Author Topic: Let's talk about health share  (Read 23961 times)

ohsnap

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Re: Let's talk about health share
« Reply #100 on: June 15, 2017, 05:50:37 PM »
...

we're getting really nit picky over one comment in this thread here.  if you'd like to debate the cost of vaccines feel free to start a different thread.

This isn't a debate about the cost of vaccines.  It's a discussion about how vaccines are handled when on a medical sharing plan - I thought questions about the plans and answers from those with experience was the point of this thread:

...
The goal of the thread was to get people with actual experience using it.  so here's hoping more show up.

...

...

If you don't have insurance, which we didn't, they will charge you $1,000+ dollars. I can tell you, from experience, they will in fact charge you that money if you don't have insurance. Or you can go to the health center and get it for free.

The point is that we didn't have health insurance and they tried to make us pay. We didn't have health insurance because we had Medi-share. Medi-share isn't considered "real" insurance and sometimes people can't wrap their head around the fact that you are, in fact, not insured.

FIREby35

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Re: Let's talk about health share
« Reply #101 on: June 15, 2017, 07:42:39 PM »
I think we should be able to re-route this to actual experiences about Medical Bill sharing.

Boarder was really just trying to protect me from a severe reaction to my own inarticulate writing which I hope has now been cleared to everyone's general satisfaction or they have accepted me as the liar they presume I am. There's no way he could have known I've been called much worse in my day.

So, I'm happy to hear any one else's medi-share stories. The stories usually involve some sad medical situation. Those experiencing those conditions have my sympathy.

We can share experience for mutual benefit on the MMM forum, right? :)
« Last Edit: June 15, 2017, 07:47:02 PM by FIREby35 »

Daisy

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Re: Let's talk about health share
« Reply #102 on: August 01, 2017, 04:31:50 PM »
I am starting to look into these health sharing options now for my upcoming FIRE (a few months from now).

How is it going for everyone?

I'm also having a hard time with google search in finding the other health sharing threads on this forum. Maybe we should have a "sticky" for these types of plans in one of the sections of the forums.

retiringearly

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Re: Let's talk about health share
« Reply #103 on: August 01, 2017, 06:14:49 PM »
I am looking into this.  I just struck a deal with my boss to work 7 more months.   

My concerns:  If I look at what are supposed to be the three largest health share organizations, they have significantly different share rates (the amount you pay in per month).  It makes me suspicious of the lowest cost organization.   I would expect them to be somewhat close in monthly cost.  But they aren't.

Roots&Wings

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Re: Let's talk about health share
« Reply #104 on: August 02, 2017, 05:53:57 AM »
Following, and agree with a sticky or subforum for health care.

Daisy

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Re: Let's talk about health share
« Reply #105 on: August 04, 2017, 01:57:47 PM »
Well I called Liberty Health Share and am going through the approval process. i hope I get through!

After talking to their representative, I am very excited about Liberty. It seems like a great plan. Some of the highlights important to me:

- I can go to any doctor anywhere, any hospital, there is no network.
- Even international medical bills are considered! As long as the bill is in USD and in English.
- Covers naturopathic doctors.
- If you are a member over 2 years and you die, your family gets about $10,000 for funeral costs.
- It just seems so much simpler than dealing with insurance companies, at least for now.


boarder42

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Re: Let's talk about health share
« Reply #106 on: August 04, 2017, 03:22:21 PM »
Well I called Liberty Health Share and am going through the approval process. i hope I get through!

After talking to their representative, I am very excited about Liberty. It seems like a great plan. Some of the highlights important to me:

- I can go to any doctor anywhere, any hospital, there is no network.
- Even international medical bills are considered! As long as the bill is in USD and in English.
- Covers naturopathic doctors.
- If you are a member over 2 years and you die, your family gets about $10,000 for funeral costs.
- It just seems so much simpler than dealing with insurance companies, at least for now.

I'd agree please keep us updated on your progress.

tmillican

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Re: Let's talk about health share
« Reply #107 on: August 11, 2017, 11:21:52 AM »
I am self-employed.  I had the same traditional insurance for fifteen years, major medical, traditional, 10k deductible then 80/20.  Started at age 31. Premiums gradually increased until ACA.  Now no one new can join this grandfathered plan, so premiums will eventually go up exponentially.

I was paying a little over $8000 per year for premiums.  So with deductible, I would have to pay $18,000 per year before I get a dime back.  Fortunately, we never had a medical condition that expensive. 

Last October, I switched to Medi-share.  I kept the $10,000 annual household portion (their name for deductible--they don't use insurance terms because it is not insurance).  Difference is it is 10k for the whole family.  Old plan was 10k per person which could have become a nightmare.  Monthly share portion (their name for premium) is about $351 ($80 of which is for a health partnership fee because one of us does not meet their height/weight standards) which is $4212 annually.

I had one medical issue this year.  One family member had to have an outpatient procedure in an ambulatory surgery center.  The surgery center was not familiar with medi-share.  Once I explained it, they said they are not in the PHCS PPO network that medi-share uses (even though the PHSC website says they are--they said yes but not they don't take this kind of PHCS.  Whatever.).  No problem, though, because they said that with the PHCS PPO discount even if they take medi-share our cost would have been well over $10,000, not including anesthesia.  Instead they were able to offer me a cash price of $7600 including anesthesia. 

The surgeon had checked beforehand and told us our cost would be $600, which we paid.  Later we got a bill for about $2800 more.  (because "deductible" was not met, they said).  I argued and told them their cash rate would be way less than this.  The office manager settled the account for $1800.  With all the other charges (pathology, lab, etc.) the charges were all reduced an appropriate amount by the PPO network. 

So, all said and done I'm still slightly under the $10,000 annual sharing portion. 

By continuing to save $4000 per year on an ongoing basis, I feel this is an acceptably low risk option for my family. 


caracarn

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Re: Let's talk about health share
« Reply #108 on: August 14, 2017, 12:21:25 PM »
So I had indicated earlier in this thread that my wife is on Liberty Healthshare because we gave it a try after we could not have her on my insurance plan due to employer restrictions. 

We have been in this situation for about 18 months.  She had a scan several months ago and we are still waiting for a ruling for Liberty on if they will cover it and this is about six months ago.  My wife has been very unhappy with the service level and how long it takes to get any answer.  We will most likely move to using her employer plan for her next year even though the premiums are higher because the unknown of what we have to pay and when we do have to pay a full bill ourselves is too big of a risk.  This scan was $2,800 as billed and if we end up on the hook for that (they were looking for ovarian cysts, so certainly nothing that would be out of their acceptable coverage clauses) then Liberty becomes more expensive than her employer medical option.  I have heard a lot of good things about medical sharing but so far our experience has been poor.

retiringearly

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Re: Let's talk about health share
« Reply #109 on: August 14, 2017, 07:51:57 PM »
So I had indicated earlier in this thread that my wife is on Liberty Healthshare because we gave it a try after we could not have her on my insurance plan due to employer restrictions. 

We have been in this situation for about 18 months.  She had a scan several months ago and we are still waiting for a ruling for Liberty on if they will cover it and this is about six months ago.  My wife has been very unhappy with the service level and how long it takes to get any answer.  We will most likely move to using her employer plan for her next year even though the premiums are higher because the unknown of what we have to pay and when we do have to pay a full bill ourselves is too big of a risk.  This scan was $2,800 as billed and if we end up on the hook for that (they were looking for ovarian cysts, so certainly nothing that would be out of their acceptable coverage clauses) then Liberty becomes more expensive than her employer medical option.  I have heard a lot of good things about medical sharing but so far our experience has been poor.
Thanks for posting this.  I sincerely appreciate it.

boarder42

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Re: Let's talk about health share
« Reply #110 on: August 15, 2017, 06:08:20 AM »
So I had indicated earlier in this thread that my wife is on Liberty Healthshare because we gave it a try after we could not have her on my insurance plan due to employer restrictions. 

