What exactly is health sharing and how does transparency pricing from physicians play an intracule roll?
People are amazingly adaptable. They find creative ways to thrive even when money is tight and options seem limited. When it comes to the confusing world of medical insurance, there are more options out there than just large corporations. One of the latest trends is a Healthcare Sharing Program.
In Washington State, two adults and one child can expect to pay anywhere from $1,300 to $1,950 a month for insurance according to Healthcare.gov. If this cost is out-of-pocket, with little or no employer assistance, some people turn to healthcare sharing programs as a way to keep costs low but still have a cushion in case of emergency.
Financial consultants describe these as “faith-based programs… which facilitate voluntary sharing among members for eligible medical expenses. Specifically, members send in monthly ‘shares’ (i.e., premiums) which are distributed to or on behalf of other members with medical expenses (i.e., benefits payments) in accordance with program guidelines. They are built upon the principle of people with similar beliefs and values coming together to share each other’s burdens, not unlike the risk-pooling nature of health insurance.”
By removing the corporate middle-man, families can participate for less than $500 a month. Sharing programs are not insurance but instead ways to pool money amongst a like-minded group. To make every dollar stretch further, outpatient surgery clinics like Longview’s Pacific Surgical Center (PSC) are crucial. They believe in up-front, transparency pricing to help avoid post-surgical sticker-shock.
Monthly healthcare sharing program costs vary by plan and type of coverage chosen. There are options for families and individuals of all ages. Some, however, do include lifestyle and religious requirements. One researcher stresses that “medical cost-sharing ministries are a group of people who band together to help each other pay for medical expenses… You must meet all the requirements and have the same religious beliefs to be accepted into any health sharing ministry.”
Some of these requirements may be abstaining from alcohol, being an active church member, and exercising regularly. Most accept patients with coverage lapses and pre-existing conditions though there are often stipulations about continuing care and treatment.
Some sharing programs, but not all, will help negotiate discounted pricing like an insurance company does. Another thing to note is that most of these programs typically count towards the Affordable Care Act’s insurance mandate so you won’t be penalized come tax time.
At Pacific Surgical Center, no complex negotiation is necessary. Costs are fixed, clearly posted, and include the facility fee, surgeon’s fee, and anesthesiologist’s fee. Procedures are done quickly, professionally, and—thanks to on-site imaging and lab facilities—with as few extraneous visits as possible.
To keep you on your feet, PSC offers an array outpatient orthopedic, urology, podiatry, gastroenterology, and general surgery specialties. Their physicians are highly skilled in the latest techniques and financial counselors are always available to answer any questions.
Depending on your medical needs, a healthcare sharing program may be a good option. Some allow families to mix coverage levels, balancing healthier individuals with those needing more services. Others include in-person or telephone-based consultations, preventive care, maternity, and urgent care.
On the downside, there’s typically no guarantee of coverage, payment, or reimbursement. Industry resources explain that “consumers who face problems with a healthcare sharing ministry, such as when a claim is paid or service is not covered, aren’t protected by their state’s insurance department…Most health care sharing ministries do have formal appeals processes in place, but they aren’t enforced by federal or state law.”
These ministries are a growing field. The Commonwealth Fund estimates that “since enactment of the ACA, enrollment in HCSMs has reportedly spiked, growing from fewer than 200,000 before 2010 to perhaps 1 million today.” They are a creative way to spread dollars and keep members healthy and active. Some organizations are starting to pop up using like principals, without the faith requirement as well.
In a recent study, 64% of people “said they avoided or delayed medical care in the last year due to anticipated expenses. Among respondents who avoided or delayed care, 23 percent reported delaying or avoiding follow-up care after being hospitalized…Additionally, 18 percent avoided or delayed a physician wellness visit, and 12 percent avoided or delayed prescribed rehabilitation or therapy following surgery or a procedure.”
Don’t let uncertainty postpone a vital operation. Let PSC walk you through all the options, whether using insurance, Medicare, or an alternate method. Their staff is always willing to work with your primary care physician and network administrators with a goal of simplifying the process and maintaining utmost transparency.
Schedule an appointment online or by calling 360-442-7900. Then get back on your feet so you don’t miss out on a single minute.