For general provider office visits, log in to your Member Center and click on Find Provider on the right-hand side of the screen. The link to finding a provider takes you away from the Medi-Share website and connects you to the PHCS website. Medi-Share is not responsible for the accuracy of the information you will find. Before you receive care, you should contact your chosen provider to verify new patient status, location, network participation, and services currently being offered.
Emergency/urgent care visits do not require pre-notification; however, notification of emergency/urgent care is highly recommended within 72 hours of service.
Medi-Share is all about choice and you can continue seeking care at your current provider. However, it is important to note that by using an out-of-network provider, you will not receive the significant network discounts and may have additional financial responsibility based on the Medi-Share Guidelines Section V. B.
When talking to a provider, be sure to mention the network in the top left of your Member ID card as this is what will be more familiar to your providers. You should confirm with the provider's billing office that they are still in network.
Present your green Medi-Share Complete ID card and pay your provider fee as listed on your card. If you do not have a copy of your Medi-Share Complete card, you can access it through the Medi-Share mobile app or by logging in to your Member Center at member.medishare.com.
You should pay the provider fee listed on the front, upper right hand corner of your Member ID card when you receive medical services. If you have not met your AHP, the provider may bill you for an additional amount after the bill is processed.
Every time you visit a medical provider, you will present your Member ID card and your provider should submit your medical bills to Medi-Share. They will be processed and discounted, and then your provider will bill you for the portion you owe. Once the amount you pay meets your chosen Annual Household Portion level, eligible medical bills will be eligible for sharing.
Your providers will submit all medical bills to Medi-Share who will process the bills and apply any discounts. Eligible amounts are applied to your Annual Household Portion. If you have met your AHP, the bills will be submitted for sharing.
You should still pay your provider fee, even if you have met your AHP, as the fee is not applied to your AHP.
For a short video tutorial on how medical bills are applied to your Annual Household Portion, click here
The bill should be submitted electronically through EDI #59355 or can be mailed to Medi-Share, PO Box 981652 El Paso, TX 79998.
If traveling or living outside of the U.S., you are responsible to pay the bill, obtain an itemized bill (in English), provide proof of payment and submit to Medi-Share. For eligible medical needs, currency exchange will be calculated on the date bill was paid.
Medi-Share’s partnership with Healthcare Bluebook provides an improved provider search experience that lists providers by price and quality ranking, giving members additional data to help them be good stewards of their healthcare dollars.
Healthcare Bluebook quality rankings are calculated for each clinical area by assessing performance by the hospital or physician in several measures such as patient complications, patient safety, and unplanned re-admissions. A green, yellow, and red color-coding system is used to determine quality rankings on inpatient procedures. A Green Check Plus indicates the top 3rd of all facilities, a Yellow Check indicates the middle 3rd, and Red Check Minus is the lowest performing 3rd of all facilities.
No, Healthcare Bluebook only provides quality rankings for most inpatient procedures. Any outpatient procedure or service will NOT have a quality ranking available, only a Fair Price*.
For inpatient procedures, Healthcare Bluebook will only provide a ranking when the amount of information available is sufficient to accurately evaluate the hospital or doctor for that specific inpatient procedure.
The Fair Price facility and physician quality rankings (for inpatient procedures) use data from the CMS Standard Analytical File and commercial bills. Rankings are calculated for each clinical area by assessing performance by the hospital or physician in several areas: patient complications, mortality, and unplanned encounters.
The inpatient quality rankings highlight which facilities and/or physicians have historically demonstrated better patient outcomes for a particular service. The quality score is a reliability score relative to other facilities/physicians in the US – it is not a guarantee, but it increases the likelihood of having high quality care for inpatient procedures.
The data sources and analytics approaches for quality and price are different, and so is the amount of information available. Bluebook will only provide a ranking when the amount of information needed to accurately evaluate a provider meets their standards.
Medi-Share partnered with Healthcare Bluebook to provide quality and pricing insights because healthcare is one of the least transparent industries in the US. Even consumers with the best intentions cannot access fee schedules or quality data to inform their decisions. As Medi-Share members, our worldview is shaped by Biblical principles that include stewardship. You can now better practice stewardship with your healthcare. This puts members in a position to get higher quality care and the most out of your healthcare dollars. However, ultimately, the choice is yours as to which provider you choose. If you selected your provider using the 'Find Provider' link in the Member Center, your provider is in-network or has a direct contract with Medi-Share and there will be no additional responsibility (beyond your provider fee and AHP) for using a provider who is in-network.
*Healthcare Bluebook and Fair Price are trademarks of CareOperative LLC.