We have been in this situation for about 18 months.  She had a scan several months ago and we are still waiting for a ruling for Liberty on if they will cover it and this is about six months ago.  My wife has been very unhappy with the service level and how long it takes to get any answer.  We will most likely move to using her employer plan for her next year even though the premiums are higher because the unknown of what we have to pay and when we do have to pay a full bill ourselves is too big of a risk.  This scan was $2,800 as billed and if we end up on the hook for that (they were looking for ovarian cysts, so certainly nothing that would be out of their acceptable coverage clauses) then Liberty becomes more expensive than her employer medical option.  I have heard a lot of good things about medical sharing but so far our experience has been poor.
Thanks for posting this.  I sincerely appreciate it.

i would say much more information is needed to determine why they may be witholding payment or reviewing.  but one 2800 dollar scan shouldnt be breaking a mustachian bank.  and you're looking at this in a vacuum sure it becomes more expensive this year.  but you have to look at the whole cost over time.  not just this year it cost a bit more.

KBecks

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Re: Let's talk about health share
« Reply #111 on: August 15, 2017, 06:28:09 AM »
I love the concept and should explore this more for our family.   It is definitely something I think that would help in the early years of FIRE, and I think I would enjoy giving money to families with health needs directly.   The only concern is maintaining our own health -- my weight is creepnig up but I'm not near obese, but my husband's weight is creeping up and he's closer to obese and has high blood pressure and not the greatest diet, so I don't know if he would get coverage without cleaning up his life a bit.   But I love the concept.  I'm a little afraid to try it.  Our health bills are in many ways minimal, but...  I had a breast infection earlier this year that required mammogram, ultrasound, specialist, and I also had another concern checked out that required ultrasound.  I'm not exactly free, but on the other hand most years we have very little for expenses. 

Question -- so if you go the medi-share route, are you paying the government penalty for not having "health insurance"?  Or will a medi-share count as coverage in the government's eyes? 
« Last Edit: August 15, 2017, 06:31:52 AM by KBecks »

CindyBS

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Re: Let's talk about health share
« Reply #112 on: August 15, 2017, 06:51:28 AM »
I am not involved with a health share, but would like to share my experiences of the last 13 months.

We were a pretty typical, normal family that paid for health insurance for decades and with a few exceptions here and there (pregnancy), paid way more into the system that we got out.  With preventative care being covered by the ACA, our out of pocket expenses were typically about $300/year. This does not include premiums.  We never met our deductible.    Although I never felt this way, we could argue that we were the healthy people who didn't want to be forced to subsidize sick people.

In July 2016, my then 13 year old was diagnosed with cancer.  In an instant, we became a family with a high risk, critically ill child with catastrophic medical expenses.  From July 2016-July 2017, he has spent about 150 days in the hospital with literally dozens and dozens of appointments.  He has had more than 50 transfusions, at least 10 operations and procedures that use the OR.  Our typical bills before the negotiated rate were about $100,000 per month.  I'm sure the negotiated rate was probably at least $25K.  Chemo and support drugs are insanely expensive - one month the charge was $156,000 before the negotiated rate (so probably at least $40K).  One of the prescription drugs he takes at home (so from a pharmacy - see what a health share says about those) is $11,000 per month.

His treatment wasn't going as well as we had hoped, so in June 2017 he got a bone marrow transplant.  That is at least $1 Million. 

There are cancers and conditions that only really have transplant as an option to cure.  Meaning you or your child could be diagnosed with cancer  (and we had no warning AT ALL), get chemo for a few months to prepare for transplant and then get a transplant.    The time from diagnosis to transplant could be as little as 3-4 months.

Is my situation rare, sure.  But with 1 out of every 300 or so kids gets getting diagnosed with cancer before age 20 - it is not that rare.  And cancer in adults is not rare at all.

I would be VERY careful about signing up for these plans.  I would also be VERY careful about thinking if you are diagnosed with something, you can just hold out until open enrollment for the ACA.   You can incur millions of $$ of expenses in a matter of months.  Also, keep in mind that if it is the person who is working that gets sick - they most likely will not be able to work either.  I had to stop working to care for my son, we on top of everything else, we have lost 1 of our incomes.


If we had been on a health share instead of real insurance, we would be financially ruined.

FIREby35

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Re: Let's talk about health share
« Reply #113 on: August 15, 2017, 06:59:20 AM »
I am not involved with a health share, but would like to share my experiences of the last 13 months.

We were a pretty typical, normal family that paid for health insurance for decades and with a few exceptions here and there (pregnancy), paid way more into the system that we got out.  With preventative care being covered by the ACA, our out of pocket expenses were typically about $300/year. This does not include premiums.  We never met our deductible.    Although I never felt this way, we could argue that we were the healthy people who didn't want to be forced to subsidize sick people.

In July 2016, my then 13 year old was diagnosed with cancer.  In an instant, we became a family with a high risk, critically ill child with catastrophic medical expenses.  From July 2016-July 2017, he has spent about 150 days in the hospital with literally dozens and dozens of appointments.  He has had more than 50 transfusions, at least 10 operations and procedures that use the OR.  Our typical bills before the negotiated rate were about $100,000 per month.  I'm sure the negotiated rate was probably at least $25K.  Chemo and support drugs are insanely expensive - one month the charge was $156,000 before the negotiated rate (so probably at least $40K).  One of the prescription drugs he takes at home (so from a pharmacy - see what a health share says about those) is $11,000 per month.

His treatment wasn't going as well as we had hoped, so in June 2017 he got a bone marrow transplant.  That is at least $1 Million. 

There are cancers and conditions that only really have transplant as an option to cure.  Meaning you or your child could be diagnosed with cancer  (and we had no warning AT ALL), get chemo for a few months to prepare for transplant and then get a transplant.    The time from diagnosis to transplant could be as little as 3-4 months.

Is my situation rare, sure.  But with 1 out of every 300 or so kids gets getting diagnosed with cancer before age 20 - it is not that rare.  And cancer in adults is not rare at all.

I would be VERY careful about signing up for these plans.  I would also be VERY careful about thinking if you are diagnosed with something, you can just hold out until open enrollment for the ACA.   You can incur millions of $$ of expenses in a matter of months.  Also, keep in mind that if it is the person who is working that gets sick - they most likely will not be able to work either.  I had to stop working to care for my son, we on top of everything else, we have lost 1 of our incomes.


If we had been on a health share instead of real insurance, we would be financially ruined.

Cindy - I'm really sorry to hear your story and I'm glad to hear it might be looking up.

I just want to point out, you don't know how health share would have handled your situation because you were not on health share.

CindyBS

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Re: Let's talk about health share
« Reply #114 on: August 15, 2017, 07:52:33 AM »
I am not involved with a health share, but would like to share my experiences of the last 13 months.

We were a pretty typical, normal family that paid for health insurance for decades and with a few exceptions here and there (pregnancy), paid way more into the system that we got out.  With preventative care being covered by the ACA, our out of pocket expenses were typically about $300/year. This does not include premiums.  We never met our deductible.    Although I never felt this way, we could argue that we were the healthy people who didn't want to be forced to subsidize sick people.

In July 2016, my then 13 year old was diagnosed with cancer.  In an instant, we became a family with a high risk, critically ill child with catastrophic medical expenses.  From July 2016-July 2017, he has spent about 150 days in the hospital with literally dozens and dozens of appointments.  He has had more than 50 transfusions, at least 10 operations and procedures that use the OR.  Our typical bills before the negotiated rate were about $100,000 per month.  I'm sure the negotiated rate was probably at least $25K.  Chemo and support drugs are insanely expensive - one month the charge was $156,000 before the negotiated rate (so probably at least $40K).  One of the prescription drugs he takes at home (so from a pharmacy - see what a health share says about those) is $11,000 per month.

His treatment wasn't going as well as we had hoped, so in June 2017 he got a bone marrow transplant.  That is at least $1 Million. 

There are cancers and conditions that only really have transplant as an option to cure.  Meaning you or your child could be diagnosed with cancer  (and we had no warning AT ALL), get chemo for a few months to prepare for transplant and then get a transplant.    The time from diagnosis to transplant could be as little as 3-4 months.

Is my situation rare, sure.  But with 1 out of every 300 or so kids gets getting diagnosed with cancer before age 20 - it is not that rare.  And cancer in adults is not rare at all.

I would be VERY careful about signing up for these plans.  I would also be VERY careful about thinking if you are diagnosed with something, you can just hold out until open enrollment for the ACA.   You can incur millions of $$ of expenses in a matter of months.  Also, keep in mind that if it is the person who is working that gets sick - they most likely will not be able to work either.  I had to stop working to care for my son, we on top of everything else, we have lost 1 of our incomes.


If we had been on a health share instead of real insurance, we would be financially ruined.

Cindy - I'm really sorry to hear your story and I'm glad to hear it might be looking up.

