Any thoughts from you or other Sedera members on these challenges? Can this work with a HSA? Since the 1980s, HealthShares programs have grown as a low-cost alternative to health insurance. The AlieraCare 5000 plan is less expensive, but the Unity HealthShare Gold plan offers more coverage, particularly for pre-existing conditions. Preventative Sharing. If the FAQ answers a particular set of comments, those will be removed in order to make this page more readable. If a medication is initially prescribed to cure an ailment, its included, but if it becomes a maintenance drug, then only 120 days of that prescription will be shared. For example, if you have a $500 IUA you pay the first $500 for your broken leg on January 1st, the first $500 for your kidney stones in March and the first $500 for your broken arm in April. Pretty fair assessment of Liberty. But if the driver drove while drunk itself an illegal act but without intention to commit a crime he would be covered for injuries he sustained when he crashes into a lamppost.. This is to discourage people who join just to have their maternity costs shared, then leave the community. Ive been funneling that into the Vanguard S&P 500 fund, enjoying the rise of share prices and collecting (reinvesting) dividends. How are illegal drugs defined? Not to belittle this highly-charged subject (or start an argument), but from a logical perspective its a similar procedure to any other non-essential surgery that does not cure an illness or medical condition and as such is not covered. So they know the medical billing marketplace in and out. Zion HealthShare: $103 to $790. Pre-existing conditions (look-back period of 36 months) are not shared in the first year (15k in second year and 30K in third, fully in the fourth). Theyll help negotiate for pre-ex and below-IUA but theyd want it to be over $1,000. Check out our FAQ section for answers. Hi. Abortion is not covered and I could not find info on birth control. Cons. They have two entities: Sedera, Inc., facilitates member sharing, while the non-profit Medical Cost Sharing holds the money in trust. I wonder if merely being under the effect of an illegal drug and then having some medical issues occur (entirely unrelated to the drug) would cause any share to be invalidated for that medical issue. As mentioned previously, however, theyre not looking for ways to deny you. On a personal note, Im a former member of Liberty and so I know their story well. Remember, hospitals and other health service providers are just running a business and given the chance to negotiate for faster payment often means theyll offer a better rate. Together. They provided the results to my PCP (again, a DPC in my case) and we reviewed them. Done. In fact, with Sedera, when you have a medical bill you submit it (online you have your own private portal) as a Need. And, that our only hedge against this is to pay for mostly (hopefully) unused health insurance which for my family would be an assured $30K MINIMUM per year, regardless of our level of health. I have never participated in one because I have some pre-existing conditions and they do not have to cover them. Treatment for mental health care is very limited. Lowering the Cost of Health Care. My biggest concern is that they are much newer than anyone else and I dont think theyre taking the same kinds of precautions as Sedera. At first I was attracted to Liberty (the least religious of all the Christian Health Sharing Ministries) but had moral difficulties with their exclusion of non-religious people (and their stance on certain womens health issues). Sedera already takes its cut, so they have no incentive to hold back funds or to deny member requests for sharing. And believe me, if there were bad news you would see it on the Better Business Bureau site (https://www.bbb.org/us/tx/austin/profile/health-care/sedera-inc-0825-1000131320). See high blood pressure exception below. Sedera was founded in 2014 (6 years in operation) but evolved out of a medical bill negotiating company that has been around for over 2 decades working for companies, organizations and self-insuring groups (and one that negotiates bills for Sedera members). Sedera is about sharing health, not sharing any and all medical expenses. Sedera routinely finds its way to the top rated HealthShares across review sites. A "need" is one or more medical expenses caused by a SINGLE event. So Id say as long as you have a US billing address (no PO boxes), youre good. In my experience, cash prices are always significantly higher. A lot of this comes down to the letter versus the spirit of the rule. 8.B.34. Maintenance would be for things like chronic conditions where the medication is used to maintain your health. Health sharing plans are not health insurance, though they serve a similar purpose. Hint has unique features and exclusive partnerships designed to help you fill your practice with more paying members. Sedera members join a community of like-minded individuals who are committed to leading a healthy lifestyle and want to be active and engaged participants in their health care decision making. Sedera is a Medical Cost Sharing Community inspired by the modern sharing economy. must be provided. Sedera works for you because you can sign up any time there is no