When they tell you up front that it won’t work (why you should shy away from a Health-share ministry)

Just before I purchased the car, they gave me a statement that said

“I understand that this vehicle-type item might not operate like a car with an actual running engine. And that if I try to put gas into said vehicle-type item it might just fall directly on the ground as some models don’t have an actual gas tank, but instead are equipped with a hole in which to fit a gas pump but nothing else that would work as any kind of receptacle that would cause gas to congregate and/or collect together in anything more than nominal amounts”

I thought to myself “I’m not really sure what this means. But, I’m getting such an incredible deal on this bad-boy.  Whoo-doggie am I happy to be spending so little on a car!”*

 * example cited for dramatic effect. Did NOT really happen

It’s not cheese it’s cheese-food

If you’re a fan of any one of the many almost-cheese cheeses that dot our grocery landscape you’ve no-doubt read the label that says that you’re about to eat Cheese-food.  “No biggie,” you think “cheese is cheese. And I’m eating it, so it’s food. Duh”  True enough.  But it’s called cheese-food for a reason. The FDA has strict rules about naming a food product that is made up of stuff besides the food that it’s named for.  If it’s all cheese, you can call it cheese. If it’s only half cheese (or 51% to be exact) you have to call it cheese-food.  Calling something “not quite cheese” doesn’t bother us so much.  But, if the salesman says that your TV is a “TV-type product,” or that the fridge you’re looking at is what we call a “Nearly refrigerator” that should make you stop and wonder.

“We’re not an insurance company”

Which leads us to the focus of this week’s post – Liberty Health Share .  We had a friend ask us if this is legit.  He was approached by a (non-insurance) insurance salesman with a great deal about how to pay ½ the amount of money he was paying for his health insurance.  Health insurance is one of the most unsatisfying things a consumer can buy.  If all goes well, you’ll use it very seldom.  When you DO use it –  it’s because you had to go to the Doctor (which is not pleasant).  And you’ll probably get charged MORE money every time you see somebody new, even though you pay every month, anyway. 

Editor’s analogy: It’s like when you take your car in for an oil change and wind up paying for a new timing belt.  You don’t know what it does, where it is or why you need one – but you do it anyway.  Did they replace your timing belt, or did they just take your hundred bucks and SAY that they gave you a new timing belt?

As it happens, the Health-share folks say right on their website “Liberty HealthShare is not insurance.” Which is kind of weird, because they want to replace the insurance that you have. It goes on to say “It simply unites like-minded Americans to share medical costs together.”  If you’re reading this and alarm bells are going off in your head, it’s for good reason.  Unlike our cheese example, non-insurance health insurance could be really problematic. 

What else aren’t they…?

  • Responsible for your medical bills – for starters, the health share folks say several times on their website that they are not responsible for your medical bills. Maybe because this is said in such nonchalant fashion it doesn’t seem like a big deal.  But, remember, insurance companies don’t pay your Doctor bills because they are nice people or because they loooove you.  They pay because they have to.  If health insurance companies weren’t required by law to pay your bills, they would stop doing it. 
  • Your Doctor – they claim to have “a team of professionals that will advocate for you throughout your medical incident to manage your care efficiently.”  Absent from this sentence is the word “medical” or “doctor.”  Even if they had medical professionals helping you manage your care, we’re not sure that somebody on a phone 7 states away whose job is to help you “keep your medical costs down” is the person you should be turning to for help to figure out if you should really be having that test done.  YES not having a C-T scan will keep your medical costs down.  But, skipping that scan is also a great way to ignore something that might be seriously wrong with you.
  • Fooling anyone
    • Self-pay, volunteer assistance – You are referred to as a “self-pay” patient on the website.  That’s because when you go to the Doctor (or lab, or hospital, or clinic) you tell them that you are “self-pay.” When this happens, the hospital gives you a form to sign which states something like this right above the signature line “I agree to be responsible for the full balance of the bills that result from any medical care, treatment or test that I undergo.” In the legal realm this is known as “signing your life away.” In the story-telling realm this is known as “I don’t know what possessed me to do this.” 
  • “A substitute for an insurance policy”
    • Their disclaimer states (in part):

    This program is not an insurance company nor is it offered through an insurance company. This program does not guarantee or promise that your medical bills will be paid or assigned to others for payment. Whether anyone chooses to pay your medical bills will be totally voluntary. As such, this program should never be considered as a substitute for an insurance policy. Whether you receive any payments for medical expenses and whether or not this program continues to operate, you are always liable for any unpaid bills.

    • “does not guarantee or promise that your medical bills will be paid….
    • “Whether anyone chooses to pay your medical bills will be voluntary….
    • “you are always liable for any unpaid bills….
    • Oy..

