. Said another way, MS probably accepted you for membership, just like any other member, taking what your put on your application as truthful.

    Said yet another way, and writing this on the presumption that you have been a member less than three years, if your chest pain episode from last July had taken place outside of three years since you joined Medi-Share and since any other related episode of chest pains, and certainly outside of five years, then, MS probably would not even ask for more details. I’d try to keep calm and let things play out; being confident that even if you are a relatively new member, but nothing comes in to conflict with the Member Guidelines, then things might be ok.

    … back to the Manna program… This is a separate and distinct program from Medi-Share. We have not participated in Manna, but it is for folks who want to get income potentially reimbursed in the event of a disability. It is not based on your income from what I read. Rather, it is based on how much income you want reimbursed in the event of a disability. Participation in Manna is optional. But if you do participate, the more income you want reimbursed, the more you pay.

    -” I don’t know about all insurance companies but the one I worked for did. I was a review nurse and routinely reviewed prior authorization requests which required medical records review to determine eligibility of the request. I also reviewed current hospital stays which required medical records for review to determine eligibility. I also NEVER had to request the member to sign any additional forms so their medical records would be sent to me.”

    An acute event like your chest episode wouldn’t require eligibility determination, even for an insurance company. It is something that happened out of the blue. On, the other hand, if you had a non-acute medical need (something that didn’t require immediate and unforeseen medical care), then Medi-Share also has pre-eligibility determination. See clause G, “Optional Review for Pre-Existing Medical Conditions prior to Surgical/Medical Procedures” of the MS 2.0 Guidelines above.

    Yes, the insurance subscriber typically is never asked to sign an additional form granting access to Detailing Billing and Medical Records. But, as I mentioned in my prior post, once an insurance company pays a claim, they rarely do a line-item audit. They just pay the claim according to the terms of their contract with the network and provider. This results in faster bill processing and paying, but, paying more in total claims. The result? At the end of each plan year, the insurance company has to raise rates even more to account for overpayment. It is true that a high percentage of hospital bills have errors/oversights/overcharges in the hospitals favor, for example. A detailed line-item audit (bill validation) is more likely to catch these things.

    -” As for the increase, I spoke to a gentleman regarding this and he told me that the reason the cost went up was because the requests for medical sharing exceeded the amount they had coming in from member sharing. He didn’t say it had anything to do with my birthday.”

    I am still muddy on this point. In four years on Medi-Share, we have never been asked to pay an extra amount because requests for sharing exceeded the amount that had come in from member sharing. Now, at the end of each year, our monthly share does go up, because everyone gets a little older, but this is expected. Is this specific concern perhaps related to the Restore/Health Partner program that you are involved?

    I am sorry to hear your troubles. However, in the nearly four years we have been on Medi-Share, overall, we appreciate it, and, as time goes on our appreciation of it, and our understanding of how it works, seems to have inched up along the way. Hopefully that will continue.

  30. Todd Fuller says

    Hi Kimberly

    Do you have any new developments to share related to your SIBO condition? Maybe you still are subscribed to this thread. Hopefully you are having positive resolution.

    My sister-in-law can not eat gluten, so that, and my inquisitive /analytical nature got me going; I did some research in to SIBO and celiac disease. In response to your prior post (re-posted below), it seems like that there can be a relationship between SIBO and celiac disease. I will post some links. The first is from the University of Virginia – School of Medicine, you can just jump right to page 21 where it chats about a connection between SIBO and celiac:

    http://www.medicine.virginia.edu/clinical/departments/medicine/divisions/digestive-health/nutrition-support-team/nutrition-articles/DiBaiseArticle.pdf

    The second is a medical journal, from BMC Gastroenterology. It is kind of thick to read, but it basically states that in patients that have celiac disease, SIBO or lactose intolerance may be suspected:

    http://www.biomedcentral.com/1471-230X/4/10/

    Maybe your specific SIBO is unrelated to celiac.

    “Let me share my latest experience with MediShare: I have been to the doctor in the past for gluten-intolerance, which means I cannot eat gluten. Upon applying, MediShare informed me that they won’t cover treatments related to this condition, which I completely understand. Recently I went to the doctor for stomach issues. I was diagnosed with SIBO (Small Intestinal Bacterial Overgrowth), a new condition completely unrelated to celiac disease. MediShare denied my doctor visit, claiming it was “related to a pre-existing condition.” I was stunned and called them for an explanation. They told me to go through the appeals process. I informed my doctor, and he too was surprised it was declined in the first place. He wrote MediShare a letter clarifying that SIBO was a NEW diagnoses unrelated to any pre-existing condition. I will keep you posted after it goes through the appeals process.”

  31. Pam says

    My chest pain episode was an acute event out of the blue. I put exactly what signs and symptoms I experienced that caused me to call an ambulance and be taken to the hospital. There should not even be any review of the past three years to determine if they are going to pay for this acute, emergent event, yet, because I feel that they know they will have to pay this, they have requested records from three years past to determine if there is something they can claim is pre-existing that caused this acute, emergent, event.

    Yes, insurance companies pay for hospital stays based on the admitting diagnosis and signs and symptoms. Yes, the hospitals probably do overcharge for things while the patient is in the hospital, I have seen my line by line charges for hospital stays and it boggles the mind how hospitals can get away with charging for a glass of water that the patient needs in order to take medicine. Insurance companies just pay a blanket amount no matter what the patient has done. The medical need for the stay is determined, like I said, by the admitting and ongoing signs and symptoms of the patients.

    The insurance company I worked as a review nurse for didn’t even require a review for lab work and routine X-rays. If the patient needed any further testing like CAT Scans or MRIs, we had guidelines we used to determine medical necessity and those were done prior to the exam.

    That being said, this event was an acute event and should fall under the criteria for a medical emergency admit which it was. I provided in great detail my signs and symptoms prior to calling for help. I probably provided more specific detail than the normal lay person would being as how I am a nurse by license and an ER by history.

    As I said, I know what the guy told me in Customer Service about the raise in my share. I guess I missed the part where it said Manna was optional or I wouldn’t have participated in it.

