Understanding Healthshares: Bills, Payments, and Peace of Mind

In this episode of The Pulling Curls Podcast, Hilary Erickson delves into the complexities of navigating healthcare without traditional insurance. Sharing her personal experience with an appendicitis, Hilary discusses the use of health shares, detailing the ins and outs of how her family manages medical expenses as self-employed individuals. Learn about the advantages, challenges, and practical tips for those considering a health share alternative.

If you’d like to check out Zion Healthshare please do use my link: https://www.pullingcurls.com/go/zion-healthshare/ It really helps when you say you heard about them from Pulling Curls! 🙂

Find it here on Apple or Spotify Podcasts

Links for you:

My other healthshare info:

Timestamps:

00:00 Zion reimburses quickly; other health shares delay.

06:13 Unexpected healthcare costs due to insurance complexities.

06:59 Bills cleared monthly; sometimes paid using credit.

12:47 Waited 30 days for medical bill, frustrated.

13:24 Frustrated over hospital billing and collection threats.

Keypoints:

Hilary Erickson shares her personal experience with non-traditional healthcare, specifically a health share organization, rather than traditional health insurance.
The high costs of traditional health insurance for self-employed individuals prompted Hilary to explore alternative options, leading her to Zion Healthshare.
Health share organizations allow for greater flexibility in choosing hospitals, doctors, and labs without restrictive networks.
Hilary explains that with health share organizations, patients are often considered self-pay and need to be proactive in managing and submitting medical bills for reimbursement.
Unlike insurance companies, health shares may take time to process and reimburse bills, sometimes taking up to six months, but Zion Healthshare was notably faster.
Hilary highlights the concept of a per-incident deductible with Zion Healthshare, explaining that for each new medical incident, her family is responsible for the first $1,000.
The episode details the various medical bills Hilary received following her appendicitis surgery, including bills from the hospital, anesthesiologist, radiologist, and other specialists.
A key frustration was the medical billing process, where hospitals initially billed exorbitant amounts before drastically reducing them for self-pay patients.
Hilary emphasizes the importance of having some form of healthcare coverage to manage unexpected medical expenses and stresses the necessity of understanding and navigating the billing process.
The podcast episode aims to demystify health share organizations and provide valuable insights into alternative healthcare options for families, particularly those who are self-employed.

Producer: Drew Erickson

Transcript

[00:00:00.590] – Hilary Erickson

Hey, guys. Welcome back to the Pulling Curls Podcast. Today on episode 249, we are talking about how we do insurance at our house, so let’s untangle it.

[00:00:11.610] – Hilary Erickson

Hi, I’m Hilary, a serial overcomplicator. I’m also a nurse, mom to three, and the curly head behind Pulling Curls and the pregnancy nurse. This podcast aims to help us stop overcomplicating things and remember how much easier it is to keep things simple. Let’s smooth out those snarls with Pregnancy and Parenting Untangled The Pulling Curls Podcast.

[00:00:39.680] – Hilary Erickson

Okay, so if you listened to, I think it’s two episodes ago, I shared about how I had an appendicitis. And then I also at the very end shared that we don’t use traditional health insurance. We own our own business, and traditional health insurance would have been, at this point, probably double what our mortgage is. And we just decided that that wasn’t worth it if there was another option. Now, I am a believer that you need to have insurance, but we’re going to dive into that in this episode.

[00:01:07.400] – Hilary Erickson

So first off, we use what’s called a Christian Health Share, although our Health Share is not considered Christian. Most people call it a Christian Health Share. I believe they just go buy a Health Share. We use Zion Health Share. If you’re interested in it, I have a link in the show notes that you can check them out. I love it when people use my link, it lets them know that I’m giving them business. And I can get a little kickback sometimes if you sign up through me. Just full disclosure. But I really like Zion Health Share. We ended up using a few of the different ones.

[00:01:34.320] – Hilary Erickson

We use Liberty. We use, I think it’s Samaritan. Liberty was a huge mess. So it is something that you have to be on top of. I could tell that Liberty was going down, and so we jump ship. It’s not insurance. So regular insurance has specific laws in your state where they’re required to do specific things, pay your bills, stuff like that, according to their policies.

[00:01:55.880] – Hilary Erickson

Of course, so many people get caught off guard by the policies because it It is impossible to read all the policies and know, especially when you go in for something emergency, like an appendicitis. Now, a health share, surprisingly, is sometimes more flexible. This is confusing. So if you have an insurance company, usually they say You can go to XYZ hospital or XYZ doctor. But with a health share, I could go anywhere. I could go to any hospital that I wanted to go to. So that’s really nice about it. I can go to any doctor I want to. I can go to get any lab I want to. They don’t have certain requirements It’s at least mine doesn’t, other ones might. But it’s really nice that when I thought my appendix had burst, I could pick any hospital I wanted.

