Liberty HealthShare is first and foremost a community of like-minded individuals and families who come together under the biblical mandate of sharing one another’s burdens to manage healthcare expenses. There are many safeguards and processes in place to help make this mission a reality, and one of the strongest ways this is achieved is by repricing eligible medical expenses to fair and reasonable amounts. Liberty HealthShare is not insurance, so those who only have experience with insurance may find this process confusing. What is a fair and reasonable amount? How is it determined? Why should it be important to our healthcare sharing ministry? In this blog we’ll dig into these questions and more!
What is fair and reasonable pricing?
Let’s tackle first things first; what is fair and reasonable pricing? According to the Liberty HealthShare Sharing Guidelines, found in section XIV, fair and reasonable pricing is pricing that takes into consideration the cost to the Provider for providing the services and the Medicare reimbursement rates for such services. For a given procedure the fair and reasonable amount eligible for sharing is not a randomly selected number, but rather an amount that takes into consideration a significant number of factors.
First, Liberty HealthShare considers the Medicare allowable amount for a service. Essentially, what is the standard rate that Medicare would pay for such a service? Second, Liberty HealthShare explores the reasonable and customary charge for a service or treatment in the same geographic area that a member will be receiving the service or procedure in. If a member in Wichita, Kansas needs an MRI, Liberty HealthShare uses the reasonable and customary charge for such a service in Wichita, Kansas to help determine what is fair and reasonable. The costs of healthcare vary based on location, so Liberty HealthShare is very cognizant of ensuring that eligible sharing matches costs appropriate to a given geographical area. Finally, depending on services rendered and area-dependent reasonable costs, Liberty HealthShare will facilitate the sharing of a percentage of costs over the Medicare allowable amount. For inpatient or outpatient facility eligible medical expenses an amount equivalent to 140% of the Medicare allowable amount is used, and for Physician or ancillary eligible medical expenses an amount equivalent to 120% of the Medicare allowable amount is used.
Okay—that was a lot of information about how fair and reasonable costs are determined, and it’s clear that the amounts eligible for sharing going through a rigorous determination process. So why does it matter? We can think about this in two ways; for you the consumer and for the greater Liberty HealthShare community.
Fair & Reasonable is important to you as the consumer.
As a consumer, utilizing fair and reasonable pricing can save you money without having to sacrifice the quality of your care. Not only is the internet at your fingertips to explore what reasonable medical costs are in your area, but your powerful Liberty HealthShare membership tools like HST Connect help you find providers in your area that are more likely to accept fair and reasonable pricing, reducing the likelihood that you receive an unshareable balance bill. If you’re buying a car or a new TV, you do your research to discover which car or TV would best fit your needs and budget, right?
With Liberty HealthShare you have the freedom to do the same with your healthcare! Liberty HealthShare does not dictate that you must use a certain provider or facility no matter what, but we do provide you with the tools, knowledge, and freedom to explore your healthcare options and find more affordable services through the process.
You also protect yourself as a member of a healthcare sharing ministry. Liberty HealthShare is not insurance. The ministry does not, and cannot, have large reserves of money, nor does it guarantee the payment of medical bills. By doing your research when appropriate, you can better insulate yourself from unexpectedly high medical costs and have a higher chance of your eligible medical expenses being shared in full.
Fair & Reasonable is important to you as a member of this community.
This leads to the final point to consider, the impact of fair and reasonable pricing on the Liberty HealthShare community. Our community is committed to supporting one another, and when we do well in the little things, we can help our fellow members when big things arise. If you need to receive that MRI in Wichita and just accept the first recommendation from your medical provider for where to receive that service, you could possibly put a larger strain than necessary on the resources of our community.
When you take the time to explore and research your options for medical care when the opportunity is available, you are serving your fellow member as Christ has called us to do. You have time to research needed lab work or imaging services—you don’t have time to research when you’re having a heart attack. By protecting the community’s funds when you have time to research, you enable your fellow members to better navigate their emergency health events.
There’s a lot of information to parse when considering fair and reasonable pricing but navigating this topic is important for the strength of our community. If you have any questions or concerns, you can always call our knowledgeable and friendly Liberty HealthShare employees at 855-585-4237 and they will be happy to help you! Prefer to schedule an appointment to talk to one of our team members on your time?
⭐️ Pro Tip: Bookmark this page for later! ⭐️
Press Cmd+D (Mac) or Ctrl+D (PC) to save this page as a bookmark and return to it whenever you need a brush-up on Fair & Reasonable Pricing.