    I have a feeling with the new Healthcare Law going into effect and with people being given credit on their bills according to their income, Medishare may find further drops in their members. It is my feeling that the only ones who really benefit from CCM are the ones who are in perfect health, with perfect body size with no medical history what so ever.

    They wouldn’t be able to deny a stay for any type of injury because obviously there is not way that could be due to a pre-existing condition. And they couldn’t deny a birth, but they could deny coverage for the C-section if they wanted to get picky about why the C-section occurred. A lot of C-sections occur because Doctors schedule women to be induced so the doctor will be able to deliver on his own time and not the baby’s. This results in C-sections due to baby’s not being ready to be born or women’s bodies just not being ready to give birth yet. I’m glad you have had good luck with them, but I have not and I won’t be recommending CCM to anyone.

    Pam

  32. Todd Fuller says

    Pam,

    You might have missed the opening line, but, how long have you been a Medi-Share member; what date (1st day of the month) did your membership start?

    Thanks

  33. Patty says

    I had commented a couple weeks ago about being interested in Medishare. Since then we had applied for the coverage and got accepted to Medishare 2.0. I was happy with everything until I scrolled down to the very bottom and saw that there is a monthly administrative fee in addition to our share amount. This administrative fee for our family of four was $114. I was kind of bummed that we had gotten this far and were about to sign everything. When I called the woman at Medishare said they don’t mention the administrative fee until now because it differs for everyone. Maybe it was in the fine print and I didn’t see it. I just felt it was substantial and it will cause us to unfortunately continue looking for something affordable for our family when we thought we found something. Just my two cents.

    • Todd Fuller says

      Hi Patty

      Your last post makes no sense. What was your quoted monthly share amount before you became a member?

      We have been members for almost four years. The monthly share amount INCLUDES the administrative fee. In other words, the $295 a month share we are quoted at the beginning of our last year starting August 1st, includes about $115 in administrative costs and the other $180 goes to actually paying other members eligible medical needs. I wish I could attach files to this blog, so I could show you a real sample of the monthly share notice.

      But, in lieu of posting, the monthly share actually does a reasonably good job of “breaking down” how much of a member’s monthly share goes to administrative cost, medical bills, Extra Blessings, American Christian Credit Union (ACCU), and late fees (if any).

      About the ACCU, there is a monthly $2 fee for ACCU, but Medi-Share makes it clear from the beginning there is a monthly $2 fee to maintain your separate ACCU account.

      Members have to keep an ACCU account b/c this is where monthly member shares are deposited and held. Medi-Share can’t actually keep and hold the money b/c then it will be called “insurance” as defined by law.

      • Todd Fuller says

        Actually, I just logged in to our MS 2.0 account and double checked, our monthly share notice breakdown is as follows:

        beginning balance-> $0.00
        MS2-3750 Share Amount-> $283.96
        MS2-Program/Admin Portion-> $79.79
        MS2- Health Initiative-> ($69.00)
        Medi-Share Fee: $0.00
        Health Initiative Fee: $0.00
        ACCU Fee: $2.00
        Extra Blessings: $0.00
        Late Fee: $0.00

        Total Due by 11/1/2013: $296.75

        So, of our $295 monthly share (actually $296.75), of that, $79.79 is for administrative purposes and included in the monthly share.

  34. Patty says

    Hi Todd,

    I understand what you are saying but here is what my breakdown is:
    Direct Household share: $478.16
    Admin Portion: $114.84
    ACCU Membership fee:$ 5
    ACCU Statement fee: $4
    Total due for first month: $722.00

    When I called and talked to the woman at Medishare, she said that for the first month I would owe the $722, and then every month after that I should subtract $125 (the one time Medishare fee and the one time ACCU fee) from the $722 and that’s what I would owe. So I originally thought I would only owe $478.16, but she explained that I would owe $593.00. It seems to me that they are adding my administrative fee to my direct household share. Am I understanding this wrong?

  35. Todd Fuller says

    Patty, did you pay the one-time $125 membership application fee with your application?
    What is your age and how many family members are on the MS membership?

    Normally, your $125 one-time membership fee, and, your one-time ACCU membership fee which I think is $5 are paid and don’t even show on your first monthly share.

    Since your first post, today at work, I asked a colleague who just joined MS effective 11/1 about his billing, and he said his first bill was as expected.

    If you want to email me your statement I’d be happy to take a look at it, but it seems as if there are more details not known yet that if known, will make sense of things. The bottom line: if your quoted monthly share is say is $478.16, then that is what you expect to pay each month for that year, unless you have a late fee, contribute to Extra Blessings, or have other “one off” fees.

    • Todd Fuller says

      I messed up, the one-time MS fee is $120 not $125.
      Patty, what is the age of the oldest member on your MS plan and how many family members?

  36. Todd Fuller says

    Hi Patty

    According to the MS rate calculator found here: http://mychristiancare.org/medi-share-pricing-tool.aspx

    … If you are being told to expect to pay $593 per month, then, this means your oldest member on your plan is somewhere around age 57 and you want about a $2,500 AHP (assumes you have not qualified yet for the health discount).

    If this two pieces of data above are not close, then they might have told you something wrong.

  37. Pam says

    Todd, I joined Medishare in July 2013 so I wasn’t a member even for a month when my acute, emergency happened. I just feel that the radio commercials that CCM has on the radio are very misleading. They sound as if CCM is cheaper than insurance and all your needs are shared once you become a member.

    What they don’t say is that some medical needs will automatically be denied due to pre-existing conditions, signs or symptoms of that medical need if that is found by review of medical records from three years previous. They also don’t mention that if you aren’t in perfect health or have perfect proportions that there will be an extra fee for “Health Coaching”. Yes, I know all of this is in the membership package once you have been accepted as a member and they have your money. They also don’t mention the administrative costs in the commercials which jacks the price of the membership up as well. It is my feeling that CCM isn’t any cheaper, and in some cases, more expensive that insurance.

    I really do believe that, starting in January, CCM is going to lose members because of the afore mentioned costs because insurance companies will no longer be able to deny coverage due to pre-existing conditions, and because there will be a healthcare credit for some people which could substantially lower the cost of being insured.

    The man I spoke to the second time I called mentioned that that is what the Extra Blessings are for, in cases where they had to deny the claim. The first lady I spoke to never mentioned that! But since I was never able to contribute to Extra Blessings, it won’t surprise me if I don’t qualify for that either.

