Liberty HealthShare, Inc.

[A default letter is provided here which indicates your acceptance of the business's response.  If you wish, you may update it before sending it.]
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted]6, and find that this resolution would be satisfactory to me.  I will wait until for the business to perform this action and, if it does, will consider this complaint resolved.
Regards,
[redacted]

This member does have a legitimate concern. We do not bait and switch, and would not want to make decisions that would give any member that impression. However, because his concern was not addressed appropriately, he obviously felt that is what was happening. The time frame in which our 3 different...

messages were emailed and mailed did fall outside the time frame in which he became a member. The Member Services Supervisor is contacting him to resolve this.

On 2/19/18 we responded to you that your expenses had been reprocessed. The bills just had a check assigned to them and they will be going out in the mail tomorrow. A member of our Research and Resolution team will be in contact with you today regarding these expenses. Our records indicate you had two active membership so our IT staff has now corrected this problem.  You should be able to log into your ShareBox at this time.   Please reach out to our Member Services Supervisor if you have any further issues.

Revdex.com:Thank you for paying the bill before it went into collections; however I will not be continuing my membership and wish to end this relationship.
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution would be satisfactory to me.  I consider this complaint resolved.
Regards,
[redacted]

We received a call from you asking us to send the checks directly to the provider and not as reimbursement to you. When we reprocessed the request, it created a different date because we had to modify. In doing that, it did delay the checks from immediately going out. The updated batch has been...

created and the checks will be mailed to the provider in the amount of $510.65 for the date of service to which you are referring. The entire amount is not being shared because there is a code on one of your bills that is not eligible for sharing under our guidelines.   If you have any additional questions, please do not hesitate to reach out to our Member Services Supervisor.

Your membership was cancelled for the end of December, however we are changing that for you to the end of November. You will be refunded the amount of $181 for December. Have a blessed day.

Revdex.com:
I received the reimbursement checks from Liberty Healthshare today in the mail.  This complaint is resolved and the issue can be closed.  Thank you.
Regards,
[redacted]

The appeal you are referring to was reviewed and approved. All your expenses were reprocessed accordingly as eligible for sharing; the bills you are receiving now would be balance bills. Balance billing is when Providers bill you for the remaining amount because they refuse to take anything less...

than the inflated billed charges. Our records indicate that you sent information regarding balance bills to MCS yesterday and a patient advocate has been into contact with you today regarding these bills. We will be sharing with one of these since that particular Provider is not willing to make any adjustments.  We will be in contact with the remaining facilities.  In the meantime, if you have any additional questions, please do not hesitate to reach out to the patient advocate that has been assigned to you.   Below please find an excerpt from our Sharing Guidelines regarding Excess Charges.   5) Excess Charges. In furtherance of the shared beliefs of all members, it is the mission of Liberty HealthShareSM to assist members to manage, control and direct their individual healthcare and the costs of that care. This includes the duty of each individual member of Liberty HealthShareSM to protect all members from unfair, unreasonable, or hyperinflated charges submitted by providers of healthcare services. Provider charges must first undergo assessment of reasonableness, and if unreasonable, negotiations with health care providers will be required to be undertaken by Liberty Healthshare before being eligible for sharing. Members are expected to cooperate with Liberty HealthShare’s negotiation efforts. Liberty HealthShareSM reserves the right, on behalf of its members, to determine what part of an expense for the care and treatment of an injury or illness is unfair or unreasonable, based on techniques, criteria and standards established or adopted by Liberty HealthShareSM. It is the intention of Liberty HealthShareSM to limit the sharing of charges determined to be unfair or unreasonable and may choose to advocate on behalf of Sharing Members against any healthcare service provider demanding payment of such unfair charges. In this event, Liberty HealthShareSM will make concerted effort to encourage those physicians, providers, or facilities to agree to more reasonable prices, but if this is unsuccessful, the member will be notified by Liberty HealthShareSM that these practices/facilities are not willing to charge reasonable fees, and should the member continue to utilize these practices/facilities, they will be doing so with the understanding that the excess charges are their (the member’s) responsibility and future excess charges will not be eligible for sharing