[00:02:37.110] – Hilary Erickson

I didn’t have to go to a specific one. Now, the other thing to know about a health share is when you go to the hospital, you tell them you are self-pay. Now, I usually use an addendum. We have a health share, so I’ll need to get the bill so then I can submit it to them. But according to all of the billing departments, we were considered self-pay. Now, you get those bills, and some health shares take a really long time to reimburse you for that money. So let’s say the hospital gave us a bill for 40,000. Some health share, it’s going to be two to six months before they send you a check for that bill.

[00:03:09.760] – Hilary Erickson

That’s the problem. You’re stuck in the meantime, trying to either make payments on it or whatever you’re going to do so that you’re just waiting for that check. With Zion, which is actually why we chose to go with Zion, it was pretty quick. They had the check to them within the month. And honestly, it was shocking how long it took for a lot of these bills to come in. I let Zion know about the appendix with my discharge instructions as soon as I could so that they could then let me know that it was a covered cost.

[00:03:37.820] – Hilary Erickson

And then I submitted bills from there. We are almost eight weeks out from the appendix, and I just got another bill last week. It’s shocking to me that these people don’t have to send bills within any specific time frame. I’m hoping that’s our last bill. We’re going to talk about the bills. Don’t worry, we’re going to talk about the dollar bills. Anyway, the speed at which they paid off stuff was a big reason why we chose Zion Health Share.

[00:04:01.060] – Hilary Erickson

Now, with Zion, we have what’s called a per-incident deductible. So every time something happens, we are responsible for the first $1,000. So when I was in the hospital, the billing people came in and they’re like, We need a payment, and I just gave them $1,000 because I knew that that is what we were going to owe. I then submitted the receipt to Zion. They want to see that you paid that $1,000, and then they end up paying the rest. They paid the absolute rest of any of our visits after after that. So I saw a physical therapist, I saw a chiropractor. All of that was paid. There was no deductible after that because I paid the first $1,000 of an incident.

[00:04:39.610] – Hilary Erickson

Now, your kid breaks their arm and it’s $750. You pay all that. Your kid again breaks their other arm. It’s $750. You pay all that. They don’t kick in at all until you hit your per incident deductible, which for us is $1,000. But you can pick 2,500, you can pick 5,000, where they kick in after that. But the nice thing is when you have something really big that happens, They are going to pay all of that for as long as the incident happens. So let’s say this appendix a month later has an abscess, that’s still under the first $1,000. So you’re not required to pay more for this new thing that’s cropped up.

[00:05:14.260] – Hilary Erickson

But you are responsible for everything up until $1,000, which is part of why we have a DPC. I have a whole episode on that. Some people call it a concierge doctor. I just think of it like as Netflix for a doctor. I pay this doctor every month, regardless of if I see them or not. And then they’re there that I can make a phone call, send an email to, have a visit with whenever I need, which I absolutely love. I love that part of it.

[00:05:39.250] – Hilary Erickson

Now, a lot of you are thinking, but insurance is a sure thing, and I get that line of thinking, right? We all need to have insurance. I’ve seen so many expensive bills. We’re going to talk about my bills. But so many people end up getting caught off guard. They end up needing to somehow use two deductibles because it’s split over a year. The doctor isn’t in network. That’s a big one that I hear, and especially with my appendicitis, that’s something I couldn’t control who my radiologist was. I couldn’t control who my anesthesiologist was. I couldn’t control who the surgeon was. All I could control was which hospital I went to. Not in every state. I think they’re trying to work this so that it doesn’t keep happening.

[00:06:17.350] – Hilary Erickson

But some doctor who you have no choice over, you might end up having to pay out of network for that radiologist because they aren’t on your insurance’s plan, even though the hospital that they work at is on the plan. You know what I’m saying? There’s just so many times that people are caught off guard by bills and end up paying way more than they thought they were going to because of how insurance works.

[00:06:40.200] – Hilary Erickson

Okay, so we use a health share, which means that every single bill gets sent to me. With a self-pay. They think Hilary is going to pay it, which is not a really good feeling. I will say that when we were in the hospital, I was like, well, we’re really going to see if this thing works out. And when that bill comes to me, I scan it, or sometimes it’s already a PDF, and I just submit it to the health share company. And then about every month or so for each incident, they would go in, maybe every three weeks, go in and clear all those bills. They would pay everything that had come in. Sometimes they just pay it. If they’re able to pay it on their end, they’ll just pay it. On one of them, they gave me a digital credit card that had $32,000 on it, and I paid it using that credit card with the hospital. So you have to take a little bit more responsibility in getting those bills to them so that they can pay it, which is annoying when you’re already not feeling your very best because of surgery.