    At any rate, I am waiting for the final decision for all of these bills, meanwhile I am sure I am going to start getting collection calls for these unpaid bills which I will either have to pay and hope I get reimbursed if CCM decides to pay them or just let them go to collections until CCM makes their decision. It isn’t fair. My incident occurred nearly 5 months ago. CCM does not have a very organized or timely manner of handling reviews in my opinion. This is coming from someone who reviewed cases such as these for a living for 6 years so I do have some knowledge of what they are doing with my case as far as reviewing it goes.

    Again, I will not be recommending CCM to anyone. And Todd, I pray that if your wife has another baby and has to do it by C-section that CCM doesn’t deny that claim due to her pre-existing of condition of a past history of C-section birth. I’m glad you have had good luck with CCM. I did not.

    • Todd Fuller says

      “Todd, I joined Medishare in July 2013 so I wasn’t a member even for a month when my acute, emergency happened. I just feel that the radio commercials that CCM has on the radio are very misleading. They sound as if CCM is cheaper than insurance and all your needs are shared once you become a member. ”

      -Hi Pam, Thanks for your reply. I know you are upset b/c Medi-Share said that will not automatically cover your $50K need from July 2013 (which I thought you said above was from 2012). But, I do respectfully disagree; Medi-Share is following the guidelines linked and partially posted above; being good stewards of member resources. Consider: If lots of folks joined, stating that they had no pre-existing conditions, then had a big medical need within weeks of joining, and Medi-Share did not do any due diligence, and just paid the bill. Do you think rates will be reasonable?

      “What they don’t say is that some medical needs will automatically be denied due to pre-existing conditions, signs or symptoms of that medical need if that is found by review of medical records from three years previous.”

      - From other experiences from some other members, this is not true. I personally know some that have had needs that were known to be related to a pre-existing condition and occurred right after joining, that ultimately were picked up in whole or in part, by the Medi-Share program, and/or, the Extra Blessings program.

      “They also don’t mention that if you aren’t in perfect health or have perfect proportions that there will be an extra fee for “Health Coaching”. Yes, I know all of this is in the membership package once you have been accepted as a member and they have your money.”

      - This is not true. The two main things to qualify for the Health Discount are weight/body mass, and, blood A1c levels. Medi-Share’s we find are very liberal; body mass index can approach 25%, which is downright near obese with many people. Blood A1c levels can be as high as 5.7 that even the Mayo Clinic says might be pre-diabetic, see here: http://www.mayoclinic.com/health/a1c-test/MY00142/DSECTION=results

      In my personal case, Medi-Share granted me a one year exemption to qualify for the Health Discount because my A1c one year was just over 5.7%, but, after going through my diet, the daily glucosamine chondroitin pills I was voluntarily taking daily for preventative care of my joints ( I actively participate in joint pounding sports) was possibly elevating my A1c levels. I stopped the G.C. Three months later, I re-tested my A1c anyway, and it was back down, even though MS gave me one year to “fix it” on the health discount level.

      “They also don’t mention the administrative costs in the commercials which jacks the price of the membership up as well. It is my feeling that CCM isn’t any cheaper, and in some cases, more expensive that insurance.”

      - This is not true either. The administrative costs are included as part of whatever monthly share you are quoted, see the multiple links to rate calculator above. In fact, many insurance and/or health plans do not, not at least until Obamacare has started kicking in, tell you what share of your monthly premium is going to admin versus what share is paying medical bills. MS has always done this with each monthly bill, at least with the four years we have been on it.

      “I really do believe that, starting in January, CCM is going to lose members because of the afore mentioned costs because insurance companies will no longer be able to deny coverage due to pre-existing conditions, and because there will be a healthcare credit for some people which could substantially lower the cost of being insured.”

      -I disagree. The data trend vector also does not support your claim. When we joined April 1, 2010, there were about 40,000 MS members. Today, there are about 67,000 and that number was under 60,000 a year ago. In other words, more people seem to be joining more recently.

      The healthcare credit; I think you are referring to the subsidies in Obamacare. To get a reasonable level of subsidy, a family has to make not only less than about $85K but substantially less, and that still leaves the question of high deductibles and high out of pocket especially for the bronze plan.

      “The man I spoke to the second time I called mentioned that that is what the Extra Blessings are for, in cases where they had to deny the claim. The first lady I spoke to never mentioned that! But since I was never able to contribute to Extra Blessings, it won’t surprise me if I don’t qualify for that either.”

      -Contributing to Extra Blessings has nothing to do with qualifying to receive aid from Extra Blessings.

      “At any rate, I am waiting for the final decision for all of these bills, meanwhile I am sure I am going to start getting collection calls for these unpaid bills which I will either have to pay and hope I get reimbursed if CCM decides to pay them or just let them go to collections until CCM makes their decision. It isn’t fair. My incident occurred nearly 5 months ago. CCM does not have a very organized or timely manner of handling reviews in my opinion. This is coming from someone who reviewed cases such as these for a living for 6 years so I do have some knowledge of what they are doing with my case as far as reviewing it goes.”

      -Your prior posts led me to believe your incident took place in July of 2012, not July of 2013. This new revelation is a game-changer. Five months is not unusual for a medical bill to be resolved. It took…. would you believe…. almost 10 months for pretty much all bills to get resolved for the birth of our son Grant on July 2012. Many delays had little to do with MS. One delay took about two months alone due to a bill validation. All the while, no provider balance billed us while waiting for this resolution, except for one provider.

      That was for a $5 bill that the provider overlooked that a doctor’s fee to conduct a routine lab on a newborn was part of a bundled service per contract with PHCS, the PPO Medi-Share uses. Once a phone call was made to that provider, the bill was eliminated. Pam, you might want to call your hospital and a couple of providers, if you have not already, and ask them to consider waiting to the resolution of the Medi-Share research of your medical records. Chances are they won’t likely bill you since it has been just 4 months, and, they are actively engaged with a health plan on your behalf. But being proactive never hurts with providers.

