Will You Offer Health Ministry Plans in 2018?

Discussion in 'Health Care Reform Forum' started by Yagents, Aug 22, 2017.

?

Will you offer Health Ministry Plans in 2018?

Poll closed Yesterday at 10:54 AM.
  1. Yes, because it's a great solution

    10.7%
  2. Yes, but reluctantly

    10.7%
  3. No, because it's not major medical

    17.9%
  4. No, for a host of other reasons

    42.9%
  5. Undecided as of now

    17.9%
  1. kgmom219
    Offline

    kgmom219 Guru

    Posts:
    4,978
    Likes Received:
    23
    State:
    Texas
    1. There are no primary providers in Dallas TX.

    Search Type: Provider Location: dallas, TX Type of Doctor: Family Practice / General Practice / Internal Medicine

    No results were returned.

    2. 24 months of pre-ex

    Isn't 2 enough???
     
  2. STIBROKER
    Offline

    STIBROKER God Moderator

    Posts:
    10,017
    Likes Received:
    34
    State:
    Texas
    As a non-insurance membership Altrua HealthShare or the
    membership is not liable for any part of an individual’s medical need.

    MEDICALLY NECESSARY
    A service, procedure, or medication necessary to restore or maintain physical function that is provided in the most cost-effective setting consistent with the member’s condition. The fact that a provider
    may prescribe, administer, or recommend services or care does not make it
    medically necessary. This applies even if it is not listed as a membership limitationor an
    ineligible need in the Membership Guidelines.

    Ineligible Needs
    Any need that requires pre-authorization is considered ineligible within the first 90 days from the effective date

    Inpatient hospital stays exceeding 60 days per medical need.

    Lifestyles or activities engaged in after the application date
    that are in conflict with the Statement of Standards

    Any illness, injury, or condition for which there is a
    membership limitation. The member will be notified of membership limitations
    when applying for membership


    https://altruahealthshare.org/pdfs/ahs_membership_guidelines_2017-2.pdf

    [​IMG]
     
    Last edited: Aug 23, 2017
  3. junkman
    Online

    junkman Guru

    Posts:
    622
    Likes Received:
    5
    State:
    Tennessee
    Bummer. If you're married, can't get any stray. If you're not married, can't get any stray. Many in the church could not live up to that.

    UHC said that STM may be able to be sold for 12 months. They are currently only 3 months. Here's hoping the Repubs at least can get that done.

    What's a person to do? Pay $28,000 in premium for the cheapest plan or ????
     
  4. somarco
    Offline

    somarco Guru

    Posts:
    26,696
    Likes Received:
    129
    State:
    Georgia
    Arguing for or against the nuances of a CSM may be fun on this forum but in real life it could be less enjoyable.

    I do a very good job of educating my clients on the downside of enrolling in insured plans. Yet when claims roll in many of them forget what we discussed. Almost no one bothers to read their policy when it arrives, much less attempt to understand it.

    If you visit consumer sites you will find numerous complaints about how the insurance carrier screwed them over by denying their claim. If you press them for details you will almost always find the following.

    - they had no idea what was covered because they did not read their policy until AFTER the claim (if then)

    - they almost never cross-check EOB's against medical bills, even when they get dunning letters

    - they ASSUME once they pay their copay that is the extent of their liability

    - they almost never understand what happens when they use a non-par provider and complain that failure of the carrier to pay the full amount is unfair

    - more often than not they view their insurance card as medical credit card with an unlimited line of credit and expect it to pay everything

    So why would you think they will read and understand the limitations of a CSM plan?

    The health insurance market (including CSM and ancillary plans) is a snake pit right now. Enter at your own risk.

    [​IMG]
     
  5. yorkriver1
    Offline

    yorkriver1 Guru

    Posts:
    1,128
    Likes Received:
    1
    That says it all. We would be essentially sharing in the client's risk, too.

    Somarco mentioned clients not reading policies. They have what I call the "motel theory" of assumptions about insurance, it covers almost everything, right?
    When we think of a motel room, we make certain assumptions about the basic features: 1. TV with remote 2. toiletries in the bathroom, also bathroom for you, not shared with other guests. 3. clean linens (well, some are aware this could be an issue) 4. coffee maker with supplies to make coffee. 5. ice machine down the hall, bucket with plastic bag liner in your room. 6. hoping for breakfast buffet and free parking, sometimes disappointed. 7. fridge & microwave, disappointed if not there.

    Insureds think insurance covers sickness and accidents, maybe a deductible, these days they usually expect copays, some sharing, but a maximum out of pocket. Essentially the structure of group and individual coverage for several decades. In rare instances some bumped up against lifetime limits pre ACA, and there are still stories searchable online, heart wrenching ones about coverage denied to sick kids, etc.