I just want to point out, you don't know how health share would have handled your situation because you were not on health share.

A previous post stated that Liberty paid out a max of $1 million for the higher plan and $125,000 per incident on the lower plant and prescriptions for 45 days per incident.  I'm not sorting through pages of posts to find that.  Assuming that is the case, and we had been on that health share in 2016, we would have been financially ruined.   My son probably consumed $150,000 of medical care in the first 6 weeks.  Even a negotiated rate would for the first 6 weeks was probably about $50,000.  My son has been ill for 10 times longer than that. 

Suppose we had gotten the higher plan, we may have squeaked by with $1 million until we could enroll in the ACA but that is *only* because he was diagnosed in July - had it been Feb - no way.  That prescription plan would have ruined us.  One year of just one the lifesaving drug my son takes costs $138,000 (NOT the negotiated rate).  That is the most expensive prescription he has, but there are at least a dozen more that total tens of thousands of dollars.  45 days is a joke.  My son has taken those for more than 300 days.   

All that with no guarantee that they will pay.  Nice. 

I hope you are lucky enough to not have any idea of how expensive the non-medical portions of having cancer are as well. 


caracarn

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Re: Let's talk about health share
« Reply #115 on: August 15, 2017, 08:17:56 AM »
So I had indicated earlier in this thread that my wife is on Liberty Healthshare because we gave it a try after we could not have her on my insurance plan due to employer restrictions. 

We have been in this situation for about 18 months.  She had a scan several months ago and we are still waiting for a ruling for Liberty on if they will cover it and this is about six months ago.  My wife has been very unhappy with the service level and how long it takes to get any answer.  We will most likely move to using her employer plan for her next year even though the premiums are higher because the unknown of what we have to pay and when we do have to pay a full bill ourselves is too big of a risk.  This scan was $2,800 as billed and if we end up on the hook for that (they were looking for ovarian cysts, so certainly nothing that would be out of their acceptable coverage clauses) then Liberty becomes more expensive than her employer medical option.  I have heard a lot of good things about medical sharing but so far our experience has been poor.
Thanks for posting this.  I sincerely appreciate it.

i would say much more information is needed to determine why they may be witholding payment or reviewing.  but one 2800 dollar scan shouldnt be breaking a mustachian bank.  and you're looking at this in a vacuum sure it becomes more expensive this year.  but you have to look at the whole cost over time.  not just this year it cost a bit more.
I do not disagree, but my wife's frustration with their entire lack of communication is what makes this difficult.  I have some more patience and am willing to hound them to get an answer.  She (somewhat rightfully) expects them to do their jobs like a "regular" insurance company and give timely responses, not just sit on things with zero communication.  We both expect it to take 2-3 months like normal, but she has literally not had them pay anything yet over 18 months.  She feels bad for the doctor's offices etc. and also is concerned (again, perhaps rightfully) that this dragging of feet in the process will impact her ability to get services if she really needs them from a doctor who is sitting there waiting for a payment on something for 9-12 months.

While the $2,800 does not break the bank, if they cover nothing, just paying less premiums only goes to far and it very quickly adds up to being more expensive.  And that's the problem right now, is that we've not gotten a single dollar back from Liberty.  My wife does not go to the doctor very often, most cases just for annual checkups, so not that many opportunities for Liberty to pay granted but it is just a very noticeable difference from what we had read they do (respond just like an insurance company) in a couple months to what we have experienced, which is nothing.

caracarn

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Re: Let's talk about health share
« Reply #116 on: August 15, 2017, 08:31:51 AM »
I am not involved with a health share, but would like to share my experiences of the last 13 months.

We were a pretty typical, normal family that paid for health insurance for decades and with a few exceptions here and there (pregnancy), paid way more into the system that we got out.  With preventative care being covered by the ACA, our out of pocket expenses were typically about $300/year. This does not include premiums.  We never met our deductible.    Although I never felt this way, we could argue that we were the healthy people who didn't want to be forced to subsidize sick people.

In July 2016, my then 13 year old was diagnosed with cancer.  In an instant, we became a family with a high risk, critically ill child with catastrophic medical expenses.  From July 2016-July 2017, he has spent about 150 days in the hospital with literally dozens and dozens of appointments.  He has had more than 50 transfusions, at least 10 operations and procedures that use the OR.  Our typical bills before the negotiated rate were about $100,000 per month.  I'm sure the negotiated rate was probably at least $25K.  Chemo and support drugs are insanely expensive - one month the charge was $156,000 before the negotiated rate (so probably at least $40K).  One of the prescription drugs he takes at home (so from a pharmacy - see what a health share says about those) is $11,000 per month.

His treatment wasn't going as well as we had hoped, so in June 2017 he got a bone marrow transplant.  That is at least $1 Million. 

There are cancers and conditions that only really have transplant as an option to cure.  Meaning you or your child could be diagnosed with cancer  (and we had no warning AT ALL), get chemo for a few months to prepare for transplant and then get a transplant.    The time from diagnosis to transplant could be as little as 3-4 months.

Is my situation rare, sure.  But with 1 out of every 300 or so kids gets getting diagnosed with cancer before age 20 - it is not that rare.  And cancer in adults is not rare at all.

I would be VERY careful about signing up for these plans.  I would also be VERY careful about thinking if you are diagnosed with something, you can just hold out until open enrollment for the ACA.   You can incur millions of $$ of expenses in a matter of months.  Also, keep in mind that if it is the person who is working that gets sick - they most likely will not be able to work either.  I had to stop working to care for my son, we on top of everything else, we have lost 1 of our incomes.


If we had been on a health share instead of real insurance, we would be financially ruined.

Cindy - I'm really sorry to hear your story and I'm glad to hear it might be looking up.

I just want to point out, you don't know how health share would have handled your situation because you were not on health share.

A previous post stated that Liberty paid out a max of $1 million for the higher plan and $125,000 per incident on the lower plant and prescriptions for 45 days per incident.  I'm not sorting through pages of posts to find that.  Assuming that is the case, and we had been on that health share in 2016, we would have been financially ruined.   My son probably consumed $150,000 of medical care in the first 6 weeks.  Even a negotiated rate would for the first 6 weeks was probably about $50,000.  My son has been ill for 10 times longer than that. 

Suppose we had gotten the higher plan, we may have squeaked by with $1 million until we could enroll in the ACA but that is *only* because he was diagnosed in July - had it been Feb - no way.  That prescription plan would have ruined us.  One year of just one the lifesaving drug my son takes costs $138,000 (NOT the negotiated rate).  That is the most expensive prescription he has, but there are at least a dozen more that total tens of thousands of dollars.  45 days is a joke.  My son has taken those for more than 300 days.   

All that with no guarantee that they will pay.  Nice.

I hope you are lucky enough to not have any idea of how expensive the non-medical portions of having cancer are as well.
This is the biggest issue.  My wife is convinced they will sit on their hands and simply say they can't pay.  I'm trying to be optimistic and point out that it certainly does not violate any of their provisions so that if they do that she could just push back.  Her point is she should not have to fight for general coverage.  If we were in Cindy's situation and waiting around for months with no response, we'd be emotional wrecks.  Also Liberty and others are $1 million per incident as she indicated, and looking at any of their guidelines, the situation she described would certainly be viewed as 1 incident and capped at the $1 million.  This is where for all the groaning about the ACA provisions needing to be repealed things like pre-existing and no life time maximums need to be retained or we create a very untenable situation for families like Cindy's. 

If our experience with the health share had any positives to it, I'd be more likely to try to defend it, but so far, I have been very sad to be the one who encouraged my wife to strongly look into this option for her insurance and now seeing the strife it has caused her, and she's not dealing with anything like a situation like Cindy.  Unless something massive changes, we'll be switching her to her employer plan at the end of 2017.

boarder42

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Re: Let's talk about health share
« Reply #117 on: August 15, 2017, 09:20:26 AM »
simple solution to the above proposition is to have an insurance policy over the top of the healthshare for extreme cases where something like that may happen.  i know they are much harder to find now that the ACA has jacked up everything. but you can still have super high deductible plans to supplement a healthshare if you're that worried.  also your bone marrow thing face value was 1MM just b/c it was 1MM face value does not mean it would have cost that on healthshare as they negotiate those down.

so while mostly anecdotal i'd have been much more interested to hear about this case on healthshare and how it was handled.

rulesofacquisition

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Re: Let's talk about health share
« Reply #118 on: August 23, 2017, 08:31:21 AM »
I had promised an update on medical bills I submitted to SMI (Samaritan Ministries International) from (still) undiagnosed GI issues. I had 2 ER bills in Dec. 2016, a followup with a surgeon, GI specialist, a lab test for ulcers, and a family doctor followup (I didn't even have a family doc at this point). I have had no health issues since early 2017.