      “Again, I will not be recommending CCM to anyone. And Todd, I pray that if your wife has another baby and has to do it by C-section that CCM doesn’t deny that claim due to her pre-existing of condition of a past history of C-section birth. I’m glad you have had good luck with CCM. I did not.”

      -Thanks Pam. We have notified MS of our most recent pregnancy a month ago. They have taken note, had us fill out the NNF (Need Notification Form), and, Eligibility Form (to see if we might qualify for Medicaid – probably won’t), basic one page forms a piece. Then they sent us a packet about pregnancy and Medi-Share. I see no sign of them telling us our latest (and probably last) pregnancy will not be eligible for sharing. But, regardless of the outcome, I am sure I will keep blogging away. :-)

  38. Patty says

    Todd,

    Thanks for replying. My husband is the oldest and he is 31. However, after talking with the third person today about the issue of the administrative fee in addition to the monthly share amount, I found out that I was quoted with the health incentive discount which is what I thought my premium would start out being but it only starts that after the first full month of coverage. I was appreciative of the third person pointing this out. I do wish that the first two women would have been more clear on this. It does make me wonder how competent they are in handling claims since they did not explain things well from the beginning.

    Pam-I have also read all of your posts and the last line of your last post spoke to me because I have had two c-sections and while I am not planning on getting pregnant again, if I did, I would have to medically have a c-section. I had specifically asked the woman at Medishare if this would be considered a pre-existing condition and she said “if the pregnancy is eligible for sharing, then the c-section is eligible for sharing.” I just don’t know for sure if I completely trust that answer because I know insurance companies have a problem with this being labeled as a pre-existing condition. All of these do make me hesitant to proceed with Medishare. My husband and I will do some more research before switching.

    I want to thank everyone for their thorough entries. This blog has been so helpful to us.

    • Todd Fuller says

      “Thanks for replying. My husband is the oldest and he is 31. However, after talking with the third person today about the issue of the administrative fee in addition to the monthly share amount, I found out that I was quoted with the health incentive discount which is what I thought my premium would start out being but it only starts that after the first full month of coverage. I was appreciative of the third person pointing this out. I do wish that the first two women would have been more clear on this. It does make me wonder how competent they are in handling claims since they did not explain things well from the beginning. ”

      -Hi Patty, did you select the $1,250 Annual Household Portion? The MS rate calculator says that a family of three or more, with the oldest age 31, will have a standard monthly rate of $593 and as low as $474 on the health discount.

      I have heard of cases where a MS rep has said something that is not quite accurate. Let me give you a piece of advice; and to MS’s credit – they always record all calls. So, whenever you call, get the date, time and name written down, then, if they don’t give you a call reference number (they usually do), then ask for one before the call ends. If further issue arises related to the same issue, piggyback off that same call reference number you called the prior time.

      “Pam-I have also read all of your posts and the last line of your last post spoke to me because I have had two c-sections and while I am not planning on getting pregnant again, if I did, I would have to medically have a c-section. I had specifically asked the woman at Medishare if this would be considered a pre-existing condition and she said “if the pregnancy is eligible for sharing, then the c-section is eligible for sharing.” I just don’t know for sure if I completely trust that answer because I know insurance companies have a problem with this being labeled as a pre-existing condition. All of these do make me hesitant to proceed with Medishare. My husband and I will do some more research before switching. ”

      -I am not Pam, but I would completely trust that answer. Pregnancy is not considered a pre-existing condition, not even in the standard health insurance market. On MS, just make sure that the soon to be newborn is that of you and your husbands, and, that he/she was conceived after your member start date, and you should be in good shape. :-) ….

      The insurance market (nor much of American culture today) does not care about pregnancies out of wedlock. We as Medi-Share members do, and I think I speak on behalf of virtually all members when I say this. As far as getting pregnant, not even regular insurance will cover a pregnancy that was conceived after the subscriber start date, unless perhaps you are able to get on a really nice employer group health plan and that plan does not dig in to the date you got pregnant. Sorry to be matter-of-fact.

      “I want to thank everyone for their thorough entries. This blog has been so helpful to us.”

      - I am glad to be on some assistance. I always value user input on many other forum topics where I am new to things, not just medical care/billing/health plans.

      • Todd Fuller says

        “The insurance market (nor much of American culture today) does not care about pregnancies out of wedlock. We as Medi-Share members do, and I think I speak on behalf of virtually all members when I say this. As far as getting pregnant, not even regular insurance will cover a pregnancy that was conceived after the subscriber start date, unless perhaps you are able to get on a really nice employer group health plan and that plan does not dig in to the date you got pregnant. Sorry to be matter-of-fact.”

        -Oops. Forgot one thing. And stay away from the fertility drugs. MS has limits if you have multiple pregnancies due to “human intervention” drugs used to help get pregnant. I forget the exact language, it is in the MS 2.0 Guidelines, but since my wife and I had given zero thought to these drugs and I didn’t focus on that part of the guidelines.

  39. Sarah says

    11-14-13

    I’m so glad I found this discussion. I’m concerned about all the changes taking place with insurance, and have considered Medi-share, Samaritans, or Christian Healthcare Ministries after I have our first baby and I stop working. My husband is self-employed and has carried the same inexpensive plan through BCBS-TX in the individual market for several years (and thankfully it looks like it won’t be canceled because of AHCA). I’m thankful that individual plans in TX will now offer maternity (though I know the mandate is frustrating for people who don’t need or want it). Before AHCA there were virtually NO plans that offered maternity coverage, and I wasn’t sure what we would do. However, the plans I’ve seen on the healthcare.gov website are not affordable for us and would stretch us very thin, especially since we will go down to one income when the baby is born.

    By the way, I’m not pregnant at this point, but would like to be. I’ve had two miscarriages in the past year, and I’m wondering if Medi-Share would call this a preexisting condition, even though two doctors (one a specialist) have said they were randomly occurring and my odds of another are about the same as they were before I ever got pregnant. I’m also a little worried about how MS would handle pregnancy complications and labwork. With my history of miscarriages, my doctor likes to draw blood ever few days very early in the pregnancy to see if hormones are rising as they should and if we need to supplement progesterone. Progesterone supplementation can save pregnancies in certain situations, and early detection of a miscarriage can prevent complications, but I’m not sure if MS would see it that way.

