Medi-Share FAQs

You Have Questions,
We Have Answers.

Medi-Share Value FAQs

You Have Questions,
We Have Answers.

How To Self-Pay

What does it mean to be a self-pay patient?

  • As a self-pay patient, you are not limited by a network. You’re empowered with information to shop providers by quality and price. You can use any provider, even those who may charge more than the Fair Price* displayed in Healthcare Bluebook*, provided you understand that you may be responsible for the charges beyond the Fair Price*.
  • When you speak with providers, you simply tell them you are a self-pay patient and request a self-pay discount. You can also ask for a Good Faith Estimate. Under the No Surprises Act, providers are required to include all relevant charges in the Good Faith Estimate. Providers are familiar with offering self-pay discounts to uninsured patients. Your provider’s self-pay rate or Good Faith Estimate should fall within the range displayed for that provider or procedure.
  • If your procedure is expensive or complicated, Healthcare Bluebook* will prompt you to notify the Navigation Team so we can guide and support you. For example, doctors often perform procedures at multiple facilities, so we’ll help you find a high-quality provider at a Fair Price*. We can also help you evaluate and secure a Good Faith Estimate for relevant procedures. The No Surprises Act protects patients from being billed more than $400 over the Good Faith Estimate. For additional information, please refer to the CMS website at https://www.cms.gov/nosurprises
  • For additional information about the Navigation Team please refer to the Navigation Team FAQ section.

What steps do I take when I need care?

  1. First, members can access a telehealth provider at no cost for non-emergency needs including but not limited to: Allergies, Cold & Flu, Cough, COVID-19, Ear Pain, Headache, Insect Bites, Medication Refills, Pink Eye, Rash, Sinus Problems, Sore Throat, UTI (Adult Females, 18+), Yeast Infections, and more.
  2. If your care requires more than telehealth, use the Member Center to search Healthcare Bluebook* for care, notify the Navigation Team (when indicated), and submit bills. 
  • First, consider scheduling a telehealth call from the Member Center, at no cost, for non-emergency needs including but not limited to: Allergies, Cold & Flu, Cough, COVID-19, Ear Pain, Headache, Insect Bites, Medication Refills, Pink Eye, Rash, Sinus Problems, Sore Throat, UTI (Adult Females, 18+), Yeast Infections, and more.
  • If your care requires more than telehealth, use the Member Center to search Healthcare Bluebook* for care, notify the Navigation Team (when indicated), and submit bills.
  • To ensure eligible medical bills are considered for sharing, Medi-Share Value members:
  1. Login to the Member Center to use Healthcare Bluebook* to find Fair Price* providers or procedures before seeking care.
  2. When indicated by Healthcare Bluebook*, complete the Notification process
  3. If no notification is required, proceed with the following steps.
    • Request a self-pay price with the provider at time of visit. Providers are familiar with offering self-pay discounts to uninsured patients.
    • If you’re having a procedure or something more substantial than an office visit, you may want to ask for a Good Faith Estimate. Under the No Surprises Act, providers are required to include all relevant charges in the estimate. Your provider’s self-pay rate or Good Faith Estimate should fall within the Fair Price* displayed for that provider or procedure. Keep your Good Faith Estimate documentation because providers are limited to billing no more than $400 over the Good Faith Estimate.
    • Avoid signing documents that waive your protections and make you liable for charges over your Good Faith Estimate.
  4. Submit bills that exceed the Initial Member Responsibility (IMR) per day or per stay using the Member Center Bill Submission process as soon as possible. Bills submitted after 6 months from the date of service or discharge will not be eligible for sharing.
  • In the event of a medical emergency, you should seek care from the nearest hospital or doctor. Members should pay the minimum amount at the time of service, and ask to set up a payment plan. It is important to notify the Navigation Team after receiving emergency care so they can assist you if additional medical care is needed, or to help settle your medical bill with the provider.
  • For additional information about the Navigation Team please refer to the Navigation Team FAQ section.

How do I get Navigation Team support?

What do I do if I have an urgent need and cannot wait for a telemedicine visit?

  • Start with the service you feel is most appropriate for your situation, whether urgent care or emergency room care. o In the event of emergency room care, you should pay the minimum amount at the time of service, set up a payment plan, and contact the Navigation Team.
  • For additional information about the Navigation Team please refer to the Navigation Team FAQ section.

How does prescription sharing work?

  • Medi-Share's partnership with Navitus Health Solutions gives members access to significant savings on prescriptions as well as personalized care from a team of pharmacy professionals.
  • Be sure to download/print a copy of your Navitus Member ID card from the Medi Share Value Member Center. It’s important that you provide a copy of your card to your pharmacist during your next visit so they can update your information to ensure you start receiving the best prices on your medications immediately.
  • You can also create a member profile on the Navitus portal here. Once you are logged in to the Navitus portal, you should be able to:
    • Search for participating pharmacies by location
    • Compare prescription prices by pharmacy
      • Use the formulary/drug lists to identify preferred products
      • Receive mail order info for 90-day supply of maintenance meds
  • Specialty Medications Require Pre-Notification Through Navitus. Members who take medications for certain complex or rare diseases, including cancer, are required to pre-notify Navitus at 1.833.837.4306 for any specialty medications, including infusions/injections given at home or in a doctor’s office.
  • Certain medical conditions and services are subject to limited sharing per the Medi-Share Value Guidelines Section VI.I.
    • Prescription medications, including maintenance medications, are eligible for sharing for six months per each new condition that is not pre-existing. This includes prescription drugs that may be dispensed, infused, injected, or administered by a Medical Doctor (M.D.), Doctor of Osteopathy (D.O.), Nurse Practitioner (N.P.), Physician Assistant (P.A.), or Doctor of Podiatric Medicine (D.P.M.). A new medication for an existing condition does not restart the six-month timeline. Exceptions may be made in the case of medications for cancer and transplant recipients. Requirements for exception consideration include application to a Patient Assistance Program (PAP) and other available programs for medication cost when available. Use of Medi-Share Value preferred specialty pharmacy formulary and providers are required when applicable.
  • The cost of prescription medications for pre-existing conditions is never eligible for sharing.
  • For additional information about prescription reimbursement, please refer to the Submitting Bills FAQ section.

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