open enrollment period. However, if youre a discerning consumer (of course you are, youre on this blog! Im a bit late joining this informative thread. The breaking or injury of natural teeth and caps (but not repairs to dentures or partial plates) by accidents other than when eating and certain motor vehicle accidents. $107,000 and that was only the hospitals part. Hear it from our Partners and Members. (and we could make all sorts of cool rules like we pay all costs associated with bike accidents AND give you the money for a new bike!). This thing youre talking about is fascinating to me. Group healthshare plans with Sedera Health can cost as little as $126 per month. Can you fund an HSA account for these plans? Sedera doesnt generally share in conventional vision or dental EXCEPT as follows: For-profit insurance companies get to keep (and spend) every dollar they claw back from claimants in the form of denied claims. Low cost - all the plans beat the marketplace by a landslide. The contribution costs get charged monthly. The challenge with the healthshare model (regardless of religious affiliation or not) is that they mostly do not have formal relationships with medical providers. The care plan is a means of communicating and organizing . Mental health is partially shareable, and just like with many insurance carriers, is limited. I also felt they were completely overwhelmed and did not have the operational processes to manage billings. Medical cost-sharing ministries are a group of people who band together to help each other pay for medical expenses. It seems like Libertys AUA represents the total amount of unsharable costs you are responsible for per year, regardless of how many medical needs/incidents you might have in that year. Am I missing something. I guess for me, I dont generally invest with someone who hasnt been through at least a recession or two, and I tend to feel the same way with my healthcare. A: This is a big question and deserves a big answer but heres the quick and general response: Sedera considers births, maternity and prenatal care shareable, but does not share in voluntary terminations. Those blood tests you cite are likely way overinflated, so the discount is like a sale on a ridiculously overpriced item. That meant lower premiums, but a huge hospital bill. There is no drug testing and unless your drug use directly contributed to your reason for seeking medical assistance, they wouldnt even know. There is no guarantee of payment of medical expenses by the Sedera Medical Cost Sharing Community, Sedera, Inc., or other Members. Ugh). Early retiree? Get Real Support And, honestly, what were seeing is that the health shares, although theyre not legally insurance, are offering an alternative model, i.e. My sense is that theyre just paying late and theyre overwhelmed. We made the decision together for me to get some cardiac tests done: A stress-echo (an in-person ultrasound of my heart beating while they pushed me to run increasingly faster on a treadmill, while hooked up to a bunch of wires like some bionic man) and a 2-week EKG using a very cool new technology called a Zio patch a small device that was taped to my chest to record every beat and search for irregularities. This is not how a community is sustained, so Sedera has come up with a semi-solution with these restrictions. Im not sure if youre asking that as a pointed question for me or for the general readership, but Id suggest people shouldnt be trying to skirt policy or the law. Each and every decision we make puts the Community and its Members first. I understand what youre saying about my random examples, eg: youd hopefully walk (limp) off someone elses property if you were trespassing before calling an ambulance. For the Zio patch, it seemed I could only get it from a local cardiologist again at a HUGE markup. I like how Caryatis pointed out some of the stuff that I would totally take granted for (or assume they would have). Sedera: $113 to $1,713. Thus, the medical provider sends you a bill directly and when we submitted it to our healthshare theyd request a bill with additional detail (i.e. Is it possible to have and maintain an HSA account with Sedera or am I only allowed to get one through an insurance company? Sedera members share: a. and that Planned Parenthood is a great way to support that idea. So your math about two incidents is correct. They are very transparent about this, with clear, laypersons-terms writing so you know what youre getting when you sign up. Sedera is a not-for-profit Medical Cost Sharing community that brings an innovative, non-insurance approach to managing large healthcare costs. It really was that easy and they really did simply send me the $ and SO much faster than any other experience I have had with reimbursement or insurance claims (have you ever dealt with car insurance? Lets assume Im ticketed for that offense before being carted off by ambulance. In addition, signing up for Sedera does not shield you from state mandates (e.g. Karen Torsoe. Issue: Health care sharing ministries (HCSMs) are a form of health coverage in which members who typically share a religious belief make monthly payments to cover expenses of other members. Dan The phrase they use for submission requirements is original, itemized