    As I type all of this, I’m thinking MS might not be for us at this point. Too many what-ifs in regards to the pregnancy, and it’s not worth the risk of having to choose between paying a huge bill out of pocket or getting what we truly believe we need to help ensure a healthy pregnancy. I’m glad that it is a good option for many and maybe it will be for us at some point.

  40. Todd Fuller says

    “By the way, I’m not pregnant at this point, but would like to be. I’ve had two miscarriages in the past year, and I’m wondering if Medi-Share would call this a preexisting condition, even though two doctors (one a specialist) have said they were randomly occurring and my odds of another are about the same as they were before I ever got pregnant. I’m also a little worried about how MS would handle pregnancy complications and labwork. With my history of miscarriages, my doctor likes to draw blood ever few days very early in the pregnancy to see if hormones are rising as they should and if we need to supplement progesterone. Progesterone supplementation can save pregnancies in certain situations, and early detection of a miscarriage can prevent complications, but I’m not sure if MS would see it that way.”

    Hi Sarah, hopefully you will soon have a healthy baby boy or baby girl on the way…. The biggest issue, and the only “what if” that might apply for you, will be progesterone.

    It sounds like you are a thorough investigator and you likely have already investigated the MS 2.0 Guidelines (upteen links above). But I’ll copy/paste the part of the MS 2.0 Guidelines Section VII – Maternity, that seem to center around your worries. The biggest issue for you will likely be is if your progesterone will be considered “infertility treatment” which if so, will limit your eligible need for sharing to $25,000…. should twins, triplets, etc. be delivered:

    “B. Maternity Complications

    The cost of treatment for life-threatening complications to mother and/or child(ren) can be shared when the maternity is eligible for sharing. The treatment expense for complications is considered a separate event from the maternity.

    C. Multiple Births as a Result of Infertility Treatment

    Sharing up to $25,000 is available for multiple births resulting from infertility treatments. The $25,000 includes the cost of delivery and complications to the mother and/or children.”

    … A phone call to CCM asking about the progesterone and your situation can’t hurt. If you call, I’d get the time, date, who you talk to, and get a call reference number, even though MS records the call and provides a call reference number anyway.

  41. amelia wolthers says

    so a few of questions to clarify understanding of how this works:

    1) to members who have been on MS for a length amount of time:
    how much have your shares gone up and how do they go up? Is it from what people vote on to make shares go up and if they do go up/or have gone up…. Did they come back down?
    2) on MS, My understanding is that when we choose an AHP, Let’s say of $3750, do we have to pay out of pocket up until that amount and then medical bills will be shared?
    Or are they shared before that?
    3) What is the discount difference when you say you self pay or when you say you use the PHCS network?

    • Todd Fuller says

      “1) to members who have been on MS for a length amount of time: how much have your shares gone up and how do they go up?”

      - Hi Amelia, I am not sure how often current MS members read this blog. But I tend to stick with a blog that I find valuable or enjoyable. My family joined MS 2.0 effective date April 1, 2010. In the three anniversaries since, our monthly share amount has gone up 3% per year. It is based on the oldest member on the membership. This is independent of any potential renewal (or not) of the Health Discount.

      “Is it from what people vote on to make shares go up and if they do go up/or have gone up…. Did they come back down?”

      - The primary reason for annual rate increases is the aging by one year of the oldest member on the membership. However, twice a year the members vote on things to add/remove/amend for the guidelines. Sometimes, votes in the affirmative to add things might result in a monthly share increase starting the next anniversary date for a member, but usually not. The one thing that members did vote to approve a couple of years ago that had the greatest potential to bump up monthly shares was the elimination of the maternity limit.

      The elimination of the maternity limit was approved by members for the summer ballot of 2012, and took affect for births on or after August 1, 2012. When the ballot item was presented, CCM told members that if the measure passed, then members could expect about a $5 per month bump up in their monthly share notice. However, this share bump never seemed to materialize, because our monthly share increase the following year still went up by 3%. I do not know for sure, but, my feeling is that more new members joined MS than expected, which curtailed if not eliminated the expected rate increase due to the elimination of the maternity limit. According to the more recent newsletters I’ve read from CCM, roughly two or three babies per day are born as “Medi-Share babies.” My math is good. I am a math instructor…. or it should be good. :-)

      ” 2) on MS, My understanding is that when we choose an AHP, Let’s say of $3750, do we have to pay out of pocket up until that amount and then medical bills will be shared? Or are they shared before that? ”

      -Basically, yes. $3750 is the exact AHP that my family has. So, we can expect to pay no more than $3,750 out of pocket for all four members of my family (including me) on this plan of eligible medical needs according to the MS 2.0 Member Guidelines. Notable exception: well visits for members over two years of age; not eligible for sharing. So, if you get say $500 worth of office well visits, and lab work associated with a well visit, add that to your AHP for outlay purposes. We only hit that limit one year, the birth of our son. Hopefully, next year, the birth of our next (and probably last child) will be the last year we challenge the limit of our AHP, at least hopefully not for many years.

      Many insurance companies will give you say a $5,000 deductible. But, once the first member of your family hits that $5,000, then a second member must hit 50% of that deductible, which, in de facto, means those insurance plans have in reality a $7,500 deductible for the family when trying to compare “apples to apples” with the MS 2.0 AHP. However, many health insurance plans have at least one well visit and associated lab work for each member on the plan, per year, built in to the cost.

      In any event, even if you have a medical bill that fits the MS 2.0 Guidelines; meaning, it would be shared if you were over your AHP, the discounting rules of MS’s Preferred Provider Organization (PPO), called Private Healthcare System (PHCS) still apply. For example, if you had a well visit and gave your provider your PHCS/MS card, and let’s say PHCS had a contracted 5% discount on the well visit, then, you will get 5% off the gross provider charge, at a minimum, even though the bill is not eligible for sharing b/c it is a well visit.

      “3) What is the discount difference when you say you self pay or when you say you use the PHCS network?”

