Christian Health Cost-Sharing Ministries Offer No Guarantees

[odanny]

Originally Posted by noodlecat

Until we have some sort of universal health care, I'm glad there are still choices such as HS ministries for those of us who may want or need an alternative to for-profit, conflict-of-interest insurance.

"conflict of interest insurance"?

Yea, talk about conflict of interest, if you were not leading a good Christian lifestyle before your illness, sorry, you're not covered. And the rest of the insurance pyramid in America is not much better. One is an extremely lucrative business model that is not going to stay that way by providing all the needed treatment for its patients, while the other is probably not going to either, although I have no idea what their profit margins are, or if they even report this information like the other insurance companies, be they Blue Cross, Blue Shield, Aetna, or the multiple other ones out there.

There is no greater racket in America than health care, including prescription drugs.

[Ariadne22]

Originally Posted by KaraG

Since I posted above, I have had to use my Christian Healthcare Sharing Ministry. Had a bad fall out of state, ended up in the hospital 4 days, long surgery. Bill was over $300,000. No insurance company making decisions for me, I got to decide.

I informed all the providers that I had no health insurance and I needed the self pay rate. Once I had the adjusted bills (which was hard to get in some cases, they are not used to sending bills to patients), I sent them to CHM and they sent me a check. I then paid the providers.

I am extremely happy with how it worked. We get the bronze plan which only covers hospitalization, which is what we wanted. We pay for everything else (always asking for the self pay rate). For example, my physical therapy charges $571 but the self pay rate was $120 per visit.

So, you didn't pay providers directly but waited until you got the check from CHM? How long did that take? Reimbursement from cost-sharing ministries from what I've read on this and similar threads can take three or four months, at least. You were able to keep the providers off your back for that period of time?

Also, it appears self-pay on therapy was 20% of the billed rate. That's a really steep reduction. I know we would not get that accommodation around here from any provider. My son/dil who had no insurance for a while tried to negotiate rates years back with a major hospital and got nowhere.

What were the actual numbers? Hospitalization was reduced from what to what? You then sent that bill to CHM. Did they pay it in full?

Also, if your policy covers only hospitalization, did that mean surgery costs, including the surgeon, were on you? If so, was the surgeon willing to discount his fee, as well?

Just trying to get a sense of the exposure someone might have should they have your experience and your coverage.

Thanks.

[old fed]

Originally Posted by noodlecat

I watched the John Oliver show. I thought the funniest thing was that his outrage seemed to come from some expectation or desire that HS ministries would be or should be exactly like insurance. That is like being outraged that trucks are not the same as cars, or that annuities are not the same as IRAs. Why would or should HSMs be the same as insurance? They are two similar but different things.

Until we have some sort of universal health care, I'm glad there are still choices such as HS ministries for those of us who may want or need an alternative to for-profit, conflict-of-interest insurance.

no, it came from them trying to pass themselves off as insurance or more specifically, their marketing. he was very explicit to let people know it was NOT insurance. that was the entire point.

[noodlecat]

Originally Posted by odanny

"conflict of interest insurance"?

Yea, talk about conflict of interest, if you were not leading a good Christian lifestyle before your illness, sorry, you're not covered. And the rest of the insurance pyramid in America is not much better. One is an extremely lucrative business model that is not going to stay that way by providing all the needed treatment for its patients, while the other is probably not going to either, although I have no idea what their profit margins are, or if they even report this information like the other insurance companies, be they Blue Cross, Blue Shield, Aetna, or the multiple other ones out there.

There is no greater racket in America than health care, including prescription drugs.

I said "conflict of interest" because insurance companies are for-profit, therefore it is in their best interest to make money by denying claims to satisfy their shareholders.

All insurance companies have denied people for all sorts of reasons. It used to be pre-existing conditions - have one of those? - denied. Don't follow their labyrinthian rules? - denied. Went to wrong hospital, prescribed wrong drug? - denied.

Same thing with auto insurance. Got three tickets? - policy is canceled.

