Hospital Bill Playbook: How Medical Cost-Sharing Works for Major Events

When facing a major medical event—surgery, hospitalization, cancer treatment, emergency care—understanding how healthcare sharing actually works becomes critically important. This guide explains Liberty HealthShare's approach to big hospital bills and what you can expect during major medical events.

Quick Answers: Major Medical Bills

What's the sharing limitation for hospital bills? Up to $1,000,000 per incident for Liberty Connect and Liberty Unite programs is eligible for sharing

Do I need pre-authorization for surgery? Liberty HealthShare does not require pre-authorization. However, pre-notification may apply for certain procedures. Contact Liberty HealthShare before scheduling procedures to determine if your treatment is eligible for sharing.

How do hospital bills get submitted? Providers can submit bills electronically to Liberty HealthShare, or you can submit them yourself through your ShareBox account within 180 days of service

What if my hospital bill exceeds the sharing limit? Liberty HealthShare’s sharing members may rally to support you through additional voluntary contributions or special assistance programs. This can be discussed during the pre-notification process.

Will Liberty HealthShare negotiate with hospitals on my behalf? Liberty HealthShare partners with cost containment vendors who reprice medical bills to Fair and Reasonable amounts and work with hospitals on billing issues. The Patient Advocacy Center (PAC) may negotiate on your behalf.

Which programs have no co-share for major medical events? Liberty Unite, Liberty Assist, Liberty Rise, and Liberty Freedom have no co-share. Liberty Connect has a 10% co-share; Liberty Essential has a 20% co-share

Can hospitals send me to collections while waiting for sharing? You remain responsible for your medical bills. It's important to communicate with providers about your healthcare sharing ministry membership and make payment arrangements if needed

What about balance bills? Using providers who participate in the PHCS network reduces the likelihood of balance bills. If a provider doesn't accept Fair and Reasonable pricing, you may receive a balance bill, and balance bills are not eligible for sharing. The Patient Advocacy Center (PAC) may negotiate on your behalf.

Do This Today: Crisis Action Checklist

If you're a member facing a major medical event right now:

• Call Prenotification at 855-585-4237 to notify Liberty HealthShare of planned admission or procedure
• Show the hospital your Liberty HealthShare member ID card, pointing out the EDI payer ID number
• Ask the hospital to submit electronically using UB-04 form, or confirm you'll submit itemized bills via ShareBox
• Ask whether the provider is PHCS-participating and willing to accept Fair and Reasonable pricing before receiving a service
• Pay your applicable AUA and Co-Share amount

Program Sharing Limits for Major Medical Events

How Sharing Works Step-by-Step for Hospital Bills

Before Your Hospital Stay

• Check Sharing Eligibility: Contact Liberty HealthShare, or review the Sharing Guidelines, before scheduling procedures to determine if your planned treatment is eligible for sharing under your program's guidelines and to complete any pre-notification
• Present Your Member ID Card: Give your Liberty HealthShare Member ID card to your provider at registration
• Communicate with Your Provider: Inform hospital billing that you're a healthcare sharing ministry member and explain how the process works. Many providers are familiar with healthcare sharing 
• Verify PHCS Participation: Ask if your provider participates in the Private Healthcare Systems (PHCS) network. PHCS providers streamline the sharing process and reduce the likelihood of balance bills

After You Receive Care

• Provider Electronic Submission: Ideally, your hospital submits bills electronically directly to Liberty HealthShare using standard billing forms (HCFA-1500 or UB-04)
• Bill Review and Repricing: Liberty HealthShare's cost containment vendor reprices bills to "Fair and Reasonable" amounts. This works best when providers participate in the PHCS network and are willing to accept Fair and Reasonable pricing
• Member Submission Option: If your provider doesn't submit electronically, you can submit itemized billing statements yourself through your ShareBox account
• 180-Day Filing Requirement: All eligible medical expenses must be submitted within 180 days of the date of service in the manner and form specified by Liberty HealthShare to be considered for sharing
• Sharing Facilitation: Once bills are reviewed and deemed eligible, Liberty HealthShare facilitates sharing by sending member-sharing checks to you or your provider

Understanding Your Financial Responsibility

You Pay First: Your Annual Unshared Amount (AUA) - the amount you pay before expenses become eligible for sharing

You May Pay a Percentage: Your Co-Share (if applicable) - for Liberty Essential (20%) or Liberty Connect (10%) after your AUA has been met. Other programs have no co-share

Sharing Members May Share the Rest: After AUA and Co-Share, the remaining eligible expenses may be shared by the community up to your program's sharing limits

You Remain Responsible: You remain ultimately responsible for your medical bills and making necessary payment arrangements with providers

Understanding Balance Bills

What is a balance bill? When a provider charges more than the Fair and Reasonable amount determined by Liberty HealthShare's cost containment vendor, the difference is called a balance bill.

Key fact about balance bills: Balance bills are not eligible for sharing, but Liberty HealthShare provides access to a Patient Advocacy Center to assist members with balance bills

How to reduce balance bill risk:

• Use providers who participate in the PHCS network whenever possible
• Ask providers before service if they participate in the PHCS Network
• Have providers submit bills electronically to Liberty HealthShare for repricing

Using PHCS network participating providers streamlines the sharing process and reduces the likelihood of receiving balance bills.

Real-World Sharing Examples

Major Surgery

Example Scenario (Individual on Liberty Unite):

• Total surgical costs: $150,000
• You pay (before sharing eligibility): AUA amount (if not yet met)
• Co-share: $0 (Liberty Unite has no co-share)
• Liberty HealthShare’s members may share: Remaining eligible expenses up to $1,000,000 per incident

Cancer Treatment

Different limits may apply for cancer care. Review your program's Sharing Guidelines for complete details. Additionally, contact the Prenotification department and a Care Navigation facilitator can be assigned to help you.