What’s the difference?

  • Insurance companies regulated by DoI – Insurance companies are regulated by the states.  If they misbehave, your state’s Department of Insurance (DoI) will get on their case and force them to pay your medical bills (or the portion of those bills that they have agreed to pay)  The DoI will also make sure that the health insurance company will not make you sign a statement that says that they are not “guaranteeing that your bills will get paid.” Guaranteeing that your medical bills get paid is what insurance companies do.
  • Medical providers have deals with insurance companies (UCR) – UCR means “Usual Customary and Reasonable” and it speaks to certain pre-agreed prices for services, treatments and tests.  The medical provider has said to the insurance company “if you pay at least this much for each bill, we’ll forgive the rest of the bill, and we won’t chase the patient down for the difference.”   This lets the insurance company tell the consumer “the Doctors have agreed to take what we give them as full payment.  You won’t have to worry about paying the rest.”  This is precisely why you agree to pay the insurance premiums.  If you had to worry about paying the rest of the bill, you’d never go to the Doctor (and you’d surely never buy insurance in the first place)  Ironically, keeping the Doctor from chasing you for the balance is the very thing that the Health-share folks tell you they’re not going to do.

How does it work?

In a nutshell, the Heath-share works like this:

  • You sign up and pay the monthly fee;
  • You sign their pledge to live a biblical lifestyle (including a disdain for alcohol, a promise to exercise regularly and other religious-based sentiments);
  • You tell the hospital that you’re a self-pay patient; 
  • You ask the other people in the Health-share community to designate that their monthly premium should go to pay your bills;  
  • There is a chart for medical providers that hints at some type of UCR arrangement. But, since there’s no contract with the providers, they don’t have to follow it;
    • If your bills aren’t paid by the community, the website is devoid of advice of what to do, how it affects your credit or your ability to get future care. 

But it works just like an insurance company does, right?

Not exactly. Their FAQs page is full of legal forshadowing (or if you prefer a more descriptive term: waving red-flags of impending horror and regret):

  • Q 2: Are pre-existing conditions covered?
    • In the first year your pre-existing condition is NOT covered;
    • In the second year it is, but ONLY up to $25,000
    • This goes up in the third year to fifty grand, but will that be enough?
  • Q 5: Is there a health exam I have to take?
    • No. But, since it’s a ministry (many of the Health-share plans are faith-based) you’ll be expected to live a healthy, alcohol-free lifestyle and be free of harmful foods (among other things)
    • Which makes us curious – if you’re pledging to live a certain way and the benefits are voluntarily paid by the other plan members, what if they see you on Facebook with a beer in your hand?  Will they refuse to help you because you drink?
    • Orwellian is not a term that we used to use to describe health plans (until now)
  • Q 10: What happens if the Health share decides NOT to help you pay your bills?
    • They suggest you call and make an appeal.  This section ends with the following: 

    “STEP THREE: Regardless of who wins or loses, remember who and what we are. Liberty HealthShare is a voluntary association of like-minded people who come together to assist each other by sharing medical expenses. Such a sharing and caring association does not lend itself well to the mentality of legally enforceable rights.”

    • We had to rub our eyes after reading the last sentence.  “Does not lend itself well to the mentality of legally enforceable rights.”
    • Meaning to say: If you try to sue us, not only do you not have a legal claim, you’re not a good person.
  • Q 15: Will my bills get paid?
    • Keep in mind, this is the single most important question that anybody anywhere should ask when purchasing health insurance; 
    • This one is answered with a video.  Click here for the non-answer
    • Our favorite quote? “We don’t have a written contract that we can use to sue each other.  Our contract is here in our hearts”
      • We’ve been in Court before. Trust us, the Court doesn’t care what’s in your heart.  They’ll only enforce what’s written in the contract.

So what? If my bills get paid….

If the medical provider doesn’t agree to wait for volunteers to help out or to cut the bills when you ask, the amount you don’t pay is likely headed to collections.  If that happens, even though they get paid off, your credit will take a hit.  In addition, you won’t have that peace of mind that comes with not having to worry about what your medical care is going to cost.  Ongoing treatments are bad enough.  What do you think you’ll feel when you get home and open up a giant medical bill?  The worst part of a deal like this is that you’ll start to skip treatments, advice and prescriptions because there isn’t a guarantee that the bills will be covered. 

 If you wanna eat cheese that isn’t really cheese, have at it.  If you wanna buy something called “pasteurized processed insurance food” you’re asking for trouble.

Posted by: Mark Wiseman (who can neither confirm nor deny that he is somewhere on Facebook with a beer in his hand)