[A default letter is provided here which indicates your acceptance of the business's response.  If you wish, you may update it before sending it.]
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution would be satisfactory to me as long as the bills are fully processed.  The information provided on their response, however, is not correct. The doctor and I both provided all additional information requested by Liberty Health Share on multiple occasions.  Liberty Health Share seemed to want further information which does not exist.  There are not additional medical records in existence as that condition has never been previously diagnosed or existed, neither have any other conditions.  Also, the doctor re-coded the visit as a wellness visit with the specific code requested by Liberty Health Share.  The lab work related to that visit (which is all the lab work that was done, some had to be performed on a different date due to menstrual cycle related requirements for the test to be properly performed, but all diagnostic tests were ordered in connection to the wellness visit) and should be covered in full according to the plan guidelines and shouldn't be part of the annual shared amount.  I will wait for the business to perform this action and, if it does, will consider this complaint resolved.
Regards,
[redacted]

Liberty HealthShare is a Medical Cost Sharing Ministry, who assists its members with their medical expenses. We are not Insurance.  That message is consistent in all of our printed and online materials, as well as our website. Memers sign that they understand. We also do not use PPO's, but...

instead, reimburse Physician's and other medical providers at a percentage above Medicare. This information is on the back of member's identification cards. Sometimes a physician or other medical provider will still try and balance bill their patient, our member. Once our member alerts us that there is a balance bill, we will work with that Physician or provider. The member is not responsible for the balance bill. Occasionally we will negotiate with them on a more acceptable reimbursement, usually once we've talked to them, they accept the payment in full. In some accelerated cases, (and one to which the member is referring in the complaint) that negotiation takes some time, and the member may feel fearful that a portion of the bills will be their responsibility. I understand that is a scary feeling, and don't want to minimize it at all. However, it appears that we are taking the proper steps in dealing with his physician's and providers, and sharing his expenses. The $500 Annual Unshared Amount is what he is responsiblie for, other than bills that may not be eligible.  I have attached copies of the signed form, the back of our card which explains our reimbursement and a list of submitted medical bills.

As a medical cost sharing ministry, Liberty HealthShare’s members made the decisions on what medical expenses are eligible for sharing, and those decisions make up our Sharing Guidelines.  As staff, it is our responsibility to all of our members to share only those medical bills which qualify,...

according to those Sharing Guidelines.  The reason your bills have been considered not eligible for sharing has been discussed with you personally, by our nursing staff, and you’ve been pointed towards the specific Guidelines upon which that decision was made. The discussion regarding termination has also been explained. As well, we have again expressed that if you have information that shows what we received is incorrect, we will take that into consideration.  Due to protecting both your medical and personal history, we will not discuss particulars on this forum. You are most welcome to contact a Supervisor or Manager for additional responses.

The response stated that our normal turn around time is within 30 days, and that at times it falls out of that time frame. I don't believe that's inaccurate. I also stated that these bills had been processed within 60 days, which you agree with, since you stated they were processed at 50 days. That being said, we will still be reimbursing you the amount of your enrollment fee. I've already submitted the refund request.

I am very sorry this member feels Liberty HealthShare did not live up to her expectations. Our typical processing time is within 30 days. From time to time, due to influxes of bills submitted, that processing time will fall outside of the 30 days, but has yet to be longer than 60 days. Which is...

still with the 90 day industry standard turn around time.  Her first bill would have been processed towards the Annual Unshared Amount, so there wouldn't have been any reimbursements. It's important to remember that as a Medical Cost Sharing Ministry, there is no contract.  The bills processing turn around time isn't addressed in the Sharing Guidelines, and the 30 day processing time we strive for is a time frame we've adopted for ourself, there is not written agreement.  However, if she wants her annual fees reimbursed, I will have a Supervisor give her a call to get that settled.

A member of our Research and Resolution team has reached out to you today to let you know that the check has been batched and is getting ready to go in the mail. We also have a representative from our Provider Relations team reaching out to [redacted] on your behalf to let them know a check is...

coming and to honor the self-pay discount. We have several members who go to [redacted]’s and we are working with all of them. I can understand how frustrating this might have been for you, but please know we are working on getting this resolved. If you have any additional questions, please do not hesitate to reach out to the Research and Resolution Specialist you are working with.

[A default letter is provided here which indicates your acceptance of the business's response.  If you wish, you may update it before sending it.]
Revdex.com:
I have reviewed the response made by the business in reference to complaint I[redacted], and find that this resolution would be satisfactory to me.  I will wait for the business to perform this action and, if it does, will consider this complaint resolved.
Regards,
[redacted]

We want to apologize for the inconvenience this misunderstanding has caused. This should have been a happy time welcoming your new baby without the stress of worrying about your bills. We would like to clarify our guidelines under the section not eligible for sharing; 20) Hospital employees....