Yes, I wholeheartedly agree with your comment about it all being a racket.

[noodlecat]

I have received self-pay discounts with every provider I have used - hospitals, doctors, dentists. The self-pay rate will always be lower than any insurance rate because it cuts out the middleman (the insurance company) and all its associated overhead costs (extra time, resources, people needed to process the paperwork).

[KaraG]

Originally Posted by flashlight

do you think the providers took a loss on you, since you claimed self pay?

does not sound like you were self-pay.

No I don't think they took a loss. If you have any original itemized bills, look and see if they charged your insurance company the full rate.

I have been with and without insurance many many times over my lifetime. Providers almost always lower the bill if you are self pay. This is not a new thing.

[KaraG]

Originally Posted by Ariadne22

So, it appears self-pay on therapy was 20% of the billed rate. That's a really steep reduction. I know we wouldn't get that accommodation around here from any provider. My son/dil who had no insurance for a while tried to negotiate rates years back with a major hospital and got nowhere.

What were the actual numbers? Hospitalization was reduced from what to what? You then sent that bill to CHM. Did they pay it in full?

Also, if you policy covers only hospitalization, did that mean surgery and rehab costs were on you? Or was surgery included in hospital?

Just trying to get a sense of the exposure someone might have should they have your experience and your coverage.

Thanks.

Your son/dil should try other hospitals.

The self pay rate is all over the place and depends on the providers. Always has been. Over the years I've seen 0-90% discounts for self pay.

My plan covered all charges relating to a hospitalization with a $5000 deductible. Because my discounts were over $5000, I didn't have to pay that. It covered everything once I walked into the ER until I walked out of the hospital 4 days later. Then I'm back to self pay with no sharing.

My surgeons' bill was $10,000 discounted to $7,000.
My anesthesiologist's bill was $4400 discounted to $2100.
My ER doctor's bill was only $618 and I didn't ask for a discount.
My lab and x-ray charges were also low enough not to bother asking.
My hospital bill was $295,000 and discounted to $20,000. The charges were over the top inflated, $500 a pop for every pain med, etc.

Once I got the adjusted bills or an email confirming the self pay discount, I uploaded them to CHM along with a worksheet showing each bill, original amount, discount and how much I paid so far. I got the check, in full for the self pay amount, from them in about 4 weeks and paid the providers immediately.

So now I'm back to just self pay. My doctors discount about 40% on office visits. I finished physical therapy but may go back now and then just to make sure my healing is still on the right track.

[noodlecat]

My PCP discounts self-pay, but I'm not sure how much. I think one time they mistakenly charged me the insurance rate and it was something like 30% more.
My dentist discounts self-pay 10%.
The last time I went to the ER the bill was discounted 75% for self-pay.

[Ariadne22]

Originally Posted by KaraG

My plan covered all charges relating to a hospitalization with a $5000 deductible. Because my discounts were over $5000, I didn't have to pay that. It covered everything once I walked into the ER until I walked out of the hospital 4 days later.

My surgeons' bill was $10,000 discounted to $7,000.
My anesthesiologist's bill was $4400 discounted to $2100.
My ER doctor's bill was only $618 and I didn't ask for a discount.
My lab and x-ray charges were also low enough not to bother asking.
My hospital bill was $295,000 and discounted to $20,000. The charges were over the top inflated, $500 a pop for every pain med, etc.

Once I got the adjusted bills or an email confirming the self pay discount, I uploaded them to CHM along with a worksheet showing each bill, original amount, discount and how much I paid so far. I got the check, in full for the self pay amount, from them in about 4 weeks and paid the providers immediately.

So, because you negotiated discounts in excess of $5k, you didn't pay the deductible, either. And, your $310k medical expenses essentially became $29,718 - which CHM paid in full. Good job!!!

Your costs, in the end, were very small - all things considered. I've said upthread, these ministries have a place. You being a proactive and a knowledgable consumer helped. Liberty, as I understand from what I've read elsewhere, will do the negotiating - but their payment can take a good long while to receive.

Thanks for providing this info.