Liberty Healthshare Paid $167 of a $1400 bill Ohio City Ohio

After reviewing your membership, I see we have processed all bills submitted to us by your provider. They have all been processed as eligible and applied towards your annual unshared amount and/or shared, except for the 30% you are responsible to pay based on the program option you chose.

The program option you chose was our Liberty Share option, which shares the following; Liberty Share members share up to 70% of eligible medical costs up to $125,000 per incident. Medical expenses are met on a per person, per incident basis when treated by physicians, urgent care facilities, clinics, emergency rooms, or hospitals (both inpatient and outpatient). *Annual Unshared Amount (AUA): $500 for an individual | $1,000 for a couple | $1,500 for a family The AUA is the same for all three programs. 

We process all of our expenses based on our fee schedule and that can be found in our guidelines, which is the following information. 13) Fair and Reasonable Consideration refers to an amount that would constitute fair and reasonable payment to a Provider for Services provided in accordance with the terms of the Sharing Guidelines and approved for sharing, under the facts and circumstances surrounding the provision thereof, taking into consideration the Cost to the Provider for providing the Services, the fees that the Provider typically accepts as payment for the Services from or on behalf of the majority of patients receiving the Services, the fees that Providers of similar training and experience in the same “area” most frequently accept as payment for the Services from or on behalf of the majority of patients receiving the Services, and the Medicare reimbursement rates for such Services. Regardless of typical practices of any Provider or other providers of comparable services, Fair and Reasonable Consideration shall not include amounts for any invalid charges. Currently, Liberty HealthShare SM considers a medical expense charge to be Fair and Reasonable if it is at or below 150% of Medicare allowable for physician visits, 160% of Medicare allowable for inpatient services, and 170% of Medicare allowable for outpatient related services.

I do see that a member of our Research and Resolution team has reached out to you for further information to ensure everything has been processed correctly and that you were not balanced billed and paying those additional amounts to the provider. If you have any additional concerns, please do not hesitate to reach out to him.