    I have 3 clients who have had claims over $1 mil, and those are the ones I know about. All had unlimited coverage after the Max out of pocket.

    I could not sleep if I was selling products that could be misinterpreted, give a false sense of security & I would not be covered for lawsuits/judgments under E&O.

    So, no, not selling faith based plans. People need to read up on market values and costs. Your house isn't worth what it was worth at a market peak, and lower cost health plans will cover less.
     
    Last edited: Sep 14, 2017
  6. Yagents
    Offline

    Yagents Guru

    Posts:
    9,911
    Likes Received:
    27
    State:
    Arizona
  7. scagnt83
    Offline

    scagnt83 Guru

    Posts:
    6,549
    Likes Received:
    36
    State:
    South Carolina
    I know a CPA who uses one of them (Solidarity). A local agent sold him on it, but he asked me what the downsides are. After going through the contract these are the big issues so far:

    In big bold lettering it says this at the very beginning:

    "This program does not guarantee or promise that your medical bills will be paid or assigned to others for payment. Whether anyone chooses to pay your medical bills will be totally voluntary. As such, this program should never be considered as a substitute for an insurance policy. Whether you receive any payments for medical expenses and whether or not this program continues to operate, you are always liable for any unpaid bills."

    ---

    Not Covered:

    6. Complications of non-eligible treatments.

    9. Durable Medical Equipment.

    14. Gross Negligent Acts.

    16. Hearing aids and exams.

    20. Impotence

    21. Infertility.

    22. Mental Health Services.

    23. Non-Emergency Transportation


    26. Outpatient prescribed or non-prescribed medical supplies.

    30. Replacement braces


    34. Surgical direct sterilization or reversal.


    -------


    "Sharing Limits" (more of whats not covered):


    7. Hospice Care. Hospice Care is limited up to 5 days

    12. Organ Transplant Limits. maximum of $125,000 per organ per lifetime. (small fraction of what a transplant costs)

    14. Physical Therapy. Up to 20 visits per calendar year for physical therapy

    15. Pre-Existing Conditions. Conditions that exist at the time of enrollment that have evidenced symptoms and/or received treatment and/or medication within the past 24 months are not eligible for sharing.


    Here is a BIG gap in the "Sharing Limits":

    4. Excess Charges.
    "It is the intention of Solidarity HealthShareSM to limit the sharing of charges determined to be unfair or unreasonable and will advocate on behalf of Sharing Members against any healthcare service provider demanding payment of such unfair charges.”

    10. Excess means charges in excess of fair and reasonable consideration or reasonable fees, or are for services not deemed to be reasonable or Medically Necessary or for billed amounts found to constitute invalid charges, based upon the determination of Solidarity HealthShareSM or its delegate in accordance with the terms of the Sharing Guidelines.


    So if the charges are higher than what HSM considers "fair and reasonable", you are liable for them. They do make an effort to negotiate the charges on your behalf. But you are still on the hook for anything over what they deem reasonable.

    To contrast that with actual Insurance. As long as you are In-Network, all prices are pre-agreed upon. There are no real surprises like this could have.


    ---------

    Then there is major ambiguity in the "Lifestyle" rules:

    1. ... to avoid every kind of excess to include, but not limited to, the abuse of food, tobacco, alcohol, and medicine (prescription drugs).

    2. Follow biblical teachings on the use or abuse of alcohol.

    5. Intentionally incorporate exercise and good nutrition into one’s daily life



    That is pretty loose wording on exactly how much food you can eat... or what food you can eat. Or exactly how much alcohol you can consume.

    What qualifies as "good nutrition"?

    If you develop diabetes and the doctor puts in the notes that its due to "poor diet". Are they going to cover that?? It sure sounds like that would be a Deniable Claim...

    --------

    The last issue is they do not disclose any financial info and there is no independent audit of the operation that is made publicly available or made available to members. A big black hole when it comes to the accounting.
     
  8. somarco
    Offline

    somarco Guru

    Posts:
    26,696
    Likes Received:
    129
    State:
    Georgia
    Bill & Tyler, very eye-opening. Thanks for sharing (no pun intended).

    Bill's link made reference to claims denied if you are not still a dues paying member when the claim is finally adjudicated.

    Not good.

    The Hotel California of CHSM.
     
  9. Yagents
    Offline

    Yagents Guru

    Posts:
    9,911
    Likes Received:
    27
    State:
    Arizona
    I like the comment about it not being too Christian to beat providers down on price, as they are self paying patients.
     
  10. Dave020
    Offline

    Dave020 Super Moderator Moderator

    Posts:
    3,312
    Likes Received:
    18
    State:
    California
Loading...

Share This Page