What is a reimbursement?
A reimbursement is a member request for Medi-Share to process an eligible bill you have already paid. Members can seek reimbursement on medical bills, adoption, out-of-country emergencies, or prescription costs.
When should I submit for reimbursement for a medical bill?
It is always best for medical providers to submit medical bills directly to Medi-Share to ensure that the bills are processed in a timely manner.
However, some scenarios require you to submit for reimbursement:
- If an Out of Network provider refuses to submit the bill to Medi-Share
- If an Out of Network provider required up-front payment
- If you are seeking prescription, death, adoption or out of country reimbursement.
Reimbursements can take up to 30 business days or as little as 14 business days to process. Medi-Share will notify you via email or in your Explanation of Sharing if more information is needed.
Where do I find reimbursement forms?
Log in to your Member Center at member.medishare.com, click on the Resources tab, select Forms.
Scroll down to the Reimbursement section and select Download PDF for the HCFA/UB Submission Form
How do I submit a reimbursement for prescriptions?
Log in to your Member Center at member.medishare.com, click on the Resources tab, select Forms.
Scroll down to the Reimbursement section and select Download PDF for the Prescription Form
Do I receive a payment for reimbursement?
Once HCFA/UB is received along with the needed Submission form, any eligible amounts will first be applied to your AHP, then payment is sent to you once met.
What forms do I need in order to request a reimbursement?
What is a CMS-1500/HCFA or UB-04 form?
CMS-1500/HCFA or UB-04 is an industry medical form. This is the same form the provider would submit to insurance or a Health Care Sharing Ministry for bill processing. See pages one and two of the “reimbursement-standard” form for examples – click here.
CMS 1500/HCFA(Example)
UB 04(Example)
What if the provider will not give me a CMS-1500/HCFA or UB-04?
Per the member-voted guidelines, a CMS-1500/HCFA or UB-04 is required for your medical bill to be considered for sharing. If the provider refuses to provide a CMS-1500/HCFA or UB-04, please contact the Contact Center at 800-264-2562, ext. 7077.
What if the provider offers me self-pay or a cash pay discounted rate?
- You should not accept self-pay or cash pay discounted rates. Although it might seem there is a savings to Medi-Share or you, pre-payment can negatively alter bill processing.
- If self-pay or cash pay discounted rates are accepted, Medi-Share will still process eligible CMS-1500/HCFA or UB-04 with the contracted rate for PHCS in-network providers. The self-pay or cash pay rate you agreed to with the provider may not match that contracted rate.
- Prior to making a payment, talk to the business/billing office or office manager to ask for a CMS-1500/HCFA or UB-04. This form may or may not be provided based on the provider office policy. If the provider refuses to provide a CMS-1500/HCFA or UB-04, please contact Member Services at 800-264-2562, ext. 7077
Medi-Share will process eligible out-of-network bills allowing up to what is customary for the chart in the service area. It is possible that this is less than the self-pay rate. The difference between the two would be your responsibility if the provider will not write it off.
Please visit our Sharing Guide for a short video tutorial on the topics referenced in FAQs.