Total bills before me negotiating discounts $6567.42 minus $1331.74 in discounts = $5235.86 all of which was paid. I am resposible for paying the first $300 but since I got more than that in discounts I paid nothing.

I negotiated discounts from about 15% to 67%. Not all bills showed the discount so the figures above are not exact, but close. The GI specialist and surgeon are independent practices - not owned by a hospital, and were easy to work with and big cash discount. The hospital billing dept. are assholes and so is the family doc's billing - their practice is owned by the hospital. Rural area, little choice in an emergency, but for non-emergency I have learned what questions to ask and how to deal with billing.

So, in a nutshell, this is doable but you have to be your own advocate and ask questions not just about the money end of it but what is best for your health.

Daisy

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Re: Let's talk about health share
« Reply #119 on: August 23, 2017, 12:09:00 PM »
I was accepted by Liberty Health Share! I am now ready to pull the plug on my job and FIRE and not have to play games with my Roth conversion pipeline and keeping my income in a certain range to qualify for ACA subsidies!

I am also excited by their acceptance of naturopathic practitioners and their coverage for health care while travelling internationally.
« Last Edit: August 23, 2017, 07:02:51 PM by Daisy »

homestead neohio

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Re: Let's talk about health share
« Reply #120 on: February 20, 2018, 03:01:27 PM »
Resurrecting this thread to see if any original posters have more data to share or if many more mustachians are flocking to these for 2018.  Please post more info if you can.  @caracarn , did Liberty pay that $2800 bill?

I am getting laid off at the end of March and am shopping for health insurance. ACA plans were between $860 and $1400/mo in premiums and have deductibles of at least 8k.  I do not qualify for subsidies due to decent income in 2018 (3 months wages + severance).  Looking at providers, these plans don't have my doctors in network.  From what I understand, many healthcare providers did not remain in network for ACA plans in 2018 due to funding concerns.  If federal monies dry up, they won't get paid.  So I'm looking at min $7.7k to be insured for 9 months if I have no healthcare costs post layoff.  A hopeful case in the event of a high cost health concern would be finding someone in network and spending $15.7k (OOP max).  Worst case would be I can find no providers in network and OOP max does not apply, sky is the limit on billing and maybe go bankrupt.  Healthshare is looking pretty damn good compared to the broken ACA. 

I'm considering Liberty Healthshare at least for a the remaining 9 months of 2018.  I can re-evaluate ACA plans vs. Liberty during ACA open enrollment with very low 2019 income and subsidies.  I don't think we'd have any problem with being accepted.

Since Obamacare repeal failed, seems like not as high of a risk of becoming un-insurable if some new condition is identified in these 9 months.  I can actually do COBRA retroactively within 60 days of layoff if needed. 

Gin1984

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Re: Let's talk about health share
« Reply #121 on: February 20, 2018, 03:17:33 PM »
You'll get more than 47K in 3 months wages plus severance?  Nice!  Have you compared. COBRA costs to ACA costs?

okcisok

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Re: Let's talk about health share
« Reply #122 on: February 20, 2018, 04:40:33 PM »
**Full disclosure** I am a licensed insurance agent in the state of OK. However, this product is completely new to me and my company. None of these statements should be taken as fact, or a sales pitch.

I'm going to an informational meeting tomorrow about Sedera. It's a newer health share based out of Austin, TX. From my preliminary research on sedera.com, it sounds like:

-It *isn't* insurance, so just the Medical Cost Sharing (MCS) membership alone doesn't meet ACA guidelines of insurability.  You have to have a Minimum Essential Coverage plan (MEC) to comply with ACA, and Sedera provides that as part of the package. The MCS takes care of preventative health needs and can provide a framework for Health Savings Accounts (HSA).

-They don't exclude smokers, the overweight, or non-Christians. The only mention of Christianity was to explain that "this model is built upon the principles used by some of the Christian healthcare sharing groups". I found no mention of compulsory church attendance or required religious affiliation. (And I LOOKED.)

-"No one is denied membership based on prior medical conditions." There's a certain time limit on pre-existing conditions. I believe it's 36 months with no symptoms or medical visits.

-They do the negotiation on lowering bills. You aren't supposed to pay bills up front, because they want a chance to negotiate the final cost. There is some leeway on things like childbirth that you might normally pay up front. "Please note: use of this [negotiation] service by Sedera Health members is completely voluntary."

-They haven't raised their rates since 2015.

The website is very comprehensive, so I urge everyone to check it out for themselves. 

I will bring some of these concerns to my meeting and report back here!

homestead neohio

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Re: Let's talk about health share
« Reply #123 on: February 20, 2018, 04:41:33 PM »
Have you compared. COBRA costs to ACA costs?

Cobra costs for 2017 insurance rate were higher than 2018 ACA and I know my employers health insurance costs increased for this year.  I'll have to dig around for their 2018 Cobra price, but I know it is higher.

boarder42

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Re: Let's talk about health share
« Reply #124 on: February 20, 2018, 04:56:45 PM »
1st time poster on sedera so probably a spammer but they appear to be targetted employers not individuals. But there are more and more health shares popping up. A friend just started using altura.

caracarn

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Re: Let's talk about health share
« Reply #125 on: February 21, 2018, 06:25:00 AM »
@caracarn , did Liberty pay that $2800 bill?

Yes they did.  We have stayed with it currently for my wife.  Nothing new that has been run through there so I cannot elaborate on anything else.  Me and kids are covered through my employer.


v8rx7guy

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Re: Let's talk about health share
« Reply #126 on: February 21, 2018, 08:12:52 AM »
@caracarn , did Liberty pay that $2800 bill?

Yes they did.  We have stayed with it currently for my wife.  Nothing new that has been run through there so I cannot elaborate on anything else.  Me and kids are covered through my employer.

Of course they did.  This matches their track record.

v8rx7guy

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Re: Let's talk about health share
« Reply #127 on: February 21, 2018, 08:17:57 AM »
A video that explains Liberty's 100% paid bills history:

https://fast.wistia.net/embed/iframe/4253hii376?popover=true

caracarn

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Re: Let's talk about health share
« Reply #128 on: February 21, 2018, 09:37:55 AM »
@caracarn , did Liberty pay that $2800 bill?

Yes they did.  We have stayed with it currently for my wife.  Nothing new that has been run through there so I cannot elaborate on anything else.  Me and kids are covered through my employer.

Of course they did.  This matches their track record.
That may be true, but the reason he asked was they were being anything but simple to deal with in handling this.

Also, it is important to note they paid, but were certainly not timely.  Took well over six months, and we had to fight with the providers we owed to keep them from resorting to collections.  So painting the picture that all is great because they say so on their video is not really accurate.  Hence the questions in this thread so not sure the belittling the response is really beneficial to the audience that wants to see the reality behind the promotional video on their web site.

okcisok

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Re: Let's talk about health share
« Reply #129 on: February 21, 2018, 01:00:06 PM »
1st time poster on sedera so probably a spammer but they appear to be targetted employers not individuals. But there are more and more health shares popping up. A friend just started using altura.


Not a spammer, just someone who finally got it together to register for the forums to contribute instead of just reading :)

According to my informational meeting today:
Sedera is targeted for employers, but there's nothing to stop individuals from joining the share. If not, check out sedera.com or makina.com. The latter is definitely for businesses, but it explains how the system works.

You do have to sign a 'healthy living' pledge, that you won't drive while drunk, take illegal drugs, etc. But there is no religious component at all to Sedera. It is based on a system that started (and some that continue) under religious principles by religious groups.

Smokers pay a larger premium, just like with other insurances. But they aren't barred from participating.

homestead neohio

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Re: Let's talk about health share
« Reply #130 on: February 22, 2018, 08:41:22 AM »
Of course they did.  This matches their track record.
That may be true, but the reason he asked was they were being anything but simple to deal with in handling this.