[00:07:33.560] – Hilary Erickson

Now, when my husband had skin cancer, I took care of… Very mild skin cancer, by the way. Let’s not freak out here. I took care of all the billing so that he could heal, but that’s just not his forte. So I was still taking care of all the bills while I was healing up. Annoying. Just get a folder, start putting the bills in the folder, move them to the submitted pocket once you’ve been able to scan them and submit them. You can even take pictures on your phone. It doesn’t have to be a scanner, scanner.

[00:07:59.950] – Hilary Erickson

Okay, so let’s talk about the different bills that I had that come, because in your mind, you’re like, okay, you go to the hospital, you get a bill from the hospital, right? And you do. You get a very big bill from the hospital. So let’s talk about that very first. My bill from the hospital initially said 126,000,362$, right? But then, because I was self-paid, they brought that bill down to 34,886. So I don’t even know why the hospital comes out with a bill of $126,000. I know that that’s what they submit to your insurance, but I feel like the hospital sends you this $126,000 bill just so that you think, Oh, my gosh, I’d have to have insurance in order to pay for this, because I don’t know many families who can absorb a $126,000 bill, liquidity split, right?

[00:08:45.160] – Hilary Erickson

But if you look at the self-pay thing, and this is for four days of inpatient hospital stay and three days of outpatient stay that’s through the hospital, which is billed at a higher rate than just regular home health. So this is a pretty hefty 50 hospitals stay, including a CT scan, lots of labs, lots of IV meds. I couldn’t believe every bag of L. R. Was $400, which I could… I mean, it’s just crazy. But then they just reduce all these things down to the self-pay rate.

[00:09:15.440] – Hilary Erickson

So that, I feel, was the biggest scam of all of this, that the hospital bills you for this outrageous amount, acting like that’s the amount everyone pays, when in reality, they’re going to lower it to another rate because that’s more reasonable, right? Even though I still think 34,000 for five days of inpatient hospital is still crazy. But it’s not just the hospital bill. Then you’re going to get all these other bills. So I got an anesthesiologist bill that was 2,600. They adjusted it down to 1,200 for self-pay patients. The hospitalists, so those are the doctors, the general doctors that you see at the hospital, they submitted a bill for $630.

[00:09:55.040] – Hilary Erickson

No changes for self-pay. I did notice that a lot of the doctors don’t have a self-pay discount. That’s just the price. The pharmacy, well, we bought medications from the pharmacy, and because they’re within the 30-day window of the incident happening, Zion will pay for those. So that was like $1600. The ER doctors have their own bill, so We’ll see that there are lots of different doctors that each have their own billing. They were $1,500, and that adjusted down to $758. There was the hospital, like the surgeons, and then the follow-up surgeon people was $2,800, and the adjusted amount was $1,900. I saw physical therapy. I saw a chiropractor. Physical therapy was $150. The chiropractor was $50. I just paid out of pocket for those, but then they will just reimburse me.

[00:10:38.990] – Hilary Erickson

I ended up having this crazy shoulder pain after I stopped taking pain meds, maybe because of the way I was laying. Anyway, that’s why I went to those two different people. This one is the crazy one. So whoever read my CT, not the CT cost, because that’s in the hospital bill, so the cost of actually getting the CT. This is the doctor who read my CT, billed me $912 for it, and then lowered it to 547.

[00:11:02.470] – Hilary Erickson

But the CT, it’s like six sentences. It just said very vague things about the CT. $500 for that. That’s crazy town. Radiology, guys, think about it as a career. Pathology, which is after they take out your appendix, they send it to pathology to make sure that it’s your appendix. That was $13. Seems very reasonable, right? Don’t become a pathologist, apparently. And then I also had infectious disease following me at the hospital, and that was $810.

[00:11:33.150] – Hilary Erickson

So if you’re following along, at the hospital, as far as doctors, there was an anesthesiologist, there were the general hospitalist doctors, there was the ER doctors, there were the surgeons, there was the radiologist, there was the pathologist, there was the infectious disease doctor. So I knew that all those different bills were coming, but I think a lot of people would just think, Okay, I got the bill from the hospital. It’s 36,000 or whatever. That’s all we have to pay. So the pre-adjustment amount, in case you were was $136,069. And then the final amount that was paid was $41,028. So just over $41,000 was my total. And Zion paid all those within 2-3 weeks of getting the bill.

[00:12:14.100] – Hilary Erickson

And if they start to hound you because the hospital… We’re going to talk more about that. The hospital started to hound me, although they hadn’t even sent me the bill. We’re going to get into that. They immediately went in and paid that bill. So if people are starting to bother you about it, Zion was really good about paying that.

