Phoenix

Valley woman faces big medical bill due to lack of coverage

Judy Stewart’s 2020 colonoscopy was thought of by OneShare to be “diagnostic for conditions that are pre-existing”, in accordance to OneShare Health.

PHOENIX — As the fee of medical care rises, many Arizonans have turned to Christian healthcare ministries as an alternative of conventional medical health insurance. Members who share the same religion make month-to-month contributions and submit medical payments for reimbursement.

But in contrast to insurance coverage corporations, well being share ministries largely regulate themselves. An East Valley couple discovered the exhausting approach why these agreements can lead to unusually excessive payments.

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‘It’s a ball of confusion’

Judy Stewart belonged to OneShare Health, a company based mostly out of Texas. Health prices mounted in 2020 and Judy claimed OneShare owed her $5,500 for providers she paid past her annual $5,000 deductible and a further $18,000 for a colonoscopy that she obtained.

“It was a routine colonoscopy and the previous one was five years ago,” Judy stated.

OneShare denied her requests for reimbursements.

Judy and her husband, Jim, spent months submitting appeals and making an attempt to get explanations.

“A lot of times your call is disconnected. They assure you that they’re going to take care of it. They never do,” Judy stated.

Jim stated the couple’s odyssey of making telephone calls and sending emails and letters amounted to “a ball of confusion.”

OneShare finally instructed the Stewarts in writing that coverage for the colonoscopy was denied as a result of they submitted their paperwork too late.

“And then we appealed it, and then we got another letter back that said it was pre-existing,” Judy stated.

The Stewarts requested in writing and by telephone why the process fell underneath a pre-existing situation and didn’t obtain an answer.

OneShare is just not obligated to reimburse for the colonoscopy

After 12 News contacted OneShare on the Stewarts’ behalf, the company offered further medical documentation exhibiting that OneShare was justified underneath their settlement with the Stewarts not to cover the colonoscopy.

When Judy obtained a colonoscopy in 2015, she was recognized with diverticulitis, a situation that causes irritation within the digestive tract. Therefore, Judy’s 2020 colonoscopy was thought of by OneShare to be “diagnostic for conditions that are pre-existing”, in accordance to OneShare. 

Judy is anticipated to pay the $18,000 bill to Kingman Regional Medical Center for the colonoscopy.

“Make sure if you are signing up with one of these Christian ministries, make sure you don’t have a pre-existing condition,” she stated.

Health coverage specialists stated the Stewarts’ frustration is an instance of what can occur to individuals after becoming a member of a Christian well being care consortium. They could really feel burdened with unplanned bills and understand there’s no authorities company that has authority over the businesses.

“These healthcare sharing ministries are not subject to any regulations that govern insurance companies, so there are no required benefits. There are no solvency requirements. There’s no oversite,” stated Larry Levitt, Vice President on the nonprofit Kaiser Family Foundation.

As of final week, the Better Business Bureau confirmed 127 complaints in opposition to OneShare Health over three years. Many individuals complained a few lack of coverage and poor customer support.

In an e-mail to 12 News, OneShare Chief Legal Officer Buddy Combs stated the company works to guarantee its members are well-informed of its packages and that requests are adjudicated pretty.

“While every member complaint is important and we always have room to improve our service, we believe 127 complaints over three years does not accurately reflect the overall satisfaction of our tens of thousands of members who have made hundreds of thousands of sharing requests resulting in nearly $160 million in sharing facilitated during this time,” Combs stated within the e-mail.

OneShare paid a $54,600 surgical procedure bill

Combs stated the method for “sharing requests” are mentioned intimately through the enrollment course of and made obtainable to members on-line.

“Some medical conditions—for example, those conditions which existed prior to membership—are not eligible for sharing,” Combs stated within the e-mail. “For sharing requests which could be ineligible, we work to obtain and review all relevant medical records before making a final decision because it is not a decision we take lightly.”

OneShare additionally has “robust procedures” in place for members to enchantment choices, Combs stated.

After reviewing the Stewarts’ case, OneShare agreed on Friday to pay for a go to related to a wrist damage, calling it an “oversight” by the company.

Combs additionally said within the e-mail that OneShare paid for a knee alternative based mostly on pre-certification information.

“However… additional records we received indicated that the right knee issue was a pre-existing condition,” Combs wrote. He said that OneShare paid $54,613 “for this ineligible expense” however didn’t request an overpayment refund.

Even although the Stewarts acknowledge that OneShare is just not obligated to cover the colonoscopy, they are saying they don’t really feel the company was clear after they joined.

“It almost seems like an oxymoron to use this company posing as a Christian healthcare consortium,” Jim Stewart stated.

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