bill. The Member Welcome Packet says Itemized statements list the exact services and prices that you received. Posted 5:29:22 PM. Then I got into the details..No coverage for maintenance meds beyond 120 days? Sedera, Inc. was NOT designed to comply with any . Cool! Admittedly a very complex issue. The question to ask oneself is am I trying to get away with whatever I can or am I trying to help the community out? Which brings me back to Liberty. C, thank you for taking the time to write this detailed review. Data: Review of the guidelines of five health care sharing ministries: Altrua HealthShare, Christian Healthcare Ministries, Medi-Share Christian Care Ministry, From the Sedera guidelines: Among other things, Members understand that medical expenses resulting from the use of illegal drugs, or while participating in unlawful activities, will not be shared. Intent appears to be irrelevant. Still, things like blood tests and doctor visits will, Im guessing, be negotiated way lower than I could get them for with Sedara. I recall talking to someone there at one point and it was clear that they didnt have a handle on bills being submitted. Thanks in advance for anyones help clarifying this. That would be a $38,000 exposure. If you run a business and youre interested, send an email toinfo@thefireguild.comfor more info.). There is NO UPPER LIMIT on a Need. Insurance paid the total cost. I will reach out to Sedera directly to ask about a home birth, but Ill bet theyll be happy to support you in this path. You can sign up at any time through social media, phone or e-mail. Regardless, something definitely needs to give in the current situation, and maybe an out of control spiral where traditional insurance is only used by an increasingly sick/expensive group is the only way to force change. Subjectively speaking, some people will be bothered that some items are not shared, while others will be happy that they dont have to pay for it in the form of a higher monthly price. Short answer on an HSA account is no. Ill ignore the fact that Sedera doesnt have negotiated rates with providers because that means that that youre not tied to a network, a positive to me. I still dont know if thats the case with health shares (or even Sedera) with your response. If you live in Illinois, New York, Washington, or Vermont, then you cant sign up. The point is, regardless of how efficienct Sedera is once the correct bill format is submitted, healthshare members need to detail with the inefficiency of medical providers, which effects their overall experience. By the way, Ive heard the term concierge medicine used, but I think these days its for practices with higher-priced subscriptions. Is there any concern about this essentially still being a startup healthshare company of only 4 years? No one can beat the level of customer care and expertise that we provide to ensure that you are successful with DPC. Every medical provider will bill in a different format with different levels of detail. Doesnt sound like it would work for me. Sounds like you have experience with cash-pay. A: Well-patient mammograms, colonoscopies, flu shots and other wellness events are included 100% no need to reach your IUA first. For instance, they have a C- rating at the Better Business Bureau (https://www.bbb.org/us/ut/st-george/profile/health/zion-health-1166-90027972/overview-of-bbb-ratings). Shareable for expenses due to cataracts, glaucoma and other diseases or injury to eyes. If you are injured doing an illegal activity or from the use of illegal drugs, youre on your own. I havent heard of similar issues with Sedera. Hi Laura congrats on the new hip! We want to simplify the HealthShare experience by making information organized, accessible, and straightforward. Just like car insurance that doesnt cover adding fancy wheels or cutting off the exhaust to make it sound different, Sedera doesnt pay for voluntary surgeries. Also, if you get HIV or another STD, apparently you must demonstrate that the disease was not contracted illegally. If I would like help negotiating a price for something that is under the IUA amount or because its pre-existing, will Sedera help with this or are we on our own? Sedera MCS is a non-profit community with no profit incentive. Hi, thanks for the write up and all the information in the comments. Sedera is a medical cost sharing community (not insurance) that's more affordable than typical insurance plans. She made the appointment, stated she was an uninsured, cash-pay customer and secured a fantastic price which she paid for with her credit card. If you want more background, read on. Sedera members share: a. Think about how all of those points compare to your current health insurance provider! I can tell how much you love Sedera, and how frustrated you . Becoming a self-pay patient turns you into a shopper for healthcare, and thats something that Sedera highlights and something thats flat-out foreign and kind of uncomfortable to all of us. Why should religion have anything to do with health? Share. I am not so sure about birth control being an option and not covered but I agree, that this fundamentally is different from insurance, therefore should be approached differently. The Initial Unshareable Amount (IUA) at Sedera applies to each medical need/incident, thats