Also, it is important to note they paid, but were certainly not timely.  Took well over six months, and we had to fight with the providers we owed to keep them from resorting to collections.  So painting the picture that all is great because they say so on their video is not really accurate.  Hence the questions in this thread so not sure the belittling the response is really beneficial to the audience that wants to see the reality behind the promotional video on their web site.

Thanks for the reply, @caracarn .  I will note I've had similar experiences with employer insurance in the past.  Medical billing and payment can be a huge fucking mess.  I have no idea how many people are employed sorting this stuff out (and making it more complicated), but it is not a trivial number.

The video says they pay timely, 20-40 days, but I'm sure that is not always the case, as in your example.

boarder42

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Re: Let's talk about health share
« Reply #131 on: February 22, 2018, 09:43:39 AM »
1st time poster on sedera so probably a spammer but they appear to be targetted employers not individuals. But there are more and more health shares popping up. A friend just started using altura.


Not a spammer, just someone who finally got it together to register for the forums to contribute instead of just reading :)

According to my informational meeting today:
Sedera is targeted for employers, but there's nothing to stop individuals from joining the share. If not, check out sedera.com or makina.com. The latter is definitely for businesses, but it explains how the system works.

You do have to sign a 'healthy living' pledge, that you won't drive while drunk, take illegal drugs, etc. But there is no religious component at all to Sedera. It is based on a system that started (and some that continue) under religious principles by religious groups.

Smokers pay a larger premium, just like with other insurances. But they aren't barred from participating.

i see nothing on their site that targets indviduals if you could point me to that i'd love to see a link

caracarn

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Re: Let's talk about health share
« Reply #132 on: February 22, 2018, 12:23:23 PM »
Of course they did.  This matches their track record.
That may be true, but the reason he asked was they were being anything but simple to deal with in handling this.

Also, it is important to note they paid, but were certainly not timely.  Took well over six months, and we had to fight with the providers we owed to keep them from resorting to collections.  So painting the picture that all is great because they say so on their video is not really accurate.  Hence the questions in this thread so not sure the belittling the response is really beneficial to the audience that wants to see the reality behind the promotional video on their web site.

Thanks for the reply, @caracarn .  I will note I've had similar experiences with employer insurance in the past.  Medical billing and payment can be a huge fucking mess.  I have no idea how many people are employed sorting this stuff out (and making it more complicated), but it is not a trivial number.

The video says they pay timely, 20-40 days, but I'm sure that is not always the case, as in your example.
I have had employer insurance issues in the past.  Nothing like the difficulty we had in resolving the issues with Liberty.  I think the big difference is that insurance is regulated and they have to perform to certain levels or they lose licensing.  Health shares are beholden to no one (other than the people who pay the monthly fee) and as such are a step above a volunteer organization that passes money from one person to another.  All attempts to get any response from Liberty during the process went without a response.  To be clear, I'm not saying a response we did not like, I'm saying NO RESPONSE AT ALL.  The phone was not answered, the e-mails were never returned.  We just got to sit and wait and talk with the bill collectors that we were trying.  Never has that problem with employer insurance. 

BeanCounter

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Re: Let's talk about health share
« Reply #133 on: February 22, 2018, 05:28:27 PM »
Caracarn, you are exactly right. What scares me about health shares is that they are not regulated. State regulated insurance companies have to maintain minimum assets to insure that they can pay their members claims. And they have stop loss insurance to protect them from a million dollar claim. With health shares you get none of that. If you have a million dollar claim and your health share doesn't have enough assets to pay it, you're fucked.

You also can appeal to the state on a claim if your insurer isn't paying per the contract. I've had to do this with a nursing home claim and the state stepped in and told the insurer to pay up.

mike_R

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Re: Let's talk about health share
« Reply #134 on: September 19, 2018, 03:42:08 PM »
Hi,

My family has Christian Healthcare Ministries (CHM) so I have some experience with filing claims and thought I'd share. I'm terrible at trying to make stuff short so this is really long haha!

My parents:
They have the gold program which is $150/month (per each adult, and plus $150 for dependents combined) with a $500 deductible but if you get a discount on your bill, it count's towards this deductible so get a $500 discount and you have no deductible.

  • My dad had a kidney stone and went to the ER. He said he was not insured (healthcare sharing organizations are not insurance) asked if we paid before leaving if he could get a 40% discount and they said yes so he paid out of pocket and was reimbursed in under 60 days by CHM. Didn't have any cost that wasn't reimbursed. CHM says not to pay immediately unless the total is under $1,000 and you get a 40% discount. If you don't get a 40% discount, CHM will "coach you or even negotiate with your providers on your behalf".
    Summary: Had no cost that wasn't reimbursed and no deductible.
  • He broke his arm while bike riding. Transported by ambulance, had surgery, 3 nights in the hospital, and multiple follow up visits with the various specialist involved. Had two prescriptions (filled at a pharmacy). Since this cost was so large, no negotiations took place before he was discharged but afterwards he asked for discounts and and told some of the providers that he was not insured and to others he explained what CHM was. They all gave a discounts of at least 20% but some gave up to 40%. The pre-discount total was about $65,000 and the post-discount total was about $45,000. CHM sent a check right at about 60 days for the total cost and the only cost my parents had to pay was the ambulance ($1,200) cause CHM does not cover transportation.
    Summary: Had $1,2000 ambulance ride that was not reimbursed. Everything else was reimbursed and had no deductible.
  • He went to the ER for an eye problem. The bill was $1,700 but before he left he said we cash paying and asked for a discount if he paid now. They discounted the bill to $1,000. He also got $80 worth of prescriptions. CHM again paid for all of it after about 60 days.
    Summary: Had no cost that wasn't reimbursed and no deductible.
My brother and his wife:
Have the Silver plan which is $85 a month (per each adult, and plus $150 for dependents combined) and $1,000 deductible.

  • They've had two kids on their Silver plan which has a $1,000 deductible. Both deliveries were with a mid wife at a birthing center (not a hospital). The silver program covers $2,500 for midwife services and when that was explained to the midwife, she reduced the $5,000 bill to $2,500 for both deliveries. This resulted in no deductible because the discount was more than the deductible and no out of pocket cost since the midwife didn't want to charge more than the max coverage. The silver and bronze plan do cover $125,000 "hospital treatment" for pregnancies but I don't think that includes normal delivery charges. The Gold plan does cover all delivery cost up to $125,000 if you get the optional Brother's Keeper program (details on that program below). Not sure how long reimbursement took for them but they were satisfied.
    Summary: Had no cost that wasn't reimbursed and no deductible but only cause they used a midwife, not a hospital, and she was extra kind.
  • My brother also had a broken arm with an ER visit and an ER visit for a panic attack. The ER visits were completely reimbursed by CHM because discounts were given to cover the deductible amount. But follow up visits were not covered because the Silver and Bronze plans do not cover doctor office visits (but the gold plan does if they're related to an incident).
    Summary: ER visits were reimbursed, no deductible, but follow up visits were not reimbursed because of their plan.
My cousin and his wife:
Gold plan.

  • My cousin's wife had a terrible delivery and the wife's bill would be discount by 50% if they paid it before she was discharged so he called CHM and they overnight-ed a check to them. The baby was in the hospital longer and they just got billed after discharge and negotiated after receiving the bill. They were also satisfied with when they got the money but couldn't remember the exact time frame.
    Summary: Had no cost that wasn't reimbursed and no deductible. CHM even overnight-ed a check to ensure a discount.
Things worth noting:

  • CHM doesn't cover transportation to hospital but does cover transportation between hospitals if it's a life threatening matter. Ambulances are expensive but medical helicopters are crazy expensive! The national average for a medical helo flight is 55 miles. That would cost an average of $23,000 with the providers in my state but that can, and does go up to $70,000+ sometimes. But regular insurance doesn't always help either since some helicopter companies aren't in-network. North Dakota has one company that charge an average of $44,000 and insurance companies only paid 33 percent of that, on average.
    Those numbers are from this article: http://archive.sltrib.com/article.php?id=4139196&itype=CMSID

  • Prescriptions are only covered with gold plan and still, that only covers incident-related prescriptions.

