Liberty HealthShare

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.

When reviewing your membership, I see we processed your son’s medical expense on 2/28/18. The bill that was submitted to us had total charges of $3,932.00 and showed that you paid $982.99. The provider then wrote off the rest of the amount. That bill was one of the first ones applied towards your...

AUA, so you will not be reimbursed for it. The other amounts that you paid to the hospital were applied towards your own medical expenses, not your son’s. Those amounts are not eligible for sharing, as your pregnancy was pre-existing since you were pregnant before you enrolled with Liberty HealthShare. If you have questions on how the money you paid was applied, you will need to contact your provider.   We had a member of our Research and Resolution Team reach out to you and your provider to clarify this. I know it can be a little confusing when you are not used to Health Care Sharing, but we would like to make sure your billing concerns are addressed. If you have anything additional to submit, please reach out to the representative working with you.

[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.

We can understand the frustration of seeing a bill repriced so low. We have escalated this issue to the company that handles our repricing and are awaiting their follow up. We are hoping to get an answer regarding this by tomorrow at the very latest. As soon as we receive the information from them,...

we will follow up with you and your providers regarding the status of your bills.

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]

Thank you for your feedback, as member service is a top priority for Liberty HealthShare, our Quality Control department is currently doing additional training and coaching with our call agents to ensure correct information is being communicated.

[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]

Our thoughts are with you as you and your family have gone through this tough time with your husband.   I am attaching the information from our guidelines for excluding an individual who does not list all medical information in full at the time of enrollment. Below that information, you will...

also find the appeal process as well.   Our thoughts are with you as you and your family have gone through this tough time with your husband.  I am attaching the information from our guidelines for excluding an individual who does not list all medical information in full at the time of enrollment. Below that information, you will also find the appeal process as well.  As a sharing ministry, we are always constrained by finite resources no matter how many members we may have. Existing medical conditions disclosed on an application can help us make suggestions as to spiritual or lifestyle changes that can improve the health of the individual and benefit the group as a whole. If, at any time, it is discovered that a Sharing Member did not submit a complete and accurate medical history on the Membership Enrollment Application or on the Medical History Questionnaire, either a sharing limitation or membership declination may be issued retroactively to his/her Enrollment Date. In such an event, annual dues paid at the time of application will not be refunded. Sharing Members may apply to have a sharing limitation removed by providing medical evidence that they qualify for such removal, however any removal will not apply retroactively. V. DISPUTE RESOLUTION AND APPEAL Liberty HealthShare SM is a voluntary association of like-minded people who come together to assist each other by sharing medical expenses. Such a sharing and caring association does not lend itself well to the mentality of legally enforceable rights. However, it is recognized that differences of opinion will occur, and that a methodology for resolving disputes must be available. Therefore, by becoming a Sharing Member of Liberty HealthShare SM , you agree that any dispute you have with or against Liberty HealthShare SM , its associates or employees, will be settled using the following steps of action, and only as a course of last resort. If a determination is made with which the Sharing Member disagrees and believes there is a logically defensible reason why the initial determination is wrong, then the Sharing Member may file an appeal.A. 1 st Level Appeal. Most differences of opinion can be resolved simply by calling Liberty HealthShare SM . A Member Services Representative will try to resolve the matter within 10 working days in writing.B. 2 nd Level Appeal. If the Sharing Member is unsatisfied with the determination of the Member Services Representative, then the Sharing Member may request a review by the Internal Resolution Committee, made up of three Liberty HealthShare SM officials: the Needs Processing Manager, the Assistant Director, and the Executive Director. The appeal must be in writing, stating the elements of the dispute and the relevant facts. Importantly, the appeal should address all of the following: • What information does Liberty HealthShare SM have that is either incomplete or incorrect? • How do you believe Liberty HealthShare SM has misinterpreted the information already on hand? • What provision in the Liberty HealthShare SM Guidelines do you believe Liberty HealthShare™ applied incorrectly? Within thirty (30) days, the Internal Resolution Committee will render a written decision.C. 3 rd Level Appeal. Should the matter still stay unresolved, then the aggrieved party may ask that the dispute be submitted to three randomly chosen Sharing Members, in good standing and chosen by Liberty HealthShare SM , who shall agree to review the matter and shall constitute an External Resolution Committee. Within thirty (30) days the External Resolution Committee shall render their opinion in writing. D. Final Appeal. If the aggrieved Sharing Member disagrees with the conclusion of his/her fellow Sharing Members, then the aggrieved party may ask that the dispute be submitted to a Medical Expense Auditor, who shall have the matter reviewed by a panel consisting of personnel who were not involved in the original determination and who shall render their opinion in writing within thirty (30) days.

