Health shares in 10 Lessons: Christian healthcare ministries, or how to argue a bill

Filed Under: Costs

A community member shared some prices on our interactive software. We started a conversation, and learned that he is a health sharing ministry customer, and that he’d posted about his experience on his blog.

I asked if I could re-post, and he said yes. Here’s his post, with an addendum below.

Health Shares in 10 Lessons
Two rounds with CHM…

By Tim Behr

CHM stands for Christian Healthcare Ministries. It is one of several “medishare” type plans available to the general public.

Others are:

Samaritan Ministries

Liberty Healthshare

Medi-share

Altrua healthshare

Solidarity healthshare

and many other lesser known options.

All of them operate in a similar manner, and my experience with CHM should give you a good idea of what to expect with any of them.

I have had a CHM plan for many years, probably since about 2012 or so. My job didn’t offer health insurance, and my wifes job didn’t cover spouses. I paid the ACA penalty the first year, and decided I had better see if there were options. I was surprised at the large number of them.

Metal levels, coverage

The plans are tiered much like the ACA, Bronze, Silver, Gold etc. I started out with a Bronze plan, I could afford it (about $50 per month) and it covered up to $100,000 per incident. Not shabby, this would be acceptable for someone in good health and a bit younger. My concern with this type of plan was more along the line of a car accident with serious injuries. Something like that could quickly rocket to over my maximum coverage of $100,000.

After a year or so I switched up to a Gold plan. More expensive, but higher coverage per incident, and with the Brothers Keeper option (unlimited ceiling) well worth it at about $155 per month.

The promised coverage is impressive. No referrals, any doctor, anywhere, any time, including specialists. No networks to try to figure out, so you are never out of network. Like many mainstream plans, no real vision or dental coverage, but then, I never had it with any other insurance I had either.

I was hoping to never really need to use it, but that came to a quick end in 2017. For the details on that, see “First round with CHM”, a previous blog. Too lazy to look for it? No worries, Here is a quick recap.

The emergency room

A one day visit to them emergency room ran up about $4000 in bills from three sources, The hospital, the radiologists, and the emergency room doctors (who apparently don’t work for the hospital…). I submitted the bills, and yes, they paid. Eventually.

Some important lessons were learned. Even though CHM claims they will pay claims within 3 months, they never say from when those 3 months start. The time you submit the bill? The time when they approve the bill payment? When they have all the bills for the incident? Lump sum or per bill?

I never figured it out.

What I did figure out was that it took 149 days, from the time I submitted all three bills, to the time I was paid in a lump sum. Was that the answer? I didn’t really want to test the theory again. Unfortunately I did.

Since it was 149 days, and since I was expecting payment in 3 months, the first newbie mistake I made was in not paying the first months bills, expecting a check from CHM “momentarily”. By the time the third month rolled around, the collection notices were flying. Figuring (wrongly) that if I did make a payment towards each bill they would hold the account open, I made $100 payments to each bill. This did not work. The bills went to the collectors, and the phone started ringing off the hook. We had to unplug the phone and only plug it in when we made a call, then quickly unplug it again. Although we rarely used our cell phones, it seemed the only alternative left, so we canceled the landline we had for 15 years. Making payments on the bills from the collectors did not stop the calls coming in several times a day.

This is a road you do not want to go down.

Lessons learned

Lesson learned :

Lesson 1 – IMMEDIATELY upon receiving the (first) bill, call the service provider and set up a payment plan. You must begin making monthly minimum payments right away to keep these accounts out of collection.

Lesson 2 – do not, under any circumstances, give the hospital or any service providers, a phone number that you are not willing to disconnect. If I had given them my cell phone number it would have been infinitely easier to just switch numbers.

Lesson 3 – do not, under any circumstances, pay any of these bills using your credit card, or a personal check. This simply supplies bill collectors with vital information to garnish wages to seize accounts. Use money orders instead, or use online payment portals and pay with a gift card. “Blur” offers a “masked card” for a few dollars, which generates a Mastercard gift card on the fly. This works well as it contains no information traceable to your financial accounts.

Lesson 4 – Be prepared to pay minimum payments on all bills incurred for an undetermined amount of time. This means either money in the bank, or on a credit card, (or both!)

Lesson 5 – Say it to yourself, over and over. “I am self-pay”. Do not tell anyone you have a health share account. CHM used to recommend telling doctors that you had “coverage” through them. I tried this early on, and it quickly became a nightmare. The first thing they want is your member card, then they call it up. You see, they are only interested in ONE THING. Do they bill CHM? Or do you pay. It takes them a long time to figure out that billing CHM gets nowhere. This ties you up in the meantime. Skip the aggravation, you have to pay it, so that makes you….”SELF PAY”. As an added bonus, if you say “self pay” from the start, your bill will generally be five times less than what they bill the insurance companies. A $5000 emergency room visit magically becomes $1086. Self pay does actually pay. Well, you do anyway…

More lessons learned

Lesson 6 – Self pay doesn’t always get discounted. Some providers simply refuse to discount pricing for self pay. Hospitals usually do, doctors and surgeons usually do. Anesthesia providers are another story, I have yet to run across any that will discount for self pay, but they will offer a payment plan if you ask right away. Waiting for a few months bills and then asking for a payment plan will not work, it will go right to collection. Emergency services (ambulance, rescue squad, etc) are another area that do not offer any discounts, and these fees can be extremely high. Again, payment plans at the start are the way to go.