  • There is a maximum coverage. It's $125,000 on all the plans but increases if you buy the optional Brother's Keeper program which has a $40 annual fee and a quarterly fee that is based on how much the program paid out. That quarterly fee has usually been around $15 and never more than $25 in the 4 years we've had the program.
    With Brother's Keeper the gold plan increases to unlimited coverage, the silver and bronze plan get an additional $100,000 in coverage for every year you're a member.
« Last Edit: September 19, 2018, 04:03:45 PM by mike_R »

bacchi

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Re: Let's talk about health share
« Reply #135 on: September 19, 2018, 05:39:01 PM »
They're getting panned a lot lately on yelp. Mostly about delays in getting reimbursement.

https://www.yelp.com/biz/liberty-healthshare-canton-3?sort_by=date_desc


Page 8 of their annual report* is where it gets interesting. There was $167M contributed by members into their member sharing accounts and the management company received $63M for functional expenses. Of that $63M, 26% was used for management and 74% was used for "direct program purposes," whatever that means given that the member sharing accounts are segregated. You can decide if that's too high or not.

The total net assets at the EOY 2017 in the member sharing accounts is $1.6M. There were 87,000 families in the health share in 2017, which is an average of $1920 in the sharing accounts/family/year.

In summary, Liberty depends on healthy people. The low reserves and low average sharing fund might work well in, say, the Netherlands, but appears dangerously low for US health care.


* https://www.libertyhealthshare.org/content/annual_audit_2017.pdf

FIREby35

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Re: Let's talk about health share
« Reply #136 on: September 20, 2018, 02:41:06 PM »
Thanks for sharing Mike R. Real world examples are great to hear.

mike_R

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Re: Let's talk about health share
« Reply #137 on: September 20, 2018, 04:01:01 PM »
There was $167M contributed by members into their member sharing accounts and the management company received $63M for functional expenses. Of that $63M, 26% was used for management and 74% was used for "direct program purposes," whatever that means given that the member sharing accounts are segregated.

Well that may explain why Liberty is so expensive compared to Christian Healthcare Ministries for comparable coverage!

I have CHM but they require that you are active in a Christian Church (though I've never heard of them checking) and I'm no longer active cause my former church is homophobic and I'm homo so that didn't work out haha! I've looked at switching to Liberty as it's the only non-religous one but it's just really expensive compared to CHM or subsidized health insurance through the ACA/healthcare.gov.

bacchi

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Re: Let's talk about health share
« Reply #138 on: September 20, 2018, 04:18:50 PM »
Sedera, as mentioned above, is non-religious.

http://sedera.com/membership-guidelines/

A "true" health sharing plan is a substitute for an ACA plan. Sedera is not, as no new ones can be created. It's just a (for-profit) sharing program and the member has to have a MEC, which can be expensive. Lacking a MEC may not mean a penalty anymore, however.

https://www.healthcare.gov/glossary/minimum-essential-coverage/

FIREby35

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Re: Let's talk about health share
« Reply #139 on: September 22, 2018, 07:52:06 AM »
There was $167M contributed by members into their member sharing accounts and the management company received $63M for functional expenses. Of that $63M, 26% was used for management and 74% was used for "direct program purposes," whatever that means given that the member sharing accounts are segregated.

Well that may explain why Liberty is so expensive compared to Christian Healthcare Ministries for comparable coverage!

I have CHM but they require that you are active in a Christian Church (though I've never heard of them checking) and I'm no longer active cause my former church is homophobic and I'm homo so that didn't work out haha! I've looked at switching to Liberty as it's the only non-religous one but it's just really expensive compared to CHM or subsidized health insurance through the ACA/healthcare.gov.

Not active member of my church either but happy to be be in CHM. I've mostly been waiting for my church to talk about genuine spirituality rather than abortion, pedophilia and donating money. Every once in a while it peeks through the non-sense, but not as often as it should!

Chickee

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Re: Let's talk about health share
« Reply #140 on: December 28, 2018, 05:36:37 PM »
I was accepted by Liberty Health Share! I am now ready to pull the plug on my job and FIRE and not have to play games with my Roth conversion pipeline and keeping my income in a certain range to qualify for ACA subsidies!

I am also excited by their acceptance of naturopathic practitioners and their coverage for health care while travelling internationally.

Hi Daisy,

Were you able to use the international coverage? I'm planning on using mine soon but when I went to clarify the requirements last Nov 2018 they said the billing should be CPT coded too. Meaning, the international hospital/clinic should be following US medical coding standard too for their billing statements (which is very rare). Btw, that requirement isn't written in their fine print.

Daisy

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Re: Let's talk about health share
« Reply #141 on: December 28, 2018, 08:45:40 PM »
I was accepted by Liberty Health Share! I am now ready to pull the plug on my job and FIRE and not have to play games with my Roth conversion pipeline and keeping my income in a certain range to qualify for ACA subsidies!

I am also excited by their acceptance of naturopathic practitioners and their coverage for health care while travelling internationally.

Hi Daisy,

Were you able to use the international coverage? I'm planning on using mine soon but when I went to clarify the requirements last Nov 2018 they said the billing should be CPT coded too. Meaning, the international hospital/clinic should be following US medical coding standard too for their billing statements (which is very rare). Btw, that requirement isn't written in their fine print.

I have travelled internationally but have not needed to use my Liberty health share plan. No medical issues while abroad yet!

I don't know what CPT is. Let me know how it goes for you.

StashingAway

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Re: Let's talk about health share
« Reply #142 on: January 01, 2019, 08:10:32 PM »
So I had indicated earlier in this thread that my wife is on Liberty Healthshare because we gave it a try after we could not have her on my insurance plan due to employer restrictions. 

We have been in this situation for about 18 months.  She had a scan several months ago and we are still waiting for a ruling for Liberty on if they will cover it and this is about six months ago.  My wife has been very unhappy with the service level and how long it takes to get any answer.  We will most likely move to using her employer plan for her next year even though the premiums are higher because the unknown of what we have to pay and when we do have to pay a full bill ourselves is too big of a risk.  This scan was $2,800 as billed and if we end up on the hook for that (they were looking for ovarian cysts, so certainly nothing that would be out of their acceptable coverage clauses) then Liberty becomes more expensive than her employer medical option.  I have heard a lot of good things about medical sharing but so far our experience has been poor.
Thanks for posting this.  I sincerely appreciate it.

i would say much more information is needed to determine why they may be witholding payment or reviewing.  but one 2800 dollar scan shouldnt be breaking a mustachian bank.  and you're looking at this in a vacuum sure it becomes more expensive this year.  but you have to look at the whole cost over time.  not just this year it cost a bit more.

For someone claiming to be open to hearing everyone's experience with a health-share, you sure do seem to be shaming anyone who doesn't remotely agree with you. You've already made up your mind on which option is better, so why are you even on here?

DreamFIRE

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Re: Let's talk about health share
« Reply #143 on: January 01, 2019, 08:30:07 PM »
So I had indicated earlier in this thread that my wife is on Liberty Healthshare because we gave it a try after we could not have her on my insurance plan due to employer restrictions. 

We have been in this situation for about 18 months.  She had a scan several months ago and we are still waiting for a ruling for Liberty on if they will cover it and this is about six months ago.  My wife has been very unhappy with the service level and how long it takes to get any answer.  We will most likely move to using her employer plan for her next year even though the premiums are higher because the unknown of what we have to pay and when we do have to pay a full bill ourselves is too big of a risk.  This scan was $2,800 as billed and if we end up on the hook for that (they were looking for ovarian cysts, so certainly nothing that would be out of their acceptable coverage clauses) then Liberty becomes more expensive than her employer medical option.  I have heard a lot of good things about medical sharing but so far our experience has been poor.
Thanks for posting this.  I sincerely appreciate it.

i would say much more information is needed to determine why they may be witholding payment or reviewing.  but one 2800 dollar scan shouldnt be breaking a mustachian bank.  and you're looking at this in a vacuum sure it becomes more expensive this year.  but you have to look at the whole cost over time.  not just this year it cost a bit more.

For someone claiming to be open to hearing everyone's experience with a health-share, you sure do seem to be shaming anyone who doesn't remotely agree with you. You've already made up your mind on which option is better, so why are you even on here?