      -Excellent question! The answer is complicated. Generally, provider self-pay discounts are generous. The are typically at least 20%. One major hospital network in our area provides a 50% self-pay discount. I’ve seen labs offer as high as 60% on discounts. Still, this is nowhere close to what the Federal government forces hospitals and providers to accept for Medicare payments, and even worse for Medicaid. Hence, the hospitals have to jack up their gross charges to such high levels to make up for losses due to Medicaid and Medicare.

      But, with a large bill, even a 50% discount for self-pay won’t matter. If you have a three day hospital stay with a $30K bill; the hospital may still try to bill you at least $15K…. enter a health plan or insurance of some sort!

      To get back to your question, specifics depend on the procedure, demographic, and several lesser factors. Enter one of the huge problems of our medical billing system in the USA. It is hard to get prices in advance, the total opposite of it say you were deciding where/what new TV to buy. PHCS discounts for MS for well visits, are, to be honest, weak. The first year we were on MS, our well visits typically got discounted at least 5% but no more than 15%. This last year, the most a well visit got discounted was 5%, usually 3%, but the last year, usually…. zero percent! But, there is a rub, and a silver lining.

      Most providers offer some sort of discount if you self-pay, and sometimes a big discount. Many times the provider will honor a bill as self pay, if you ask, if the patient’s health plan/PPO offered no re-contracting/discount. After all, a bill for a patient with no health plan/insurance at all, is basically the same thing as a bill that is given no PPO discount at all for a patient that HAS a health plan/insurance. So, the provider might give you the self-pay discount, but only for that bill that had no PPO/health plan discount at all, and usually that provider self-pay discount is at least 20%. I hope this makes sense. So, the last couple of well visit bills we have had for our daughter who is almost four, did not get any PHCS discount at all. But, when I called the provider they offered me a 20% discount. So, in those two cases, it was actually a good thing PHCS gave no discount. For, even if PHCS had discounted the bill just 3%, the provider would, as in the past, refused to provide any additional discount. It is not the ideal scenario, b/c you have to make a phone call and do a little work. Ideally, I’d have a really good health plan that didn’t cost me anything or very little, that provided everything for free, including well visits. But who has those plans anymore? A shrinking number.

      Now, to be clear, the above involves well visits. Shifting to non-well visits, or, bills that are eligible for sharing; typically these bills have a PHCS discount of about 20%. But, I’ve had one discounted as high as 90%. For the birth of our son on MS 2.0 in July of 2012, the facility charge (hospital), which is by far and away the most expensive of the maternity bills, had a 20% PHCS discount. It didn’t say this, but I could figure it out by taking the PHCS discount and dividing it by the total gross charge. However, discounting becomes more meaningless for the end-user (you), if the bill is eligible for sharing and if it is large; because your “stop loss” will be your AHP; $3,750 using the AHP you asked about above in this post.

      But still, the more PHCS or MS 2.0 can keep the amount paid as low as possible, the less likely it is for member monthly shares to have to be increased the next year.

      • Todd Fuller says

        small correction: some of my verbage is kind of “loose.” It is the Medi-Share members, who, technically, have the PPO called PHCS, not Medi-Share. Medi-Share holds no reserves nor holds any money, it is the members whose combined monthly shares are held in something called the member share exchange. Medi-Share itself doesn’t hold a dime. So, the be accurate, and technical, the MS members use the PPO – PHCS not Medi-Share nor Christian Care Ministry.

  42. Pam says

    I just wanted to add that I applied for insurance to begin January 1st. I qualify for the Health Care Credit but even if I didn’t, the cost of the policy is still less than what I was paying on Medishare and the coverage will be better.
    I hope that other people have a better experience with CCM than I did. I still would not recommend CCM to people as I feel there are too many issues with getting acute events covered and the cost is not as inexpensive as the commercials lead people to believe, nor is the sharing of the medical needs as seamless as the commercials allude to.
    Just my thoughts. I pray that these bills will be shared in the end. Thank you for listening to my rants about this.

    Pam

  43. Jamie says

    Hey Todd & Craig,
    Thanks for the awesome information about MS, here! I am applying for MS this month and have a few questions. We selected an AHP of $10,000 and expect not to meet it most years.
    1. Are we required to submit minor claims to MS as they occur? It seems like a bit of a hassle to file these claims, without benefit (if you are able to self-negotiate with providers to get reasonable rates).
    2. When we have a bill that exceeds $10,000, can we then file previous bills within the current annual period?
    3. I’ve had numerous (skin) basal cell carcinomas removed in the past. MS indicated (specifically) future basal cell removals will not be sharable. Here’s the rub. They were all valid cancers, so will MS prevent me from sharing future cancer events? The language in the guidelines seems to allow MS to deny all of my future cancer claims, even if it’s unrelated pancreatic or liver or colon cancer. This concerns me.

    • Todd Fuller says

      “1. Are we required to submit minor claims to MS as they occur? It seems like a bit of a hassle to file these claims, without benefit (if you are able to self-negotiate with providers to get reasonable rates).”

      -No. You don’t have to tell a provider you have any health plan or insurance. When you say “minor claims” I’ll assume you mean well visits, routine lab work, and basic low tier prescriptions (anything basically well less than $1000 per item). It is not a hassle to file claims (except for perhaps scripts and if you don’t like even one page forms). If you go to a provider and hand them your Medi-Share card which has the PHCS logo, they will file the claim for you, even for a well visit. But most providers will not let you all of sudden “retract” your Medi-Share card if you gave it to them previously, just so you can get the self-pay discount just for these “minor claims.” And more and more these days, large, healthcare systems are creating individual fiefdoms within each city. So, once one provider who operates inside one of these “systems (fiefdoms)” has your insurance/health plan information, then the rest of the providers in that same system will likely know it.

      For example, here in Charlotte, it is getting harder and harder to find say an individual pediatrician or internal doctor that operates independently. Most are getting bought up by either Novant Health or Carolinas Healthcare System. At least the Charlotte area has two of these healthcare system fiefdoms. Many cities only have one. What we have done in the past for well visits is visit one provider that we know who is part of one healthcare system and pay them a cash self-pay rate if we need just a well visit. Then go to the other healthcare system when we “feel” like our claims are going to approach or exceed our AHP in any given year.