Speaking of emergency services, most of these health share plans do NOT cover emergency transportation, “unless your life is in danger”. This is open to interpretation by the various plans. Calling an ambulance for a heart attack will not be paid for UNLESS you are immediately operated on. They get to make the call, and so far, I have not seen them pay for this.

Lesson 7 – ITEMIZED BILLS. Here is another area where these types of plans can weasel out of a payment. You must supply an itemized bill for all services. You are not normally sent an itemized bill, these are reserved for insurance companies. As a “self-pay” customer, who is probably getting a serious discount, you are not a candidate for an itemized bill. Some smaller doctors will not even provide one if you ask for it, if you are self pay. Fortunately these amounts are generally not overly large, and I consider them my “deductibles”. They do add up though, figure on 500-1000 dollars will not be allowable to submit due to “non-itemized” bills.

After your first bill from a provider, if it is not itemized, (probably not), call immediately and ask for an itemized bill, and ask for it to include the insurance codes as well. This raises some eyebrows since you told them you were “self-pay”, and now you are asking for information normally given to insurance companies. I suspect they think you are trying to con them by saying you are self pay, and then providing insurance info later.

Lesson 8 – Have a credit card reserved for medical expenses only. Since this type of health plan becomes a war of attrition on your wallet, a dedicated card can be a substantial help in this instance. Yes, you will have interest charges, but the payments will be easier to manage. Note that making payments using the card is not the ideal position, for reasons we have previously discussed (traceability to your financial accounts), instead, use the card to pay in full certain medical bills as required. For instance – any scheduled procedure is generally paid for IN ADVANCE, and IN FULL. So if you have scheduled surgery, the surgeon wants payment in full, in advance. (Note that they will probably give you a good “self pay” discount for doing this).

If you are in the hospital, expect every doctor or PA or specialist that happens to walk by your door and ask “how are you feeling today?” will send you a bill for that “service” as well. If they discount it (they usually do in this case), it is one of those that can be paid in full using the “medicard”.

Yes, keep track of everything yourself

Lesson 9 – No one is keeping track of your bills, your payments, or scheduling. Normally, this is largely done through your insurance company. We are used to just reading a statement of what they did, and paying the amount left on the bottom line. Done.

This part can be the hardest to do.

You must keep a ledger of every bill, every service, and every expense.

A spreadsheet or account book is invaluable for this. Note the date, amount, and provider for each line item, and also note the minimum payment amount, and when it is due. Copy every payment you make against every bill (copy the bill as well). CHM allows these to be uploaded through the “member portal”, other company’s probably have similar portals. CHM requires all uploaded documents to be in PDF format, so this is important to know ahead of time.

I have found it is not unusual at all to get a follow up bill with an entirely different amount due. It is also common to not be credited with amounts you pay. You will need all these copies, so make them and file them by provider. Keep track of your remaining balance in the spreadsheet.

Besides the accounting side of things, you may also need to be “purchasing”. I was told I needed a cholecystectomy, or gall bladder removal. I had to shop around for a surgeon, making consultation visits, (about $250 a pop), I had to book the operating room with the hospital, and I had to set up a payment plan with the anesthesia provider. This is not as hard as it sounds, but does take some time. There are medical procedures that are prepackaged and sold available on the internet as “all in one” procedures. They even set up the payment plan. (see selfpaypatient.com and medibid.com for starters).

Lesson 10 –

Log your progress. You can see the status of your “case” by reviewing your submitted documents at the “member portal”. This may show what has been reviewed and what is “pending”. Be prepared to wait.

Round one with CHM was 149 days.

Round two has gone 157 days from the incident, and nothing yet, but round two was much more involved. Where round one consisted of 3 separate bills or so, round two has 18. Half of those 18 have been paid in full already, as they were smaller ones, except for the surgery, which is on the “medicard”. The remaining half are on payment plans, with the exception of the emergency room doctors, who inexplicably do not work for the hospital, nor will they provide any way to contact them. Strangely, their bills are identical to the hospital emergency room bills. Makes one wonder.

Summary

While I still feel that CHM is a fairly good deal, the delay on repaying these bills can be a killer. The self pay patient must be able to make payments against medical bills for the duration of the review, which took at least 5 months in my first case, and more than that so far in the second.

If you are scraping now, it will be extremely difficult to survive this.

Hopefully, with what you learn from this, maybe you can better prepare for holding out until your claim is paid.