He's not.  LOL.  That was just his way.

https://forum.mrmoneymustache.com/off-topic/r-i-p-boarder42/

reese_c_c

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Re: Let's talk about health share
« Reply #144 on: January 02, 2019, 12:37:53 PM »
I have CHM but they require that you are active in a Christian Church (though I've never heard of them checking) and I'm no longer active cause my former church is homophobic and I'm homo so that didn't work out haha! I've looked at switching to Liberty as it's the only non-religous one but it's just really expensive compared to CHM or subsidized health insurance through the ACA/healthcare.gov.
Thanks mike_R. Are you still with CHM? My family and I are looking at FIRE pretty soon and our biggest hang up is the health insurance. Its hard to swallow that when we don't have any monthly expenses near that high right now. There's 5 of us so ACA costs are quite high compared to what we pay now with my company plan.

freya

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Re: Let's talk about health share
« Reply #145 on: May 29, 2019, 08:07:38 AM »
Posting to resurrect this thread.  Health shares are an interesting alternative to traditional health insurance, and I'm interested in hearing more from people who went for this option.

I definitely hear the concerns about catastrophic costs exceeding $1 million, time-limited prescription coverage, and dangerously low cash reserves.  Also, the high overhead at Liberty rivals that of traditional insurance companies, which is disappointing.  The structure should enable them to have much lower overhead, which is kind of the point.

One thing that hasn't been mentioned:  Obamacare and other traditional insurance plans also have their risks.  No matter how careful you are, you can't be sure of avoiding these several main exposures:  out of network costs and balance billing, denials of coverage that can be capricious, and limited prescription coverage.  It is fortunate that the very high hospitalization and prescription costs cited by an earlier poster for cancer treatment were covered by insurance, but it's very common (probably more common) for families in these situations to end up with massive medical out of pocket costs that dwarf the advertised out of pocket maximums.  Health shares have the advantage here, because the OON issue goes away entirely and they don't pick and choose what prescriptions to cover based on the medication.

BTW this is also why I wouldn't under any circumstances consider a Medicare Advantage plan.


BeanCounter

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Re: Let's talk about health share
« Reply #146 on: May 29, 2019, 08:23:43 AM »
Posting to resurrect this thread.  Health shares are an interesting alternative to traditional health insurance, and I'm interested in hearing more from people who went for this option.

I definitely hear the concerns about catastrophic costs exceeding $1 million, time-limited prescription coverage, and dangerously low cash reserves.  Also, the high overhead at Liberty rivals that of traditional insurance companies, which is disappointing.  The structure should enable them to have much lower overhead, which is kind of the point.

One thing that hasn't been mentioned:  Obamacare and other traditional insurance plans also have their risks.  No matter how careful you are, you can't be sure of avoiding these several main exposures:  out of network costs and balance billing, denials of coverage that can be capricious, and limited prescription coverage.  It is fortunate that the very high hospitalization and prescription costs cited by an earlier poster for cancer treatment were covered by insurance, but it's very common (probably more common) for families in these situations to end up with massive medical out of pocket costs that dwarf the advertised out of pocket maximums.  Health shares have the advantage here, because the OON issue goes away entirely and they don't pick and choose what prescriptions to cover based on the medication.

BTW this is also why I wouldn't under any circumstances consider a Medicare Advantage plan.
Health Shares do not have the advantage in the case of extremely high cost treatments. Actually that is where they are at a distinct disadvantage. They don't have the large network negotiating power that the big insurers do. So they will be subject to whatever the provider or pharmacy charges. And if they don't have the cash reserves and go under because of your million dollar claim, you're screwed. I don't even think they are required to carry stop loss.
While traditional insurance is by no means perfect, at least it's regulated by the DOI and you have the opportunity to appeal at the state level to demand coverage. I have done this, and it was on a MA plan and the state came in and demanded the insurer pay.

FIREby35

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Re: Let's talk about health share
« Reply #147 on: May 30, 2019, 07:34:14 AM »
I have used Medishare since Obamacare cancelled my catastrophic health insurance plan back in the day. I'm a small business owner with no option for corporate health care. Don't forget, there is a large class of Americans who have never had the luxury of health insurance paid for by the corporation. It's not THAT big a deal :)

Sometimes, it takes thinking outside the box. Let me tell you what I mean...

1. By probability, the most likely traumatic injury situation any of us likely to face is a car/work accident with serious injuries. In that case, you will be immediately taken to the hospital and provided life-saving treatment without request for your insurance. Medical bill sharing should help in that situation. If it does not then the next best protection is significant property and casualty insurance with an umbrella policy. That insures a large part of the risk of unexpected medical bills.

2. Chronic health conditions are often caused by lifestyle choices. The best way to avoid type two diabetes, hypertension and many other common chronic illnesses is to control your diet and physical health. Say what you want, but that is a fact.

3. Cancer or organ failure of some sort is, generally, a slow moving situation that would allow for planning. I have saved tens of thousands of dollars in premiums over 7+ years of insuring a healthy family of five with medical bill sharing. I know I can take $50,000 cash to any major metropolitan city in Latin America (Mexico City, for example) and receive the best health care available to over a billion people who live in those countries. You can dismiss this if you want, but I have lived in Mexico and know for a fact that intelligent, caring doctors with advanced technology do, in fact, exist in their country of 190+ million people.

4. You can negotiate cash service for cancer and other treatments in America as well. $100,000 cash goes a long way. It is absolutely possible to save $100,000 in reduced premiums in five years for families (2k per month for 60 months is over 100k). I'm way past five years of ditching expensive health insurance.

5. Medical bill sharing does cover cancer issues and there is no reason to assume they will not except fear. I don't generally like to give fear that much power. As has been discussed, your health insurance can try to screw you as well.

6. Medical debt incurred in an emergency situation is highly unlikely to be collected at the billed rate. Hiring an attorney to negotiate reductions on a large medical bill could cost a few thousand dollars, block the hospital from collecting for years and eventually lead to 50%+ reductions on any bills. If necessary, you can simply stonewall a hospital's collection efforts - people do it all the time. For the record, the health insurance "discounts" are often pathetic back scratching between the health insurer and the medical provider that do no justice to the consumer. I've seen it personally, repeatedly. Negotiating with a competent attorney is likely to get bigger reductions than the health insurance provider accepts for a fraction of the price.

7. There are ways to protect assets even if a medical provider became very aggressive - which I have not seen in my county courthouse. It involves a bankruptcy attorney, moving to a state with a homestead exemption for one year and planning.

8. When it comes to anyone trying to get to the assets of a financially independent person, remember something my contracts professor told me in my first year of law school: When you have the money, you have the advantage. It is their problem to get money from you and nothing says you have to make it easy. I sue insurance companies all the time. Trust me, they don't make it easy and there is an army of attorneys who are very experienced in asset protection.

SimpleCycle

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Re: Let's talk about health share
« Reply #148 on: May 30, 2019, 01:09:34 PM »
I have used Medishare since Obamacare cancelled my catastrophic health insurance plan back in the day. I'm a small business owner with no option for corporate health care. Don't forget, there is a large class of Americans who have never had the luxury of health insurance paid for by the corporation. It's not THAT big a deal :)

Sometimes, it takes thinking outside the box. Let me tell you what I mean...

1. By probability, the most likely traumatic injury situation any of us likely to face is a car/work accident with serious injuries. In that case, you will be immediately taken to the hospital and provided life-saving treatment without request for your insurance. Medical bill sharing should help in that situation. If it does not then the next best protection is significant property and casualty insurance with an umbrella policy. That insures a large part of the risk of unexpected medical bills.

2. Chronic health conditions are often caused by lifestyle choices. The best way to avoid type two diabetes, hypertension and many other common chronic illnesses is to control your diet and physical health. Say what you want, but that is a fact.

3. Cancer or organ failure of some sort is, generally, a slow moving situation that would allow for planning. I have saved tens of thousands of dollars in premiums over 7+ years of insuring a healthy family of five with medical bill sharing. I know I can take $50,000 cash to any major metropolitan city in Latin America (Mexico City, for example) and receive the best health care available to over a billion people who live in those countries. You can dismiss this if you want, but I have lived in Mexico and know for a fact that intelligent, caring doctors with advanced technology do, in fact, exist in their country of 190+ million people.

4. You can negotiate cash service for cancer and other treatments in America as well. $100,000 cash goes a long way. It is absolutely possible to save $100,000 in reduced premiums in five years for families (2k per month for 60 months is over 100k). I'm way past five years of ditching expensive health insurance.

5. Medical bill sharing does cover cancer issues and there is no reason to assume they will not except fear. I don't generally like to give fear that much power. As has been discussed, your health insurance can try to screw you as well.