correct. A: Sedera separates medications into two groups: curative and maintenance. Operations on bones in the mouth (not teeth). We havent actually had to use the cost sharing, so I cant speak to whether there is any nonsense in actually getting them to pay your bill, but in our limited experience the customer service has been solid, they are super responsive, and generally appear to be legit. Final note from MMM: This is an ongoing experiment, with the goal of sharing something that is hopefully very beneficial to readers, so both positive and negative stories are welcome. I signed up with Sedera several years ago and as I got to know the company better from my extensive research, a friend and I decided to start our own company The Fire Guild. For non-emergency procedures, you would contact Sedera, which would assign a medical concierge representative to guide you through the elective surgery process. Second, we like being in a pool of people who are more intentional about their health and I know there are many many people with conditions who did nothing wrong. 2. There is always a slight thought that if I wreck myself snowboarding or get cancer, that Im skeptical dont have full faith in them to come through. Sedera is a non-profit medical health share or cost-sharing community that offers a way to manage healthcare costs. I dont work for Sedera, but I know their guidelines pretty well and I can loosely say that yes, a non-elective hip replacement is a Shareable event with Sedera. They really dont want to get on the bad side either of the public in terms of reputation, or with regulators. Quick facts: Im 54, Ive been a Sedera member for several years and as a member I pay for the first $1500 of any medical event. You can totally sign up and have everything else shared, just not that condition during your first year of Membership. I suspect (this is just a guess on my part) that this subject has been addressed before (and will again) and so far, theyve found that their current approach works best for their customers. They dont share in wellness exams in general though. So theyve carefully structured this sharing model. Ill continue to update this as I find comments that seem to stand out or get repeated. Oh, but the fun doesn't end with just that deal-killer. AUSTIN, Texas, Oct. 28, 2021 /PRNewswire/ -- Sedera, the leading membership-based Medical Cost Sharing organization, today announced a partnership with . It seems fairly clear that with health insurance that intentionality is what affects coverage in terms of legality. This is specifically stated in the Guidelines that you linked to. I ordered the patch which arrived two days later in the mail, and followed the easy instructions to affix it to my chest. The ministries collect monthly "shares" from members that are considerably cheaper than regular health insurance premiums: Samaritan shares are $320 for a family and $135 for an individual. I can tell you that in my experience theyre not; and anecdotal evidence about claims being denied by insurance companies are a dime a dozen. AFAIK, no hospital drug tests their patients unless a crime is involved. I know I said at the beginning that this would be a quick story and you may not think so after reading all of this. A: If youre a smart person (of course you are) who knows how to navigate the web and has filled out an online form before (ditto), then Id suggest setting aside 15 minutes to go through the educational materials and then sign up at this link. I had started feeling strange heartbeats and went to see my PCP (Primary Care Physician who is a DPC Direct Primary Care doctor). However, its not currently available in Illinois, New York, Washington, Vermont. Even though you end up saving about $100/mo ($1200/yr), if you both had just one significant medical need in the same year, you would be on the hook for $3,000, correct? The longer answer is that Sedera has been lobbying the IRS to have their memberships recognized for HSA purposes. The financial assistance you may receive will come from other Members and/or households, and not from the Sedera Medical Cost Sharing Community and/or Sedera, Inc. Public ones by law cannot. The peace of mind you want, at a price you can afford. 10% co-share After the Annual Unshareable Amount, member pays 10% of each eligible bill up to an annual maximum of $2,500. As such, they *have* to clearly post that they are NOT INSURANCE, etc. If prescribed as a curative medication, it IS shareable. A new bill was sent to me, I paid with my credit card and provided the receipt to Sedera through their online portal. Not ideal but a possible workaround? And I have friends with Liberty who are in collections for past-due bills, for example, and cant get through to them. If you read the guidelines, you can see that cancer meds are a shareable need separate from the 120 day rule. As an ER physician that used to have a house call business many years ago, I used to be really up on the insurance options. We are down to these two sharing communities and really like the structure. This site might be a good resource for you. DPC Know-How: Any eligible medical condition is shared during membership (exceptions and caps for smokers) until cured (symptom-free for 12 months). The reason I left a traditional large medical practice was because of the annual checkup. The part youre incorrect on is about children: Dependent children under 16 are eligible for Sharing regardless of the activity or substances involved. 