Member Experiences with Major Medical Events

Note: The following testimonials include both Liberty HealthShare-hosted member reviews and summaries from third-party review sites. Individual experiences vary.

Liberty HealthShare Member Testimonials

Cancer treatment: "My wife is 16 months in after being diagnosed with breast cancer. The greatest thing about Liberty HealthShare is that my wife didn't have to stress and worry about filing bankruptcy because of the huge expense of cancer treatments."

Cancer diagnosis and negotiations: "Hubby was diagnosed with cancer in 2019 and Liberty HealthShare helped us with payment and negotiations with the hospital to pay the astronomical expenses that come with a major health diagnosis"

Emergency hospital billing assistance: "I called today with an issue with an emergency hospital visit bill that came in from the hospital. Toni at Liberty HealthShare was amazing! We got on a conference call with hospital billing and got all the issues worked out. Very Thankful!"

Billing department coordination: "What I love about Liberty Health Share is the fact you can call them and they will get on the phone with the medical facility’s billing department to help solve any issues"

Medical flight: The Willington family faced hospitalization and life flights for their child. Member testimonial: "Medflight bill was going to be $12,000, and that is a lot of money. That's school for kids, I mean that would essentially be taking on a car payment"

Major surgeries: "Liberty HealthShare has been a life saver for me. I had quadruple bypass surgery in 2017 and the community shared my eligible medical expenses. In August last year I suffered multiple strokes and was in hospital for three weeks. Again my eligible expenses were shared"

Heart attack abroad: "The program helped my medical expenses from my heart attack last November. They refunded most of my expenses even though it occurred in a foreign country"

Serious car accident: "I was in a serious car accident in 2017 which caused my medical bills to exceed my auto insurance limits. Liberty HealthShare members picked things right up after that and surpassed my expectations"

Cancer treatment: "I had breast cancer in 2023, and an additional unexpected surgery in 2024. I don't know what I would have done if I didn't have Liberty HealthShare. They were kind and helpful and helped me through a process I didn't understand."

Read Our Members' Stories

Member Support for Major Medical Bills

Personal Assistance

Liberty HealthShare provides hands-on support for members navigating major medical expenses through three-way calls with hospitals, direct intervention with billing departments, and provider education about healthcare sharing requirements.

Team Expertise

Liberty HealthShare's approximately 165-person team includes nurses who understand medical complexities and can guide members through healthcare decisions. When you call during business hours, you'll speak with a real person from the operations center in northeast Ohio.

Working with Hospitals as a Liberty HealthShare Member

Before Service

Communicate Your Status: Let providers know you're part of a healthcare sharing ministry and explain how Liberty HealthShare works

Verify PHCS Participation: Ask if the provider participates in the PHCS network accepting Fair and Reasonable pricing to reduce balance bill risk before scheduling services.

Instill Confidence: Let providers know that Liberty HealthShare members share millions of dollars in medical expenses each month. On average, eligible expenses are shared in about 30-45 days.

After Service

Facilitate Direct Billing: Ask if your provider will send your bill to Liberty HealthShare directly on your behalf—this streamlines the process

Submit Bills Promptly: Remember the 180-day filing requirement. Don't delay submission

Follow Up: Track sharing progress through your ShareBox account and maintain communication with both Liberty HealthShare and your providers

Cost Containment and Bill Negotiation

Liberty HealthShare works proactively to control healthcare costs through partnerships with specialized vendors who negotiate directly with medical providers.

Fair and Reasonable Pricing: After a bill is submitted and determined eligible for sharing, Liberty HealthShare's cost containment vendor reprices medical bills to Fair and Reasonable amounts

Professional Negotiation: Liberty HealthShare members have access to the Patient Advocacy Center through HST Connect to assist them in negotiating balance bills.

Ongoing Advocacy: The ministry studies sharing patterns monthly and forecasts trends to understand cost trajectories and implement proactive measures

What's Eligible for Sharing in Major Medical Events

Once you've met your AUA, the following types of major medical expenses are typically eligible for sharing (varies by program - see your Sharing Guidelines):

Eligible Major Medical Expenses:

• Acute Hospital Charges
• Emergency Room visits
• Ambulance services
• Physical/Professional Services
• Organ Transplants
• Cardiac Rehabilitation
• Subacute Health Care Facility
• Cancer Care (different limits may apply)
• Limb Prosthetics
• Interpreter Services
• Surgical procedures

Important Sharing Limitations:

• Medical expenses $200 or less in billed charges generally should not be submitted as they are not eligible for sharing per Liberty HealthShare’s Sharing Guidelines
• Waiting periods apply for most programs (typically two months for non-emergency needs)
• Pre-existing condition limitations may apply
• Cosmetic procedures and expenses from unhealthy choices aren't eligible for sharing
• Balance bills (charges above Fair and Reasonable amounts) are not eligible for sharing but Liberty HealthShare provides access to a Patient Advocacy Center to assist members with balance bills
• Review your specific program's Sharing Guidelines for complete details

When Medical Needs Exceed Available Sharing

Liberty HealthShare's FAQ states: "If your medical need exceeds the amount available for sharing, the community may rally to support you through additional voluntary contributions or special assistance programs."

Key Understanding: Healthcare sharing operates on voluntary giving, not legal obligation. Members remain responsible for their medical expenses and making necessary payment arrangements with providers.

Choosing the Right Program for Major Medical Events

For Maximum Sharing Eligibility