While it all sounds bad, it is still better than the ACA with its “mandatory” $5,000 deductible floor and its numerous in-network, out-of-network rules.

So keep an eye out here for future blogs about this, and if you are looking at health-share options, maybe some of these tips will make it all go much smoother for you.

Here’s to your health!

Update – April 5, 2019 

Well, the check finally arrived, 143 days after the first bill was submitted, and 164 days after the incident.

So not quite 5 months later, to be fair.

But now for some disturbing news.

I knew the ambulance was not likely to be covered, even though I didn’t call for it, (I was unconscious at the time), because I was not operated on immediately while admitted. Apparently once discharged, you qualify as “non life threatening”. Okay, I don’t think its fair, but those are the rules. (See Lesson 6).

More disturbing was that the anesthesia services were not covered. I know some insurance companies do not pay for this, but there is nothing in the posted guidelines about that. Since this was administered during the operation, I would figure this to be covered, and as previously noted, this was one service that refused to discount for self-pay. I have asked for an explanation, and when I get one, I will post the information as an addendum here.

Also problematic was that payment for the radiology services, (x-ray, MRI, sonogram) was discounted by about 75%, as near as I can calculate. This bothers me because they clearly know the amounts due, and paid only a small portion of it. Again, nothing about this in the posted guidelines that I can see. Another explanation asked for.

Being that both of these bills actually exceeded the cost of the surgery itself, these are large amounts.

Emergency room doctors: Yes, they’re subcontractors

The remaining issue concerns the emergency room doctors. Apparently hospitals subcontract this service. My emergency room doctors all worked for a company based in Ohio. This is apparently because my state has laws forbidding “balance-billing”, but that only applies to organizations located “in State”. This way they are effectively “out of network” for regular insurance or the ACA plans. And can bill you additional fees to make up what they “lose” on mandated costs. So far, CHM has not paid these bills at all. No explanation has been given. What is odd, is that these bills are identical to the hospital emergency room bills. Same exact amount in every case, yet they are payable to different entities. I suspect CHM thinks this is “double billing”, but they are clearly payable to different entities. No word on this issue yet either.

So in spite of getting self pay status, and booking all these services myself, I am still left with slightly under half of all these bills unpaid. The total costs were $22,617.00 for this entire incident, but only $11,595 was shared. I still owe $11,000 according to CHM.

At this point I must question whether this is better than ACA insurance or not. At least with the ACA, I would have only paid $5,000 and some small prescription expenses, oh and the ER doctors (out of network, see?).

Anyway, updates to follow as soon as I hear from CHM. Meanwhile I will withhold judgment on the feasibility of this for uninsured people, or even as an “umbrella” policy.

Caveat emptor.

https://www.chministries.org/

April 19, 2019

Tim Behr is a chaplain and reverend loosely associated with Society of Friends, and founded the internet church in 2012.

When we talked via email, he said:

“Keep up the good work, maybe this will all be fixed someday. At this point I am working on getting the house ready to be sold, I know I can’t pay the rest and my job is getting ready to lay people off, so I will lose it all it seems. Sad that healthcare can come to this. I have had to write out instructions that under no conditions do I ever consent for anyone to call 911 or be transported by ambulance anywhere. I would rather die at home and leave my family able to survive, than burden them with bills that will ruin them. I can tell you this, the next time I go to the hospital, it will be to the morgue.”

A few weeks later, he added:

Use whatever you wish Jeanne, maybe it can help someone else.

To be fair, I have not gotten a response from CHM yet. If they do decide to pay the anesthesia, ER doctors, and radiology bills, I would be in slightly better shape than I am now. I am literally praying for that to happen.

I know they have received my letter, it is listed as “awaiting filing”, so maybe they are going to respond. Eventually.
I will update the post when they do, with whatever the reply is.

And another few weeks later, he added:

I have not had time to wade through the paperwork, but it seems they did finally pay out on two of the five outstanding charges that I questioned them about not paying. One of which may be the emergency room doctors, the other I know for sure is the third visit to the emergency room. This leaves only anesthesia, radiology, and one unknown surgeon outstanding, about 6500 dollars left to go. At least it may be survivable at this point.

I probably forgot to mention that the diagnosis of these ER doctors was wrong in every single case. The first time at Vassar they said I had an intestinal blockage, despite having been on Magnesium Citrate for over a week, and being decidedly “empty”. The second visit to Healthquest/Caremount said I had “Bilary Colic”. so they were close, but never followed it up, the third trip was for the concussion I suffered the day before when I passed out (ER visit 2), and diagnosis, concussion. surprise.

The follow up with my GP pushed me to immediate surgery as it was severe.

Had I been able to get a timely appt with my GP, all that could have been avoided, but the “quick” appt was for Nov. 7th, and my attacks were October 16, and 22. I made the appt on the 7th and was operated on Nov 19. Thats how critical it was, but I suppose the hospital did not want to get involved since I was self pay, and that would have cost them quite a bit.