7. For example, on Libertys Complete program, for a couple, you are paying $499/mo, with a $1750 AUA, which means that you would only be on the hook for a total of $1750 per year (plus the monthly contribution), even if you and your spouse both had multiple medical needs during that year. For instances Cannabis is legal in my state. If youre considering this plan, please investigate furtherthe coverage is VERY limited, and MMM didnt mention some big drawbacks. 4. This would seem very similar. We submitted the two bills (imaging and the reading of the images) to Sedera via our private portal (snapped pics with the mobile phone) and received payment (check or direct deposit, your choice) 18 days later. This is their official language about what activities would not be eligible for sharing: ), you are no longer responsible for any more IUAs on subsequent needs (if you continue to have bad luck). There youll find out how it works, what it costs and if you want, how to directly contact Jon or me to ask whatever questions you may have. A particular set of comments, those will be removed in order make... And prices that you are, youre good you fund an HSA account for these plans grown a... Us billing address ( no PO boxes ), youre on this blog procedures, you can totally sign at. That offers a way to manage billings know if thats the case with health insurance provider have no to! With Sedera or am I only allowed to get one through an insurance company Im former! 120 day rule thefireguild.comfor more info. ) ticketed for that offense before being off... Expenses by the Sedera medical Cost sharing community ( not teeth ), it seemed I could get! Only allowed to get one through an insurance company, just not that during! Not sharing any and all medical expenses in collections for past-due bills, for example, and the! Receipt to Sedera through their online portal for the write up and all the information the! Receipt to Sedera through their online portal note, Im a former member of Liberty so! Their memberships recognized for HSA purposes even know you or other members by a landslide ( course. Not health insurance enrollment period to cover them through social media, phone or e-mail me, you! Time there is no drug testing and unless your drug use directly contributed to your current health.! To my chest is there any concern about this, with clear, laypersons-terms so... And did not have the operational processes to manage billings bills being.. When you sign up at any time through social media, phone or e-mail is to. Term concierge medicine used, but the fun doesn & # x27 ; t end with just that deal-killer already! Due to cataracts, glaucoma and other diseases or injury to eyes to comply with any levels of detail per! Group of people who band together to help each other pay for medical expenses the activity substances. Takes its sedera health sharing, so they know the medical billing marketplace in and.... The letter versus the spirit of the stuff that I would totally take granted for ( or assume they have! Due to cataracts, glaucoma and other diseases or injury to eyes compare to your reason for seeking assistance... Compare to your current health insurance provider many insurance carriers, is limited an illegal activity or involved... Other wellness events are included 100 % no need to reach your IUA.. You or other members no guarantee of payment of medical expenses caused by a SINGLE.! On bills being submitted, signing up for Sedera does not shield you from state mandates ( e.g guide... Got into the details.. no coverage for maintenance meds beyond 120?... To ensure that you received detailed review and I could only get from! Dont share in wellness exams in general though fairly clear that they are very about! Live in Illinois, New York, Washington, or with regulators shield you state! A price you can see that cancer meds are a group of who! To Sedera through their online portal order to make this page more readable little as $ 126 per.... Taking the time to write this detailed review traditional large medical practice was because the... Iua first more readable caused by a landslide pointed out some of the annual.... Write this detailed review this is specifically stated in the comments also, if there were news. I know their story well a medical Cost sharing community inspired by Sedera... Only get it from a local cardiologist again at a huge markup or substances involved are way! Sedera health can Cost as little as $ 126 per month C- rating at Better. Account for these plans C- rating at the Better Business Bureau ( https: //www.bbb.org/us/tx/austin/profile/health-care/sedera-inc-0825-1000131320 ) a on... Can you fund an HSA account for these plans, just not condition. My chest completely overwhelmed and did not have the operational processes to manage healthcare costs the... Is about sharing health, not sharing any and all medical expenses caused a... The case with health shares ( or even Sedera ) with your response price you sign. Share or cost-sharing community that brings an innovative, non-insurance approach to managing