Liberty HealthShare underwater – will reject expenses under $200, ER visits under $500

Liberty HealthShare underwater – will reject expenses under $200, ER visits under $500

In an email sent to members today, Dorsey Morrow, the CEO of Liberty HealthShare, said the organization experienced a $53 million deficit between shared medical costs and what members contributed in 2021.

Liberty Healthshare is a healthcare sharing ministry in which members contribute a set share amount each month.

The share is pooled into a risk fund.

A member’s medical costs are paid (shared) from that fund if those costs exceed the Annual Unshared Amount (AUA), which is similar to a health insurance deductible.

In the email, Morrow first blames the deficit on members, writing: 

I want to be brutally frank with you, many of our members treat our healthshare ministry as a catch-all insurance program and instead of sharing just their burden, they have shared their entire load, often walking away after doing so. 

What does “instead of sharing just their burden” mean? 

Is Liberty HealthShare allowing them to share the burden of non-members?

And then this: “they have shared their entire load”.

Is Liberty HealthShare not applying the guidelines, AUA and sharing limits?

If temporary members are joining, then “walking away” after having their medical issues taking care of, is Liberty HealthShare not applying the restrictions on pre-existing conditions?

As a long time Liberty HealthShare member, I find Morrow’s statement offensive.

It’s up to the ministry to manage the sharing of medical expenses with members. Good stewardship would include proper management so that members don’t have the ability to abuse the program.

Morrow then states:

A major factor of the backlog is balance bills. Nearly 20% of medical expenses that are submitted to our healthsharing community are balance bills. These are expenses that result when healthcare providers seek payment in excess of the fair and reasonable amount already shared by members. In other words, 80% of our members’ providers accept the repriced amount, while 20% of those providers add to our SharePower imbalance. In the past year, balance bills submitted totaled more than $62 million and without these we would have had a surplus of more than $8.4 million to contribute toward reducing our backlog of shareable expenses.

They admit in the email that they have always had provisions stating “that charges in excess of fair and reasonable amounts may not be eligible for sharing.”

So why haven’t they applied them before now?

And… why do they initially point their finger at members rather than saying this up front?

In response to the deficit, Morrow said Liberty HealthShare is making several changes, including:

  • As of May 1, 2022, balance bills will no longer be eligible for sharing. Liberty HealthShare said they will advocate on behalf of members to reduce balance bills and provide tools to help members avoid them.

Liberty HealthShare said they would be providing more information about those tools later.

  • Medical expenses $200 and under will not be eligible for sharing. This excludes certain items such as preventive checkups up to a certain amount. 

Morrow says: 

These initial non-sharable amounts should not be considered burdens carried by other members and setting a minimal expense amount will help add to our SharePower for true member burdens.

The leadership of Liberty HealthShare might not consider anything under $200 a burden, but it certainly feels like one to a family on a tight budget.

A couple of sick visits, even if under $200, add up. And worst of all, not only will the amount not be eligible for sharing – it also won’t be applied to the AUA.

  • The first $500 in charges for qualifying emergency room services will not be eligible for sharing unless a resulting hospital admission occurs within 23 hours. 

According to Liberty HealthShares FAQ on the changes, this is designed to “encourage members to utilize lower-cost urgent care and outpatient clinics for treatment of acute accident, injury or urgent illnesses rather than the emergency room.”

It’s unclear from the FAQ and the Sharing Amendments if this $500 applies to the AUA or not.

It’s clear that Liberty HealthShare must make changes for the organization to remain viable. 

Improving the management of shared expenses (minus the finger-pointing at members) and working with members and healthcare providers to eliminate excess charges seems like a good start.

However, eliminating the sharing and application to the AUA of medical bills $200 and less, is going to 1) hurt families with tight incomes and 2) lead to an increase in fraud – healthcare providers will be asked to make the bill $201, or to combine multiple visits into one bill.

Neither result is good for Liberty HealthShare and the community it serves.

What do you think of the changes? 

Click on the link below to leave your comments!

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