The root cause for surprise medical billing is the failure nationally to adhere to an accepted pricing norm. Networks negotiate their rates and contracts based on their self-directed priorities and market forces. This effectively leaves self-pay/cash-pay patients struggling for fairness, equity and predictability in pricing. Price transparency is a good initial step in marketplace reforms, but it is only a first step. Consider the millions of Americans who choose health sharing as their health coverage option.
Health care sharing ministries are organizations where health care costs are shared among members who have common ethical or religious beliefs. A health care sharing ministry does not use actuaries, does not accept risk or make guarantees, and does not purchase reinsurance policies on behalf of its members. One of the largest health sharing ministries in the United States is Liberty HealthShare.
Liberty does not use a PPO network for its members. Members have the option to use any doctor or hospital they choose. Through a baseline analysis to determine fair and reasonable charges — Reference-Based Pricing (RBP): Medicare reimbursement plus 20/30/40 percent) — Liberty members share in RBP amounts and send a check for services based on that pricing analysis. Ninety-seven percent of all providers accept Liberty members’ checks. The remaining 3 percent send a balance bill to our members. Our members expect to be balance billed. We educate the member on what is a balance bill, when to expect it and what to do after receiving it.