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???
Will You Offer Health Ministry Plans in 2018?
- Thread starter Yagents
- Start date
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???
- Staff
- #32
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
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
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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 ????
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 ????
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.
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.
- 1,800
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.
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- Thread starter
- #36
I ain't touching these CHM's. Scroll down and read the actual readers comments.
Health care sharing ministry members share their experiences
Health care sharing ministry members share their experiences
- 10,824
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.
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.
- Thread starter
- #39
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