Judy Stewart’s 2020 colonoscopy was deemed by OneShare to be a “diagnosis of a pre-existing condition,” according to OneShare Health.
PHOENIX — As health care costs rise, many Arizonans are turning to Christian health departments instead of traditional health insurance. Members who share similar faiths make monthly donations and submit medical bills for reimbursement.
However, unlike insurance companies, the Ministry of Health primarily regulates itself. An East Valley couple learned the hard way why these deals lead to unusually high bills.
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“It’s a ball of confusion.”
Judy Stewart worked for OneShare Health, a Texas-based company. With medical bills rising in 2020, Judy owes OneShare $5,500 annually in excess of the $5,000 deductible for services she paid, and for the colonoscopy she underwent. claimed an additional $18,000.
“It was a routine colonoscopy, the last one was five years ago,” Judy said.
OneShare denied her request for a refund.
Judy and her husband, Jim, spent months filing complaints and demanding an explanation.
“Calls hang up so many times. I guarantee they will take care of it. They never do,” said Judy.
Jim said the couple’s adventures of making phone calls, sending emails and letters turned into a “ball of chaos”.
OneShare ultimately informed Stewart in writing that the colonoscopy coverage was denied because the documents were submitted too late.
“Then I appealed and got back another letter saying it already existed,” Judy said.
In writing and by phone, the Stewarts asked why the procedure applied to existing conditions and why they did not receive a response.
OneShare is not obligated to reimburse the cost of a colonoscopy
After 12 News contacted OneShare on behalf of Stewarts, the company provided additional medical documentation showing that OneShare was justified under its agreement with Stewarts not to cover colonoscopies.
When Judy underwent a colonoscopy in 2015, she was diagnosed with diverticulitis, a condition that causes inflammation in the digestive tract. So, according to OneShare, Judy’s her 2020 colonoscopy was deemed by OneShare to be “a diagnosis of a pre-existing condition.”
Judy will pay an $18,000 bill to Kingman Regional Medical Center for a colonoscopy.
“If you sign up for one of these Christian ministries, make sure you don’t have any pre-existing medical conditions,” she said.
Health policy experts said the Stewarts’ complaints are an example of what can happen to people after joining a Christian medical consortium. You may find that there are no government agencies with
“These health care sharing ministries are not subject to the regulations that govern insurance companies, so there are no required benefits. There are no solvency requirements. Larry Levitt said.
As of last week, the Better Business Bureau showed OneShare Health 127 complaints over three years. Many complained about the lack of coverage and poor customer service.
In an email to 12 News, OneShare’s chief legal officer, Buddy Combs, said the company strives to keep its members well-informed about its program so that their claims are fairly adjudicated. rice field.
“While every member complaint is important and there is always room to improve our services, 127 complaints over three years have contributed to the overall satisfaction of tens of thousands of members who have made hundreds of thousands of sharing requests. We believe it doesn’t accurately reflect the degree of the share that has driven $160 million in shares during this time,” Combs said in an email.
OneShare paid $54,600 for surgery
Combs said the process for “share requests” will be detailed during the registration process and will be available online to members.
“Some medical conditions (such as conditions that existed before becoming a member) are not eligible to be shared,” Combs said in an email. “For potentially ineligible sharing requests, we strive to obtain and review all relevant medical records before making a final decision. This is not a decision we take lightly. It’s for.”
OneShare also has “robust procedures” for members to appeal the decision, Combs said.
After reviewing Stewarts’ case, OneShare agreed to pay for a visit Friday related to the wrist injury, calling it “negligence” by the company.
Combs also said in an email that OneShare paid for the knee replacement based on pre-certification records.
“However…additional records we received indicated that the right knee problem was a pre-existing condition,” Combs wrote. paid $54,613, but did not ask for a refund of the overpayment.
Stewarts concedes that OneShare has no obligation to cover colonoscopies, but said he didn’t feel the company was transparent when he joined the company.
“Using this company under the guise of a Christian medical consortium seems contradictory,” said Jim Stewart.
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