A. Using Preferred Providers
To get the most from sharing, Members should use preferred providers whenever possible because these providers have agreed to discount their fees to Members. Consequently, using this network generally offers significant savings, both for individual Members in the form of lower out-of-pocket expenses and also for the membership in the form of lower Monthly Share amounts. Specialty medications (including infusions/injections given at home or in a doctor’s office) should be arranged with Medi-Share.
It’s best to identify network providers and facilities in your region before you seek care. To do so simply go to member.medishare.com, or call the provider number on your Medi-Share ID card.
Your Medi-Share ID card must be presented to the provider before services are rendered or the discount may not be honored.
As a courtesy, many preferred providers also honor their discount agreement for services ineligible for sharing (such as routine care) if Members make payment promptly after receiving the Explanation of Sharing (EOS).
B. Using Non-Preferred Providers
If a Member uses a non-preferred provider, certain additional amounts will be ineligible for sharing and will be the Member’s responsibility. In addition to the Member responsibility for Medi-Share program elements such as the AHP and provider fees, Members will be responsible for anything in excess of:
- 150% of Medicare allowable rate for Professional Services (excluding Anesthesia)
- 200% of Medicare allowable rate for Facility Charges, or 80% of total charges for any hospital or other facility where there is no available Medicare allowable rate
- 250% of Medicare allowable rate for Anesthesia
The additional responsibility associated with out-of-network costs may be waived in cases where there was a life-threatening emergency or when the travel distance to the nearest qualified provider is more than 25 miles from home.
If pre-notification as described in Section III E. is not met, the additional responsibility may not be waived. Waivers can be requested by contacting Member Services. Waivers will be given after a balance bill has been issued by the provider. The request for the waiver must be received within 90 days from the date the Explanation of Sharing (EOS) was issued or within 12 months from date of service, whichever is greater. A request for a waiver does not guarantee approval.