So You've Enrolled in one of the ClearShare Healthcare Plans. Congratulations!
Now you might be wondering what to do when you incur medical expenses, like a visit to urgent care or a scheduled surgery.
ClearShare is a healthshare plan, or a healthcare sharing ministry. With ClearShare, you’re part of a membership-based, non-insurance community of like-minded individuals who have joined together for the purpose of sharing in each other’s eligible healthcare expenses.
Because ClearShare is not health insurance, the process when you incur medical expenses is a little different from submitting a claim with a traditional insurance provider.
This article will outline the process for submitting a medical need request through ClearShare, and answer some other questions about your membership.
ClearShare Medical Need Requests
A step-by-step guide
With traditional insurance, you provide your member ID card to your medical provider, and they bill your insurance. With ClearShare, members collect the bills themselves, and then submit a “medical need request.” Medical needs are submitted on a per member, per need basis.
Medical needs may be injuries or illnesses that result in medical expenses. Needs fall under two categories: medical procedures that you know about in advance (like a scheduled surgery), and emergencies. When a member has a medical expense to be shared, the member must submit original, itemized bills for the medical expense within six months of treatment.
Here’s a step-by-step guide for how to submit a ClearShare medical need request.
Step 1: Review the Member Guidelines
Not sure if your medical expenses are eligible for sharing? The ClearShare Member Guidelines explain which types of expenses can be shared with the community. Within the guidelines, review the sections “Pre-Membership Medical Conditions,” “Specific Sharing Qualifications,” and “Medical Expenses Ineligible for Sharing” for specifics.
Step 2: Contact ClearShare
For non-emergency situations, we recommend you contact ClearShare 30 days prior to receiving medical service. Our Care Coordination team can help you save money by finding lower cost, high quality providers for your medical needs.
On top of that, when you use providers recommended by Care Coordination, your annual maximum payment requirement for the service may be waived! That’s like free money for using a service that saves you time, too.
Care Coordination can also help your provider understand how your ClearShare membership works, and make sure you’re charged the right amount for services.
Step 3: Get Itemized Bills from Providers
ClearShare healthcare plans will need you to get the itemized bills from providers, for each service received. This is a key step. You’ll be responsible for collecting your bills yourself. To be able to submit your need request, you’ll need to have all the itemized bills for your services. Just ask your provider for the itemized superbill.
Think of this like saving your receipts when you itemize deductions on your taxes. You’ll need to be able to document your medical expenses.
Why is this? ClearShare keeps monthly contributions low for all community members by sharing in medical expenses, and by negotiating fair prices for services.
To make sure the community is being billed fairly, ClearShare needs itemized bills for each service a member submits.
Step 4: Pay Your Annual Maximum
Your ClearShare healthshare plan has an annual maximum payment amount ranging of either $1,000, $2,500 or $5,000, depending on your membership type. You’ll need to meet this annual payment out-of-pocket before the ClearShare community can contribute to your medical expenses.
You may pay this initial amount directly to your provider. If you do, ask for itemized receipts for all your costs, and submit them to ClearShare to confirm you’ve met your annual maximum. Then the cost sharing can begin!
Step 5: Submit a Medical Need Request
To submit a medical need request, visit ClearShareHealth.org/need-request/. Here you can fill out all the information that ClearShare will need to be able to process your request.
When you fill out the need request form, provide specific information and attach all the supporting documents, like itemized bills and any relevant medical documents, to give ClearShare what they need to determine your sharing eligibility. The quicker you do this, the better.
Make sure to submit your need within six months of the date of service—but the sooner you submit a need request, the easier it will be for ClearShare to process your request and share in your costs. So don’t delay.
Step 6: Work With Your Provider
When determining your sharing eligibility, ClearShare may need access to medical records and other documents from your provider, in addition to the itemized bills. ClearShare will send you a HIPAA release form after you submit your medical need request, to enable ClearShare to access your medical information.
To help expedite this process, please work with your provider on getting the form returned to ClearShare as soon as possible, so ClearShare has the information they need to be able to share your medical expenses.
Frequently Asked Questions
What costs are shared as part of a single need request?
You can share medical expenses caused by an injury or illness, as detailed in the ClearShare Member Guidelines. Note that treatment must be provided by a licensed medical professional to be considered for cost sharing.
What should I expect after submitting a need request?
After submitting your need request, you’ll get a confirmation email from ClearShare, with any additional instructions. You’ll get confirmation about the sharing eligibility of your need request, too, and an Explanation of Sharing (EOS), that will outline the amount ClearShare will pay, and your personal responsibility.
How do I get the lowest possible price on my medical expenses?
When you go to your healthcare provider, identify yourself as a “Cash Pay” customer. This will allow you to receive any applicable discounts at the time of the service. Don’t present your ID card to the healthcare provider. Pay the provider directly for your services.
And don’t forget to save all your receipts, to submit a need to ClearShare!
Eligible medical expenses will accumulate toward your annual maximum every year of your ClearShare membership.
Clearshare is here to help with your membership. Our goal is to save you money on high-quality healthcare. If you have any questions, contact us at 877-405-2926 or needs@clearsharehealth.org.
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