Professional services billed by a Physician or nurse who is an employee of a Hospital or Skilled Nursing Facility and paid by the Hospital or facility for the service. This is intended for Hospital Employees receiving pay for the services they are performing. You were not paid by the Hospital during the delivery of your baby, which would make your expenses eligible for sharing. The Director of Operations has reached out to you this morning to clarify this and to let you know that we will be reprocessing your bills. Please check your ShareBox for these changes. If you have any additional questions, please do not hesitate to contact us.

[redacted] complaint  that our fine print states we do not have to pay anything is inaccurate.  As a medical cost sharing ministry, we very plainly state that fact on our website, on our printed materials, and members sign on their enrollment form that they understand that, "This...

program is not an insurance company  nor is it offered through an insurance copmpany. 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."  That being said, we have only received two bills from [redacted] family. Neither have been denied, however, there wasn't enough information on the two statements he submitted to know why the bills occured and what treatment was for. We did request that information, and have had several attempts at conversation with him. On 4/29/16, one of our Member Services representatives sent him the following email:I am following up with you in regards to your medical expense. We have received medical expense for dates of service for 1/5/2016, 1/28/2016, 2/16/2016, and 2/23/2016. Also a copy of your [redacted]ansaction history. The amounts showing paid does not reflect the amount on the billing statement. If you could please clarify the amounts that were paid are in relation to which dates of services. In the future if you would be able to send in an Itemized bill we would be able to see the brake down of those medical expenses and allow us to know what was paid towards each date of service. I also wanted to include my direct contac[redacted]. I did try and reach you at ____ please verify this is correct contact information for you. I do apologize with the communication delay you experienced. Additionally, we tried to call and followed up with an email on 6/30/16, regarding this issue.  We do have a set of Guidlines by which we share medical bills. It is in the best interest of our entire membership, that we are making sure the bills submitted for sharing, meet those Guidelines. Our request was so that we could correctly process the bills, and share what is  eligible. Since there was a descrepency in the billing statement, we needed more information.  We will go ahead and reimburs[redacted] for the two bills that have been submitted thus far, but in order to protect the integrity of the entire membership, must ask that for future reimbursement requests, that the date of service, type of treatment and diagnosis be included in the submitted statements.

[A default letter is provided here which indicates your acceptance of the business's response.  If you wish, you may update it before sending it.]
Revdex.com:
I have reviewed the response made by the business in reference to complaint I[redacted], and find that this resolution would be satisfactory to me.  I will wait until for the business to perform this action and, if it does, will consider this complaint resolved.
Regards,
[redacted]

After researching the complaint, it doesn't appear that we completely denied the bills, but there was additional information requested. This was due to the enrollment effective date of 11/1/2016, and bills that did not come in as wellness, but instead were all coded with a diagnostic reason for...

being seen, with dates of service 11.12/2016. The request for additional information, if received, could have alleviated the question of whether or not this was a pre-existing condition.The call notes indicate there was reluctance to be coached, but it was accepted. There are additional notes that indicate there appeared to be many scheduling conflicts between the member and the coach. I do not see notes that assigned a new coach, although the call notes do support the fact that the member and the coach both called reporting the issue. I am having the medical bills reprocessed, according to the notes provided through this complaint.  Wellness visits (and supporting labwork) will be processed as such, even though they are not coded accordingly. This will be the bills with date of service 11/12/2016. All other eligible diagnostic visits will be put towards the Annual Unshared Amount first, and shared once that's been satisfied.

After reviewing your membership, it looks like you had a primary insurance and the bill was pended for the EOB from the primary insurance. I see that the hospital reduced the bill amount to $2,030.47 and you paid that directly to them. I had this processed for you and the check will be going out in...

the mail by this Friday 2/9/18.  I apologize for any inconvenience this may have caused.   Regarding your request to be refunded for your monthly shares, I see that you are still an active member of Liberty HealthShare. Each sharing member’s monthly share goes towards others members eligible medical expenses. The only time that we are able to refund, is if someone were to cancel within the first 30 days of membership. Below is how we assign the monthly shares.   3. Assigned Need. Each month a Sharing Member is assigned a specific need in which to share. By submission of the suggested Monthly Share Amount, the member instructs Liberty HealthShare SM to assign his/her contribution as prescribed in these Guidelines, which set forth the conditions upon which Sharing Member medical expenses will be shared. By participation in the Program, the Sharing Member both accepts those conditions as enforceable and binding within the program for the assigning of his/her contribution, and designates Liberty HealthShare SM as the final authority for the interpretation of these Guidelines.   If you have any additional questions regarding this, please contact our Member Services Supervisor.