      But the last couple years we haven’t done this. Sometimes we might not get as big as discount as if we were paying self-pay. But, we see it as a “good problem to have” if all we have to worry about are paying for well visits and some minor prescriptions if we might pay a little more for a well visit by having the provider file the claim with Medi-Share/PHCS, than if we went through a provider that “didn’t know we have Medi-Share/PHCS” and tried to pay the self-pay discount, or, paying bigger bucks to have traditional insurance that includes an annual well visit.

      For the prescriptions, those have to be mailed or faxed in anyway in most cases. So, we wait until towards the end of our year before our AHP resets to send them in, if we are going to be over our AHP. But, and this is a big thing, your script must be matched with a doctor visit that you had and filed with Medi-Share. You can’t just have a doctor walk to you on the street, write you a script, then get that scripted reimbursed by itself.

      For example, in all years of our MS membership except one, we did not exceed our $3750 AHP. It resets April 1st. So, in 2010 for example, we only had several hundred dollars worth of prescriptions and a couple of sick visits to a pediatrician and one to an EENT specialist, all related to one ear infection for our daughter that would not go away, and one or two well visits (but which still were discounted using one of two discount cards). So come March, I didn’t mail these in because by March 31st, we were not even close to our AHP anyway. We could have still mailed them in after March 31st, if we say had a major medical event right at the end of March. Bill processing is done by the date of the event, with respect to applying your AHP.

      In your case, if you become a MS member, and since you will have a high AHP – if all I have to begin with are just a few doctors visits, some low tier scripts, and that’s about it totaling just a few grand, I might ask the provider a head of time what is the self-pay rate. If the provider’s self-pay discount rate is only going to be 20% or less, then I’d have them file it with Medi-Share anyway. Don’t forget the labs.

      Only if my provider gives a much bigger discount for self-pay, only then I might consider paying self, until something major happens, then hand them my Medi-Share/PHCS card. But, from that point on, the provider is probably not going to let you cherry pick which visits you want to work the self-pay discount outside of any insurance/health plan you have, versus those you want them to file with Medi-Share/PHCS.

      In summary, the easiest thing to do is just take a “big picture” approach and think about what is the most you can “handle” in a given year for medical bills when paying your monthly share and if you hit your AHP, outside of well visits, rather than trying to worry about getting the largest possible discount on “minor” bills, unless you know a provider provides a big discount for self-pay. You might not get as large as a discount for well visits, or some sick visits, but at least you will know the sick visits will all apply to your AHP and associated prescriptions, without having to play a guessing game.

      Even if you just having everything filed through Medi-Share/PHCS, that doesn’t mean you can’t question a providers charge, if you like being proactive, and feel like the provider is charging something unreasonable for a lab or office visit.

      Also, you’ll hit $10K anyway, if you have just a day or two in the hospital.

      “2. When we have a bill that exceeds $10,000, can we then file previous bills within the current annual period?”

      - It depends. If you already negotiated a self-pay rate with a provider and paid that bill, then, the provider may not let you “unwind” that deal, then start over by sending those gross charges to Medi-Share/PHCS for processing. If you got hit with a >$10K bill, then you can always mail/fax in prescriptions, but, those scripts must be associated with a relevant sick visit that was also filed with Medi-Share/PHCS.

      “3. I’ve had numerous (skin) basal cell carcinomas removed in the past. MS indicated (specifically) future basal cell removals will not be sharable. Here’s the rub. They were all valid cancers, so will MS prevent me from sharing future cancer events? The language in the guidelines seems to allow MS to deny all of my future cancer claims, even if it’s unrelated pancreatic or liver or colon cancer. This concerns me.”

      - Of your three questions, this one is by far the biggest concern. Yes, I see here in the Guidelines under “Part VI. Details of Sharing – Subpart F. Pre-Existing Medical Conditions or Related Conditions” it says:

      “• Cancer (including metastases or new cancer of the same type as a previous cancer) can be eligible for sharing up to $500,000 per Member per calendar year. To be eligible, the Member must be cancer-free for a period of 84 months from conclusion of signs/symptoms and/or treatment. This is regardless of cancer location.”

      The last sentence, “…regardless of cancer location” makes me see it as if they might see skin cancer somehow metastasizing in to liver cancer and may not let a potential liver cancer event be eligible for sharing unless you had no cancers at all for 7 years. But, one would think they would tell you that you that, not just the basal cell cancers. However, I would call and definitely get a clear answer, with date, time and call reference number. The guidelines tend to be written slightly to the less friendly side. Let me explain.

      Four years ago, before we joined, my biggest concern was about cancer treatment medications. Thankfully, nobody has had cancer in my family. But we have had friends, even very health friends; one of whom was a personal trainer, come down with rare cancers. The fit and active personal trainer came down with acute myloid leukemia. The way the guidelines read at that time was that prescriptions are only shareable up to 6 months, regardless. When I asked about this 6 month limit, I was told, this was for “maintenance meds” not for “cancer treatment meds.” (March 23 2010) I even have a recording of the call.

      It is rare, but, if you one were to get a rare form of cancer, it could require well in excess of 6 months of hugely expensive treatment meds. Just one of these doses can easily blow well past even a $10,000 AHP.

      Since that time, Medi-Share has “tweaked” the guidelines in Part VI by adding, “exceptions (to the 6 month limit for prescriptions) may be made in the case of medications for cancer and transplant recipients.” It seems that the guidelines are carefully worded so as to not seem they are promising more than the intent as to what is allowed. This is probably a good thing. I hope we never have to “test” this part of the guidelines.

      In any event, I’d call and bring up specific concerns, then get a call reference number, date, time, etc. for your records.

  44. says

    I have enjoyed reading the comments about the different sharing ministries. Obamacare blew up our insurance plan and destroyed the value of it. We cancelled Blue Cross and joined Samaritan Ministries after reviewing the top 3 choices. We couldn’t be happier. Its one bill I look forward to every month and can’t wait to help someone with their medical needs. I think all three have pros and cons and something to offer different family types.

  45. Jennifer hart says

    I am a full-time missionary who thought Medishare was my answer to better premiums. Was I forever fooled. I joined medishare- dropped regular health insurance and then became sick. I spent a summer trying to find out what was wrong. It turned out to be manageable and I am fine now BUT Medishare will comb thru your records- find the slightest indication of a pre ex condition and deny you payment for incurred bills. The company went thru my records and found a record of something that I had never been told. They wouldn’t pay for certain bills. I do not recommend them in any circumstance unless you have a clean bill of health.

