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In some ways, using a health share membership for medical bills can simplify the process. However, unexpected bills can affect whether or not a cost is considered shareable and cause unneeded stress. After doing some research, we’ve found some possible ways of avoiding them.
Many health shares no longer use provider networks and this eliminates a large number of potential problems. Aetna provides the example of a woman who had a surgery, then was charged thousands extra because the hospital-provided anesthesiologist was out of network. When networks are no longer an issue, patients only need to check that the providers and facility are properly licensed—and situations where that might even be in doubt are exceptionally rare.
Removing network considerations definitely also removes some of the headaches involved with medical billing. However, if you belong to one of the health shares that still uses a network, you’ll want to check that providers, and facilities, are contracted with that network. The large health care sharing ministries with networks almost all use PHCS, which is the largest provider network in the United States. This is a good thing, but keep in mind that you still need to check! This network, while large, works better in some regions than others. For example, someone living in New York City likely won’t struggle to find providers and facilities who are in-network. Someone living in a rural county might. If you know you need a procedure in advance, tell the office which network you need as quickly as possible. On the day of, double-check that those scheduled to work with you are in network.
Don’t forget that facilities also use networks! If you belong to a health share which doesn’t use a network, you have no issue, but if you do…where you go matters. Surgery centers, emergency rooms, urgent cares, imaging centers, and lab centers all have networks. Never assume that your provider will send you to an in-network facility! They rarely know which networks a facility is contracted with, and also, frequently, providers lack time and might not think to check. If your doctor recommends you have bloodwork done, for example, ask the lab if they’re contracted with Multiplan/PHCS before receiving any services. This can save you hundreds of dollars.
One of the most insidious billing practices is the addition of a facility fee to a final bill. In some cases, these fees make sense—they help cover the costs of running complicated buildings such as hospitals. However, the fee can vary widely between facilities, and in some cases they really do come as a surprise. According to The Alliance, fees are often charged by clinics owned by hospitals. In some places, hospitals have purchased multiple local clinics. This means that it may be impossible to visit an ordinary clinic without being hit by a facility fee. Even worse, one woman was charged a facility fee for a virtual appointment!
Honestly, there may not always be a way to avoid facility fees, especially if you live somewhere without many facility options to choose from. However, when possible, asking in advance allows you to choose a facility with the lowest possible fee.
You can comparison shop for healthcare just like you would anything else. It’s intimidating, perhaps, but it’s doable. Health shares in particular have begun providing their members access to comparison tools such as Healthcare Bluebook. Healthcare Bluebook does have a free option, but the site will likely be more thorough and easier to use with the assistance of your health share. Healthcare Blue Book (and other comparison sites like FairHealth or ClinicPriceCheck) provide price estimates based on billing codes. While you can choose from a menu of possible services, using your provider’s office or health share to check codes will give you the most accurate results. That makes it easier to find the most affordable, quality care in your area.
Recent legislation expands protections against balance billing for people who have health insurance. If you don’t know, balance billing is when a provider bills you for the difference between their fee and the insurance’s allowed amount. While it may seem that this legislation may not apply to health share members, that isn’t entirely true! The law makes a provision for people without insurance: providers must give a good-faith cost estimate before you receive care. Per CMS.gov, you can file a dispute if you are charged more than $400 above that estimate.
Every time you see a provider, request an itemized bill of the services received that day. Your health share will want it regardless, but there is evidence that up to half of all medical bills have an error in them! An itemized bill makes it much easier to see what you were charged for, when, and to verify the medical codes used. The Insider article linked above provides excellent information about itemized bills, and how to use them, so we highly recommend giving it a read. Understand that most providers will not give you an itemized bill unless you ask for it, but once you do, they are legally required to comply. Itemized bills help patients catch errors as well as deliberate actions such as upcoding, so it is always worth doing.
Following all these guidelines makes it much less likely that you’ll receive large, and unpleasant, surprise bills. It’s certainly a lot of work to research before receiving care, but the money and headache saved by doing so is well worth the effort.
