Lowering Costs Through Pre-Notification

May 4th, 2017

If you are a Liberty HealthShare member, you know we are not an insurance company. We are unique in many ways, most of all because we are driven by a member focus rather than a desire to please shareholders and collect profits. We facilitate the sharing of medical costs among the people who participate in this voluntary community, but the funds come from our members, not corporate coffers. For this reason, we often remind our members to do everything they can to reduce the often outrageous costs associated with healthcare. There are a variety of ways in which we encourage this stewardship mindset. One of them is through our pre-notification process.

Certain testing, treatments, procedures, and surgeries are known to have a large range of possible prices, making it easy for some providers to employ unreasonable billing practices. Liberty HealthShare asks its members to access care at the lowest cost possible, and we do not share in medically unnecessary interventions, so we want to make sure you have all the medical and financial information you need to make informed and wise choices. To that end, last October we began a partnership with BowTie Medical in order to expand our pre-notification process and offer the Member Stewardship Advisory Program.

The "nitty-gritty" of Liberty HealthShare's pre-notification process can be found on pages 18-20 of our Sharing Guidelines document, but this is how the process works, practically:

  1. A member visits their physician or another healthcare provider.
  2. The physician or provider prescribes a treatment, testing, procedure, or surgery listed within the Sharing Guidelines pre-notification parameters.
  3. The Member or physician/provider calls the pre-notification phone line (888-604-4337) immediately upon learning of the above-mentioned treatment or testing and informs the pre-notification staff of the specific need. Advance notice is expected, and at least 7 days notice is preferred (except in case of emergency). Please note: it is the responsibility of the sharing member to make sure the pre-notification staff is contacted, so if the provider offers to make the call, it is best to confirm this has been completed.
  4. Liberty's pre-notification staff requests medical records and reviews them to determine medical advisability and eligibility.
  5. The member is notified of the pre-notification staff's determination of medical advisability and eligibility.
  6. If the care or testing is eligible for sharing, Member Stewardship Advisory Program processing begins. BowTie Medical staff begin researching to find a lower cost for the member's testing, procedure, treatment, or surgery at a facility with the same quality of care.
  7. If BowTie Medical is successful in finding such a provider/facility to perform the testing, procedure, treatment, or surgery at a lower cost, the member is notified, findings are discussed, and introductions are made so the member can schedule their care.

Please remember, a determination of medical advisability does not necessarily equate to a medical cost's eligibility for sharing. As always, we expect our members to review and understand Liberty HealthShare's Sharing Guidelines so that expectations concerning the sharing of medical expenses are realistic and correct. Questions should be referred to the Member Services department, which can be reached at 855-585-4237.

Keep in mind that the Member Stewardship Advisory Program is also available for procedures and tests outside those that require pre-notification. So when in doubt, call the pre-notification phone line (888-604-4337) to ensure you are getting the best quality care for the lowest, most reasonable cost.

As members of a healthcare sharing ministry, we all have a stake in protecting and stewarding our health and the resources of this community. You have made the choice to leave a third party-arbitrated system, so you now have not only the responsibility but also the power to be a wise consumer where the costs of your healthcare are concerned.