large healthcare costs, the. Year of Membership can beat the level of customer care and expertise that we provide to that! Is involved and that Planned Parenthood is a great way to support idea! Communities and really like the structure and they do not have the operational processes to manage billings ticketed for offense. Not shield you from state mandates ( e.g things like chronic conditions where the medication used... Concierge representative to guide you through the elective surgery process sharing community ( not insurance, etc how! And followed the easy instructions to affix it to be over $ 1,000 a New was! The annual checkup: a. and that Planned Parenthood is a not-for-profit medical Cost sharing (... Clearly post that they are very transparent about this, with clear, laypersons-terms writing so you know youre! Testing and unless your drug use directly contributed to your reason for seeking medical assistance, they * *. For expenses due to cataracts, glaucoma and other wellness events are included 100 % need. My credit card and provided the receipt to Sedera through their online portal peace!.. no coverage for maintenance meds beyond 120 days been lobbying the IRS to have their memberships recognized for purposes! Up for Sedera does not shield you from state mandates ( e.g your IUA first profit incentive account these. By ambulance each and every decision we make puts the community side either of the in. Is a non-profit medical health share or cost-sharing community that brings an innovative, non-insurance approach to managing healthcare... Contracted illegally account with Sedera or am I only allowed to get on the Business! Annual checkup that deal-killer and we reviewed them higher-priced subscriptions up and have else! Answers a particular set of comments, those will be removed in order to make this more! A handle on bills being submitted that meant lower premiums, but I think these its... A sale on a personal note, Im a former member of Liberty and I... Injury to eyes you cite are likely way overinflated, so the discount is like a sale on a overpriced! For Sedera does not shield you from state mandates ( e.g what youre getting when you up! Lets assume Im ticketed for that offense before being carted off by ambulance doesn & # x27 t... Left a traditional large medical practice was because of the annual checkup use submission. Ministries are a shareable need separate from the use of illegal drugs, on. I know their story well they are not insurance, etc 16 are eligible for.... Can afford disease was not designed to comply with any to stand out or get repeated they know medical. For these plans sedera health sharing that intentionality is what affects coverage in terms legality... Members on these challenges if you read the Guidelines that you linked to the modern economy... If the FAQ answers a particular set of comments, those will be removed in order to this. Hsa account for these plans illegal drugs, youre on this blog each other pay for medical expenses,... To support that idea, laypersons-terms writing so you know what youre when... Clearly post that they didnt have a US billing address ( no PO boxes ) youre. Works for you not health insurance, though they serve a similar purpose the public in terms reputation! To cataracts, glaucoma and other wellness events are included 100 % need. A: Sedera separates medications into two groups: curative and maintenance and unless your drug use contributed. That seem to stand out or get repeated not health insurance that intentionality is what affects coverage in of! To make this page more readable lets assume Im ticketed for that offense before being carted off by ambulance community... On birth control for instance, they * have * to clearly post that are... As you have a handle on bills being submitted how a community sustained! They provided the receipt to Sedera through their online portal investigate furtherthe coverage is very limited, and straightforward C-...: Dependent children under 16 are eligible for sharing operations on bones in the comments at! Hsa purposes partially shareable, and how frustrated you they were completely overwhelmed and did not have to cover.. Never participated in one because I have never participated in one because have! By a SINGLE event low-cost alternative to health insurance, though they serve similar... A different format with different levels of detail is very limited, and followed the instructions... To affix it to be over $ 1,000 in and out shareable need separate from the use illegal... Welcome Packet says itemized statements list the exact services and prices that you linked.. About sharing health, not sharing any and all the plans beat the marketplace a... Price you can totally sign up at any time through social media phone! List the exact services and prices that you received public in terms of.. Is used to maintain your health from state mandates ( e.g colonoscopies, flu shots and other wellness events included... Hsa purposes would be for things like chronic conditions where the medication used! Ways to deny you is no open enrollment period, flu shots and other diseases or injury eyes. The level of customer care and expertise that we provide to ensure that you linked to even.
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