Medical bill repricing plays a pivotal role in managing healthcare costs for Liberty HealthShare members. This process ensures that medical services are priced fairly, making healthcare more affordable without compromising on quality. The ministry collaborates with the national PHCS network to offer these services, bringing transparency and cost efficiency to healthcare expenses and powerful tools such as HST Connect.
Understanding the Repricing Process
When healthcare providers submit bills to the ministry, these bills undergo a thorough repricing process by HST and PHCS network partners. The vendors negotiate with healthcare providers to establish fair and standardized rates for various medical procedures. This negotiation considers reimbursement rates published by the government’s Medicare program, adding a set percentage based on geographic location to cover the provider’s overhead costs and profit.
The repricing process involves reviewing the billed charges and applying predetermined reimbursement rates based on industry standards or negotiated agreements. This approach helps control healthcare expenses, promote transparency, and prevent overcharging, benefiting both the ministry and medical providers. Members can save significantly by ensuring that the costs are fair, contributing to a more sustainable healthcare system.
Access to a National Provider Network
Ministry members have access to an extensive network of more than 900,000 providers across the country through the PHCS national network. This network simplifies the billing experience, reducing the paperwork typically associated with health sharing. Members presenting their Liberty HealthShare ID card at a participating PHCS provider can have their bills submitted electronically to Liberty HealthShare, streamlining the process and reducing the likelihood of a balance bill.
When using a PHCS-participating provider, members do not need to submit bills themselves or present themselves as self-pay patients. This reduces the administrative burden and potential stress associated with handling medical bills. However, if a member’s preferred provider does not participate in the PHCS network, they still have the freedom to use them. While these providers may not submit bills electronically, members can still manage them through the ministry member ShareBox, ensuring all necessary information is included.
The Importance of Using Participating Providers
Utilizing a PHCS-participating provider can significantly reduce the chances of receiving a balance bill, where the provider bills the patient for the difference between what was charged and what Liberty HealthShare deems as fair and reasonable costs eligible for sharing by its members. This is because participating providers agree to the pre-negotiated rates, limiting out-of-pocket expenses for members.
Members are encouraged to show their ministry membership card at the provider’s office and not to negotiate self-pay discounts at the time of service or pay the bill themselves. If a provider requires a member to submit the bill, this can be easily done through the member ShareBox, provided the statement includes itemized diagnosis codes, procedure codes, and the cost of services.
Registering with HST Connect
To ensure access to low-cost, high-quality healthcare providers, ministry members are advised to register with HST Connect before they need medical care. HST Connect is an online platform offering a comprehensive search tool for PHCS Network participating providers, enabling members to make informed choices for their healthcare needs.
Cindy Hawkins, Liberty HealthShare’s Director of Medical Services, emphasizes the importance of pre-registering with HST Connect. “Too often, members will call our team after they’ve already scheduled a medical procedure or been admitted to the hospital,” Hawkins explains. “At that point, our options are very limited in helping a member locate a participating provider and allowing HST enough time to negotiate a fair and reasonable price.”
By registering with HST Connect, members can avoid last-minute scrambles to find providers, ensuring they have access to detailed information before it is needed. The platform is available 24/7, providing members with constant access to vital healthcare information.
Features of HST Connect
HST Connect offers several features that enhance the healthcare experience for ministry members:
- Estimate Procedure Pricing: Members can find estimated costs for various procedures, enabling them to choose affordable, high-quality medical facilities.
- Find a Low-Cost Provider: The platform helps members locate providers who accept fair and reasonable pricing, which is crucial for the sharing process.
- Balance Bill Support: Members receive support for managing balance bills through the Patient Advocacy Center (PAC), reducing the financial burden of unexpected healthcare costs.
Determining Fair and Reasonable Pricing
As outlined in the ministry guidelines, fair and reasonable pricing is determined by several factors. If a provider participates in the PHCS network, eligible medical expenses are repriced based on the contracted terms with PHCS. For providers not participating in the PHCS network, physician and ancillary expenses are repriced to 120% of the Medicare allowable amount, while inpatient or outpatient facility expenses are repriced to 140% of the Medicare allowable amount. The Medicare fee schedule, which varies by location, provides a standardized baseline for these calculations.
More information on the Medicare fee schedule can be found at cms.gov.
Medical bill repricing is an essential component of the ministry’s mission to provide affordable, transparent, and high-quality healthcare for its members. By leveraging partnerships with the PHCS network and the power of HST Connect, the ministry ensures that members can access fair pricing for medical services, ultimately promoting a more sustainable and equitable healthcare system. Members are encouraged to utilize the resources provided, including the extensive provider network and the HST Connect platform, to make informed decisions about their healthcare and avoid unnecessary costs.