Confused About Pre-Existing Conditions?

← Back to Blog September 7th, 2016 Tags: healthcare-costspre-existing-conditionssharing-guidelines

At Liberty HealthShare, we frequently hear members as well as health care professionals referring to Liberty as insurance. It is important for our members to remember that Liberty is a cost-sharing ministry, not an insurance company. Because we are a healthcare sharing ministry, we are free from insurance! We are free to choose our physician, choose our hospital, and choose our pharmacy. We are in charge of our own healthcare.

As members of Liberty HealthShare, we must take the role of stewards who strive to minimize cost for all of our members. One of the ways in which we accomplish this is through our handling of pre-existing conditions.

Liberty HealthShare 2017 Guidelines* Section IV, C, 15, states

Conditions that exist at the time of enrollment that have evidenced symptoms and/or received treatment and/or medication within the past 36 months are not eligible for sharing.

In order for us to administer this guideline and keep member's costs low, medical expenses incurred during the first 90 days to one year of membership may be subject to a pre-existing condition review. After one full year of continuous membership, a pre-existing condition may be eligible for up to $50,000. After 3 full years of continuous membership, a pre-existing condition is no longer considered pre-existing.

*NOTE: the above section has been updated to reflect the new sharing guidelines, which went into effect on May 1, 2017.

Here are a few hypotheticals:

· Prior to enrollment, a child has several episodes of sore throat/strep throat/tonsillitis. After enrollment, a physician recommends a tonsillectomy. This may be the best course of action and considered medically necessary; however, this is a pre-existing condition due to symptoms, treatment, and diagnosis prior to enrollment.

· A new member has been experiencing right knee pain prior to enrollment. This member goes to a physician who recommends physical therapy. Although a diagnosis was made after enrollment, this member was exhibiting symptoms prior to enrollment. This is a pre-existing condition and not eligible for sharing.

· A member has been treated by a chiropractor for back injury prior to enrollment. Even though the Sharing Guidelines state that Liberty shares in up to 12 chiropractic treatments, any additional treatments after enrollment for this back injury would be recognized as treatment for a pre-existing condition due to the treatment being received prior to enrollment.

· A member joined in March and her expected delivery date is during the month of October. The pregnancy is a pre-existing condition and is therefore not shareable. A pregnancy is shareable if the conception date was after enrollment.

Obviously, this list is not exhaustive, but our hope is that it gives you a framework for the Sharing Guidelines Liberty HealthShare uses to keep our member costs low. However, if you believe that a decision about a pre-existing condition was made in error, you as a member have recourse. You can petition to have that decision reviewed by filing an appeal (see Guidelines, V. Dispute Resolution and Appeal).

As members of a healthcare sharing ministry, we owe it to ourselves and our fellow members to be informed about our healthcare needs. We encourage you to be conscious of pre-existing conditions as you plan for your future medical care.

Thank you for joining us as we change healthcare for good!