[00:12:29.670] – Hilary Erickson

Let’s go back to the hospital, though. So I had this lady that I paid the $1,000. She was like my care counselor or something, the financial assistant. I don’t know if everyone gets this or if it’s just that you’re self pay. And then I was like, great, when will I get my bill? And she was like, oh, well, you’ll have to submit this thing. So I went home on my email, I printed it out, signed it, even though I felt like death, submitted it to get my medical records or the payment.

[00:12:54.900] – Hilary Erickson

Thirty days is what they said they would then get me the bill within 30 days. Which I was like, you know how sometimes you get those and you’re like, oh, they say 30 days, but they really mean a week? No, I waited two weeks and I called them and I was like, hey, when am I going to be able to get my bill emailed to me?

[00:13:10.320] – Hilary Erickson

And they’re like, well, it’s 30 days. I was like, you’ve got to be kidding me. I really have to wait 30 days to be able to get it? They said, Well, you can come into the hospital and get it right away. I said, That absolutely makes no sense. And they were like, Well, that’s just how we do things. So I had to haul myself back to the hospital. I think by this point, I was maybe two, three weeks out from the surgery. I couldn’t send Drew, by the way, because I need a special form to be able to have my husband, HIPAA violation, get the form from the hospital, right?

[00:13:36.390] – Hilary Erickson

So I had to haul myself in and get the bill. And you can only imagine how happy I was and how many managers I asked to speak to about how poor this process was because I couldn’t imagine. Anyway, the reason I went to the hospital is because my care coordinator, prior to me actually receiving the bill, I had no idea what the bill was, was saying, Well, we don’t want to have to send you to collections for this.

[00:13:57.060] – Hilary Erickson

And I was like, I don’t even have a bill. And she was like, Well, that’s your problem, right? How unfair is that? You haven’t even sent me the bill, yet you’re already talking about collections. And I get it. I come up as a self-care pay patient. They’re worried about getting paid, but also send me the bill. My gosh.

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[00:14:14.830] – Hilary Erickson

Anyway, all of that to say, I feel like hospitals and insurance companies are in kahoots to make this almost impossible for people to manage on their own. Trying to get all of those bills said to an insurance company. If I was just Joe Smoes trying to pay this out of my pocket. Every another $800 that comes, that’s unsettling for people.

[00:14:36.510] – Hilary Erickson

So that’s the worst part of having the health care is just having to manage the bills on your own and manage a system that is not rigged for people to succeed at all. I’m hoping that the American public wakes up at some point and realizes that insurance is just a huge fat scam. But until then, this is what we have. And I do think that most people would not be able to absorb a $40,000 hospital bill very well with their own finances.

[00:14:59.760] – Hilary Erickson

So at this point in time, we do need to have insurance or a health share. Again, if your insurance is a crazy amount, especially if you are self-employed, I would encourage you to check out the health share. You can find the link through this episode.

[00:15:13.100] – Hilary Erickson

Anyway, it’s something to consider. It did end up working out for us. They paid every bill and have been so helpful, so that was really nice. And I’m healing up nicely. I probably feel 100%. I don’t really feel any different than I did before the surgery. We didn’t end up having an abscess. We actually went on a trip to Dollywood just about a month after. I had the surgery and all things went well. So huzzah for that.

[00:15:34.100] – Hilary Erickson

Huzzah for healing. Oh my gosh, it’s amazing that my body can even heal from all these different things. So probably way more information than you wanted on this episode, but I thought it was interesting in case people were interested in it.

[00:15:46.590] – Hilary Erickson

We are actually going on hiatus until the beginning of the year after this episode. So we will see you in 2025, where we are talking about signs your birth will be hard. And then I’m talking about moving my parents into retirement living. So stay tuned for 2025. We’ll be back early January.

[00:16:03.170] – Hilary Erickson

Thanks for joining us on the Pulling Curls Podcast today. If you like today’s episode, please consider reviewing, sharing, subscribing. It really helps our podcast grow. Thank you.

Keywords:

health insurance, pulling curls podcast, Hilary Erickson, Christian health share, traditional health insurance, ZION health share, appendicitis, Liberty health share, Samaritan health share, self-pay patients, health share benefits, insurance policies, emergency medical bills, per incident deductible, health share reimbursement, DPC, concierge doctor, Netflix for a doctor, medical billing, out-of-network doctors, hospital bills, anesthesiologist bill, radiologist bill, physical therapy, chiropractor, pathology, infectious disease doctor, inpatient hospital stay, health share coverage, medical expenses, handling medical invoices.

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