    • Todd Fuller says

      Hi Jennifer

      That is too bad to hear. I’d love to hear some details, especially since your charges against Medi-Share are serious. For starters, what date do you become a member of Medi-Share, and, when did you start getting sick; was it right before or right about the time your Medi-Share membership began?

      • Jennifer hart says

        I became a member in may 2012 and I presently will be until Feb 1 of which I will again have major medical. (Insert happy face) I began having issues with my heart. I never had before to my knowledge. Never a disclosed diagnosis or exam. I had an emergency appendectomy in 2008 and because my EKG apparently showed something odd- never brought to my attention or followed up….CMS said it was a pre ex which was not true. I explained to them but that was to no avail.

        • Todd Fuller says

          Hi Jennifer

          Thanks for shedding some light. I hope your heart condition is behind you? That’s the main thing…

          … I am still curious… Did the anesthesiologist or any other doc during or just after your emergency appendectomy mention your EKG showed signs of arrythmia or Lord forbid, hypertrophic cardiomyopathy? i.e. What, precisely, is Medi-Share telling you the EKG showed?

          In any event, it sounds like you were not a MS member for 12 months at the time of your heart medical event. I’ll paste the MS 2.0 Guidelines below regarding sharing on Pre-Existing or Related Conditions. Still, it may be possible to get your bills shared with a doctor’s letter that was involved in your 2008 EKG.

          “F. Pre-Existing Medical Conditions or Related Conditions

          Medical bills for diagnosis or treatment for a non-congenital, pre-existing medical condition, defined as signs/symptoms, diagnosis, treatment, or medication for a condition prior to membership, will be eligible for sharing as follows:
          • The condition is eligible for sharing up to $100,000 per Member per calendar year if:
          -the Member has been sharing faithfully for 12 consecutive months, and
          -the medical records state the diagnosis/condition has gone 36 consecutive months without signs/symptoms, treatment, or medication.
          • The condition is eligible for sharing up to $500,000 per Member per calendar year if:
          -the Member has been sharing faithfully for 60 consecutive months, and
          -the medical records state that the diagnosis/condition has gone 60 consecutive months, without signs/symptoms, treatment, or medication.
          • High Blood Pressure:
          -Ongoing evaluation or treatment of high blood pressure/hypertension or cholesterol that is diagnosed prior to membership is ineligible for sharing.
          -High blood pressure or cholesterol that is controlled through medication or lifestyle will not be considered a pre-existing medical condition for purposes of determining eligibility for future vascular events.

          Other Pre-Existing Limitations and Exclusions
          • Permanent, lifelong diagnosis/conditions are ineligible for sharing.

          • “Mini-Strokes” or Transient Ischemic Attacks (TIA) will be eligible for sharing if there have been no further episodes, signs/symptoms, diagnosis or treatments for 60 months since the last TIA.

          • Cancer (including metastases or new cancer of the same type as a previous cancer) can be eligible for sharing up to $500,000 per Member per calendar year. To be eligible, the Member must be cancer-free for a period of 84 months from conclusion of signs/symptoms and/or treatment. This is regardless of cancer location.
          • Medical bills for the replacement of a joint will only be considered eligible for sharing if:
          -the joint was not previously replaced,
          -the need for a replacement does not stem from a pre-existing medical condition, such as, arthritis, and/or
          -the Member was not informed prior to membership of the future need to replace the joint in question.”

  46. Jennifer hart says

    My heart issue is not life threatening. I take one pill a day for it. I had not been a member for 12 months- however this wasn’t anything that was disclosed to me. Of course that is my word against their rules. In my opinion there are too many stipulations in medishare. I had a lawyer friend look into medishare and my complaint who said- “they don’t cover anything”. For some it might be the answer for good coverage but for me- it makes me shake in my shoes that if I had another medical issue they might pick thru another record to find a way not to pay the bill. That was my thought- find a way to not pay a bill.

    • Todd Fuller says

      Jennifer

      Could you please answer the prior question; what exactly did Medi-Share claim they found in your EKG related to your emergency appendectomy; arrythmia, hypertrophic cardiomyopathy, or something else specific, for which they decided to label your heart condition as pre-existing?

      For us, we are pleased overall with Medi-Share, on occasion, they are few things that initially didn’t turn out the way we expected, but MS has always provided specifics, and almost always, in turn resolved these exactly as we initially expected.

      MS even records all calls, so if these “specifics” are still not clear, the phone call recording can be reviewed. So, if MS denied your heart condition b/c they claim they found an issue related to an old EKG, then, I am curious as to what that specific medical issue is.

      It is completely unlike Medi-Share to say they are not going to make a need eligible for sharing due to a pre-existing condition; without specifics attached to it.

      As for not being aware of the $100,000 limit for the first 12 months, I am not sure how this was not clear. It is here on their website:
      http://mychristiancare.org/guidelines.aspx

      Or, what I do to find them, Google: “Medi-Share Guidelines” b/c I often forget the exact link. :-)

      … As far as your “lawyer friend” saying MS allegedly doesn’t “cover” anything:
      Has your friend gone through “blow by blow” and lined up the MS Guidelines with coverage options for commercial health insurance plans in your state to make this assertion?

      For example, in my state, North Carolina, getting maternity coverage is NOT normal on the individual marketplace. Insurance companies here almost never provide it on the individual marketplace, and, when they do, the option to add it makes the policy exceptionally expensive; usually doubling it. Starting in 2014, the Affordable Care Act, will mandate that all commercial health plans sold must provide maternity, but, this comes with a price; those health plans price tags are much higher. The reasons for why commercial health plans here in NC all pulled out of providing maternity, except for perhaps as an option, and except for one insurer (Blue Cross Blue Shield of NC – but even they found ways around providing it…) are complicated. I’ll save those from this post, but, if you want to email me I’ll tell you why.

      In any event, the bottom line; I’d line up the major medical plan you are thinking about switching to, and line it up line by line with the MS 2.0 Guidelines, or whatever plans you are considering, if that is not already done.

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