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.

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.

We do offer our [redacted]rogram to potential members who may not meet the criteria for membership, which is outlined in the Guidelines. [redacted] would've been notified by one of our Health and Wellness  intake specialist to explain the program and let her make the decision, prior to accepting...

her as a member. The fact that [redacted] submitted medical bills that were not received, and she had to follow up by sending again, is a very unfortunate experience that I'm sorry she had to endure. We do accept bills via USPS, but I'm sure she was told that with no way of tracking them, if we didn't receive them, we wouldn't know they've been sent. It did take a couple contacts before we were able to confirm  we had received the bills. As I looked at these bills, I see that they were not coded as wellness, from her physician, which is why they were applied to her Annual Unshared Amount. If she called in about that, she would've had the opportunity to explain her situation and should've been notified to have her Physicians office resubmit them with the proper codes. I do see that our office reached out to her via phone or email, to follow up with her issues, on 6/2, 6/27 & 7/1, to which she did not respond. Our desire is that our members have the best member experience and I regret that she didn't. While it's not our practice to refund annual dues after 30 days, or monthly share amounts after 60 days, we will honor her request for a full refund.

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.

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.

Revdex.com:
I have reviewed the response made by the business in reference to complaint I[redacted], and have determined that this proposed action would not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
[I think the business did not respond to the actual complaint. They did move me to my husbands account and in retrospect the manner in which they dealt with this move finally (and let me emphasis the word finally, there was a lot of back and forth) does make sense. The problem is that I did not have to merge accounts with my husband. I called in advance of asking for the merge to make sure it made sense, and based on what I was told, it seemed to make sense. However, what I was told was inaccurate. One of the patient rights as outlined in the policy is the right to accurate information from all agents, which I did not receive. And, as I tried to resolve the issue over many many weeks, the inaccuracies grew. Further, some, not all, of the agents I spoke with were rather hostile in their tone, accusing me of having not done a better job of understanding member benefits, plans and how they work. I agree, it is a patient responsibility, but also the agents responsibility to accurately communicate how changes in plans will affect individual costs. Often the literature does not explicitly make those implications clear. The dispute is resolved, for now, we shall see moving forward, but the issue of agents inaccurately providing information was not addressed in the business response. It wasn't a "feeling." They did in fact misrepresent how changes to our plans would be handled. ]
Regards,
[redacted]

[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:While I do not agree with the statements made by Liberty Healthshare regarding the handling of my account, I simply want to receive a full refund from them. With that being offered, I find the resolution to my complaint ID [redacted] satisfactory. I will wait for the business to perform this action and, if it does, will consider this complaint resolved.
Regards,
[redacted]

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted]nd have determined that this proposed action would not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
Dear [redacted] I have received your letter, thank you.Liberty Share sent me check on the name [redacted]I can`t use it and I told about that to them. They are playing game with me unwilling to pay for they mistakes.Hopefully it was mistake though I am not sure because there were many mistakes. Please, see my letter t[redacted] Thank you again for you help! [redacted]
[redacted]
 Hi, A[redacted] I have received your letter.
[redacted] [redacted].You know perfectly that I can`t put this in my account.I told about that to your person when he called and he promised to issue another check. I requested $300 because I remembered that I spent $100 for ads.I printed flyers and also I had to pay for distant calls with [redacted] which supported to be free.I told him about that but I didn`t receive any response. I did not see emails from you or probably they were inside of [redacted] files as I was told I should check it.I don`t have time to go there, I am working full day.Instead of doing help for us and people you are creating headache for us.  I am reading here that you are going to send check for $400It was on  8/25 but today is 09/14I don`t have anything from you. I have to write to Revdex.com and other org, like [redacted] and [redacted]I suspect it is fraud and it is probably the whole your org. is scam. Best, [redacted]

We do not have a network, which is why our members can go to any provider of their choice. Either they will bill us directly or our members can be a self-pay patient and submit their itemized information to us for processing. The provider you went to was willing to bill us directly, but at an...

increased rate, without accepting anything less. We shared the medical expenses, but they in turn, balanced billed you for the remaining amount. When working with balance bills, we are making sure our members are not paying for inflated prices; the process can take some time to be resolved. Your bills were submitted to a third party, who works solely on balance bills. When the provider would not accept anything lower than the billed amount, they then turned it over to their attorney for review. I see that our Research and Resolution team has contacted you and you are sending the receipts showing the payment arrangement you have made.  You will be reimbursed for the amount, since that voids us trying to negotiate the inflated price. As soon we receive that information, we will be able to process the remaining expense accordingly. If you have any additional questions about this, please reach out to our Research and Resolution Department.