6. Medical debt incurred in an emergency situation is highly unlikely to be collected at the billed rate. Hiring an attorney to negotiate reductions on a large medical bill could cost a few thousand dollars, block the hospital from collecting for years and eventually lead to 50%+ reductions on any bills. If necessary, you can simply stonewall a hospital's collection efforts - people do it all the time. For the record, the health insurance "discounts" are often pathetic back scratching between the health insurer and the medical provider that do no justice to the consumer. I've seen it personally, repeatedly. Negotiating with a competent attorney is likely to get bigger reductions than the health insurance provider accepts for a fraction of the price.

7. There are ways to protect assets even if a medical provider became very aggressive - which I have not seen in my county courthouse. It involves a bankruptcy attorney, moving to a state with a homestead exemption for one year and planning.

8. When it comes to anyone trying to get to the assets of a financially independent person, remember something my contracts professor told me in my first year of law school: When you have the money, you have the advantage. It is their problem to get money from you and nothing says you have to make it easy. I sue insurance companies all the time. Trust me, they don't make it easy and there is an army of attorneys who are very experienced in asset protection.

I only wish I could be as naive as you are about the potential for catastrophic health expenses and how they are covered.

Your umbrella insurance will pay nothing for your medical expenses in a car accident.  You will be provided services under EMTALA and billed for them.  Follow up care will also be billed to you.  There's a good chance in a car accident you'll be stabilized, sent home, and asked to return for surgery, at which point they will absolutely verify your insurance or ask for payment.

The risk of chronic conditions is not type 2 diabetes or hypertension, which are relatively cheap until you get a complication, but that you'll be diagnosed with MS at 33 like a friend of mine was.  45 days of prescription drug coverage is not going to cut it in those cases. In this case, you are provisionally insured by being able to go into the regulated ACA market, but if you are diagnosed in January you'll have to figure out a way to pay for infusions every 28 days for a year before your ACA plan kicks in.  "Just go to Mexico" is not a real option for "acute chronic" conditions which need serious immediate treatment to prevent progression and disability.

The ACA has lowered the risks of going without insurance because you can always retreat into the ACA market if something happens.  That is probably the only reason these health shares are acceptable risks to people.  At the most you are on the hook for a year of care minus whatever health share will pay.


FIREby35

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Re: Let's talk about health share
« Reply #149 on: May 30, 2019, 08:33:18 PM »
I have used Medishare since Obamacare cancelled my catastrophic health insurance plan back in the day. I'm a small business owner with no option for corporate health care. Don't forget, there is a large class of Americans who have never had the luxury of health insurance paid for by the corporation. It's not THAT big a deal :)

Sometimes, it takes thinking outside the box. Let me tell you what I mean...

1. By probability, the most likely traumatic injury situation any of us likely to face is a car/work accident with serious injuries. In that case, you will be immediately taken to the hospital and provided life-saving treatment without request for your insurance. Medical bill sharing should help in that situation. If it does not then the next best protection is significant property and casualty insurance with an umbrella policy. That insures a large part of the risk of unexpected medical bills.

2. Chronic health conditions are often caused by lifestyle choices. The best way to avoid type two diabetes, hypertension and many other common chronic illnesses is to control your diet and physical health. Say what you want, but that is a fact.

3. Cancer or organ failure of some sort is, generally, a slow moving situation that would allow for planning. I have saved tens of thousands of dollars in premiums over 7+ years of insuring a healthy family of five with medical bill sharing. I know I can take $50,000 cash to any major metropolitan city in Latin America (Mexico City, for example) and receive the best health care available to over a billion people who live in those countries. You can dismiss this if you want, but I have lived in Mexico and know for a fact that intelligent, caring doctors with advanced technology do, in fact, exist in their country of 190+ million people.

4. You can negotiate cash service for cancer and other treatments in America as well. $100,000 cash goes a long way. It is absolutely possible to save $100,000 in reduced premiums in five years for families (2k per month for 60 months is over 100k). I'm way past five years of ditching expensive health insurance.

5. Medical bill sharing does cover cancer issues and there is no reason to assume they will not except fear. I don't generally like to give fear that much power. As has been discussed, your health insurance can try to screw you as well.

6. Medical debt incurred in an emergency situation is highly unlikely to be collected at the billed rate. Hiring an attorney to negotiate reductions on a large medical bill could cost a few thousand dollars, block the hospital from collecting for years and eventually lead to 50%+ reductions on any bills. If necessary, you can simply stonewall a hospital's collection efforts - people do it all the time. For the record, the health insurance "discounts" are often pathetic back scratching between the health insurer and the medical provider that do no justice to the consumer. I've seen it personally, repeatedly. Negotiating with a competent attorney is likely to get bigger reductions than the health insurance provider accepts for a fraction of the price.

7. There are ways to protect assets even if a medical provider became very aggressive - which I have not seen in my county courthouse. It involves a bankruptcy attorney, moving to a state with a homestead exemption for one year and planning.

8. When it comes to anyone trying to get to the assets of a financially independent person, remember something my contracts professor told me in my first year of law school: When you have the money, you have the advantage. It is their problem to get money from you and nothing says you have to make it easy. I sue insurance companies all the time. Trust me, they don't make it easy and there is an army of attorneys who are very experienced in asset protection.

I only wish I could be as naive as you are about the potential for catastrophic health expenses and how they are covered.

Your umbrella insurance will pay nothing for your medical expenses in a car accident.  You will be provided services under EMTALA and billed for them.  Follow up care will also be billed to you.  There's a good chance in a car accident you'll be stabilized, sent home, and asked to return for surgery, at which point they will absolutely verify your insurance or ask for payment.

The risk of chronic conditions is not type 2 diabetes or hypertension, which are relatively cheap until you get a complication, but that you'll be diagnosed with MS at 33 like a friend of mine was.  45 days of prescription drug coverage is not going to cut it in those cases. In this case, you are provisionally insured by being able to go into the regulated ACA market, but if you are diagnosed in January you'll have to figure out a way to pay for infusions every 28 days for a year before your ACA plan kicks in.  "Just go to Mexico" is not a real option for "acute chronic" conditions which need serious immediate treatment to prevent progression and disability.

The ACA has lowered the risks of going without insurance because you can always retreat into the ACA market if something happens.  That is probably the only reason these health shares are acceptable risks to people.  At the most you are on the hook for a year of care minus whatever health share will pay.

I'm fortunate not to know much about chronic health issues. That's true.

The umbrella is for when the other person doesn't have enough insurance for an accident they caused and your own property and casualty insurance has been exhausted. In that case, the umbrella will apply and will cover your medical expenses. Since we were talking financial protection for a catastrophic event, I think of this as insuring against one of the highest probability causes of a catastrophic health event that happens with no notice (i.e. a car accident caused by an underinsured driver).

But your point about the umbrella is well taken in a situation where you cause the accident. A good insurance against this risk would be to drive as little as possible.

When/if I am asked for insurance or payment for follow up surgery (or significant care) as you described, the good news is I will have medical bill sharing and lots of cash (saved premiums over the last few years, at least). I'm not worried about not being able to pay for things that cost under 100k in the final price (approximate amount saved in premiums over the last 7 ish years). That is A LOT of things - even in America.

Everything I said about the collection capabilities of hospitals after a catastrophic event is based on personal experience defending debtors of hospitals from collections. Owing a bill is not a financial catastrophe to a financially independent person. Paying a bill might be, depending on the size of the bill. There are many steps between owing a bill and actually paying the bill. By the time you pay the bill, it should have been greatly reduced in negotiations/law suits. Paying the sticker price for a large hospital bill is a mistake. Take it or leave it, but it's true.

"Just go to Mexico" is a legitimate solution for me. I understand if it is not for you -but did you really think about it or just reject it out of hand?  It might be a solution for more people than you think. To me, the situation you described is actually a perfect example of when going to Mexico to receive the treatment would be a very interesting option. You could probably get a luxury apartment in Condessa in Mexico City, a personal doctor/oncologist/whatever to make house calls with the latest technology and plane tickets for yourself and family for the cost of the treatment you described in the United States. Thankfully that is a very unlikely scenario relative to a teenager blowing a red light and crushing us (i.e. a careless driver is a much bigger risk). Also, I said it was outside the box.

You are right that the ACA does limit the potential exposure. To me, that is a justification for getting medical bill sharing - I can get ACA coverage within one year if I absolutely must have it. Can I figure out something for a year with all the money I saved in premiums? Especially if I can take advantage of geography/currency? I do have medical bill sharing and it has worked every time I needed it. Well...I'm taking my chances.