You're a member who has successfully shared a bill! You worked closely with your doctor to evaluate the course of your care, you pre-notified Liberty HealthShare of the procedure, and your bill was submitted promptly through your ShareBox. Now what? Everything you've read says that it may take 30-45 days for your bill to be processed, but what does "processed" mean? We receive this question from members often, especially if the wait is taking longer than expected. Delays can be frustrating without further information, and it is our desire that members feel at ease throughout the course of their cost sharing by being as transparent as possible every step of the way.
Liberty HealthShare partners closely with Medical Cost Savings Solutions (MCS), a third-party vendor who negotiates with medical providers on behalf of our members to ensure that your bills are being handled fairly. As soon as they receive the bill from Liberty HealthShare, their advocates begin the process of working with the member's provider to arrive at a conclusion that is both affordable for the member and sharing community and reasonable for the provider.
Once a bill is processed by the MCS intake coordinators, it is sent to a regional advocate who is assigned to the area where the member lives. The advocate then contacts the provider to begin negotiating the balance of the bill. Balance billing is a practice in which providers inflate the price of a procedure beyond its actual cost because insurance companies will typically pay for the excess. When we asked an MCS representative how they engage the negotiation process, she said, "We will contact the provider and ask that they write the entire balance off by explaining to them that Liberty HealthShare members are self-pay patients. Informing and educating the providers of what Liberty HealthShare is a key point in our negotiations."
Once the advocate has introduced Liberty HealthShare's model, they wait to hear back from the provider. In the meantime, and any time the member's file is opened, the advocate emails the member with an update on where the bill is in the renegotiation process. If the provider chooses to work with MCS, they may go back and forth several times with proposals and counter-proposals until each side reaches an agreement.
Renegotiation takes up more time than any other part of bill processing, and in some cases, the process may exceed the 30-45 day goal. Much hinges on the provider's willingness to work with the MCS advocate. In some cases, the provider completely refuses to negotiate, and MCS has to change tactics to be able to arrive at a settlement. Efficiency also depends on how quickly the provider responds to the initial proposal. Some files are halted for weeks because a provider has not yet reviewed the proposal or responded, despite prompt communication from MCS.
Once the negotiations produce a final result, MCS sends the completed file back to us at Liberty HealthShare to get approval on any additional amounts to be shared. The advocate sends an email to the member to notify them of the resolution, and our billing department posts the bill to be shared among the Liberty HealthShare community. Most members' needs are successfully shared with no further complications.
Every once in a while, a provider will still retroactively bill a member for the excess balance of the procedure. MCS says, "The faster we receive those balance bills, the faster we can work on those. Us receiving that first balance bill is crucial." Our Member Services department is also always prepared to help answer questions by phone at 855-585-4237 or by email at firstname.lastname@example.org.
Our members are precious to us, and we wouldn't trust their needs to just anyone. We continue to partner with Medical Cost Savings Solutions because we are convinced that they are just as committed to serving our members with excellence as we are. It is our privilege to work with some of the best in the field of medical cost sharing, as they advocate on behalf of our sharing community.