Partners with
BECOME AN ACCEPTING PROVIDER!
It’s BETTER for You, It’s BETTER for Your Patients,
It’s BETTER for the Country
BECOME AN ACCEPTING PROVIDER!
When you combine an experienced and efficient non-profit health cost sharing organization with an
expert wellness education and management platform, you get the most comprehensive health sharing
program available today – Health Excellence Select!
The Health Excellence Select health sharing program featuring Liberty HealthShare
Allows patients to take back control of their health care costs through health sharing
Allows physicians to take back control of their patients’ health with no bureaucratic
intervention.
Offers its Members (your Patients) six affiliate services to assist them in becoming an
MPowered Self-Pay Patient.
What is Health Cost Sharing?
It’s a program managed by a Non-Profit Organization that helps like-minded, health-focused
members share their medical expenses.
It allows access to ANY Accepting Provider Physician or Hospital nationwide.
It costs up to 50% less monthly than traditional health insurance.
It’s RECOGNIZED BY & EXEMPT FROM the tax penalties imposed by the Affordable Care Act, but
is NOT insurance.
It has a 30 year track record of medical cost sharing success.
What is an Accepting Provider?
It’s a Physician, Health Care Professional, Hospital or Medical Facility who agrees to accept the higher and
quicker reimbursements of Health Excellence Select’s cost sharing component, Liberty HealthShare.
Benefits to Accepting Providers.
Increased revenue based on reimbursement rates of Medicare PLUS 50% - 70%.
Rapid payment for services rendered.
New Patient referrals.
Assistance to grow your practice! (See details on page 9)
In the pages that follow, you’ll learn more about how Liberty HealthShare and Health Excellence Select
have partnered to offer you an inspiring and exceptionally effective solution to benefit you, your patients
and your practice!
Find out more – www.MyLibertyHealthShare.com
Become a Provider - www.AcceptingProvider.com
It’s BETTER for You, It’s BETTER for Your Patients,
It’s BETTER for the Country
Find out more – www.MyLibertyHealthShare.com
Become a Provider - www.AcceptingProvider.com
Submit Clean Medical Bills To
Global Care For Pricing
In 3 - 7 business days, bills are
forwarded to Liberty HealthShare
for Processing
Receive Payment within 30 Days
Explanation of Annual Unshared
Amount (Members Responsibility)
within 30 days
Annual Unshared Amount (AUA)
is the amount of eligible need
that does not qualify for
Sharing. This amount is paid
directly by the Patient to the
billing Physician or Provider
Find out more – www.MyLibertyHealthShare.com
Become a Provider - www.AcceptingProvider.com
Health Care BY Americans, FOR Americans
Dear Physicians and other Healthcare Providers,
As you are aware, medical offices must contend with many different types of health plans in terms of referrals,
authorizations and uncertain reimbursements. Each patient potentially represents a different set of requirements.
When a Liberty HealthShare member becomes your patient there are no referrals needed and very limited
notifications, freeing the healthcare provider and staff of the cumbersome daily tasks which many offices
experience when dealing with the rules of insurance companies.
Liberty HealthShare is a health cost sharing program that provides our members with an affordable healthcare
option without utilizing a network and with the flexibility to see the provider of their choice. Healthcare sharing is
an acceptable choice in the Affordable Care Act, and fulfills the individual mandate.
All medical bills are re-priced by Global Care Inc. within 3 – 7 business days, giving us the ability for payment to be
made within 30 days. Members are responsible for their Annual Unshared Amount of $500 for a single
membership, $1000 for a couple, and $1500 for a family. All medical providers are reimbursed per the terms of the
health share guidelines up to the maximum payable amount. Reimbursement is based on the following:
•
For all Physician-related office visits, payment shall be reimbursed at Medicare rate +50% for
prevailing area where service is rendered. Claims must be submitted to Global Care, Inc., on a HCFA
1500 form, or electronically, inclusive of the rendering address with street, city, state and zip code
only, no P.O. boxes.
•
For all Inpatient-related services, payment shall be reimbursed at Medicare rate +60% for
prevailing areas where service is rendered. Claims must be submitted to Global Care, Inc., on HCFA
1500 or UB04 form, or electronically, inclusive of the rendering address with street, city, state and
zip code only, no P.O. boxes.
•
For all Outpatient- related services, payment shall be reimbursed at Medicare rate +70% for
prevailing areas where service is rendered. Claims must be submitted to Global Care, Inc., on a
HCFA 1500 or UB04 form, or electronically, inclusive of the rendering address with street, city, state
and zip code only, no P.O. boxes.
Bills must be sent directly to the address shown on the member’s identification card.
This program provides you, the provider of medical services, with timely, accurate and reasonable reimbursement
for services rendered within your service area. The Medical Cost Sharing Summary has been attached for your
review.
Please feel free to contact me with any questions or concerns you have. I will be happy to discuss this with you, at
your convenience.
Thank you,
Liberty HealthShare
Kimberly Pantoya
Provider liaison
Phone: 855–585–4237 EXT. 1170
Email: [email protected]
4845 Fulton Dr. NW.
Canton, OH 44718
Find out more – www.MyLibertyHealthShare.com
Become a Provider - www.AcceptingProvider.com
MEDICAL COST SHARING SUMMARY
Expenses
Eligible
For Sharing
Health after
Excellence
Health
Excellence
Select 100% up to $1 million
AUA Select
Annual Unshared Amount (AUA) – first dollar amount of
annual medical costs not eligible for sharing)*
Annual Unshared Amount
(AUA)*
Single
Couple
Family
$500
$1,000
$1,500
*Note: the annual unshared amount (AUA) is the amount of an eligible expense that does not qualify for sharing, and is calculated upon each members
enrollment date until their next annual enrollment date.
Note: A medical expense incident is the charge (s) incurred for eligible medical treatment arising from any illness or accident of a sharing member, and any
fees incurred by Liberty HealthShare to reduce such charges. All providers treating the same illness (diagnosis) are combined in the same incident.
Maximum Eligible Sharing Limit Per Incident
Single
Couple
Family
100%
up to
$1,000,000**
**Guardians Group is for catastrophic expense needs up to $1 million is included with Health Excellence Select.
Note: The following expenses will not apply towards the maximum expense limit: (1) Reduced share amount for failure to follow healthcare management
procedures. (2) Any charge excluded in the sharing guidelines. (3) Any other charges that exceed maximum limits.
Pre-Notification
Step One: The Pre-Notification staff must be notified of the following services before occurrence:
• Inpatient confinements (including hospital, skilled nursing, inpatient rehabilitation facility & hospice care)
• Emergency admission (within 48 hours)
• Pregnancy/Maternity
STEP ONE:
• Organ/tissue transplants services
Call Pre-Notification at 877-202-6379
• Home healthcare services
• Outpatient surgery
Step Two: Contact customer service@ 855–585–4237 to verify eligibility of charges. Charges will be ineligible for
sharing if timely notification is not received for all charges for rendered services listed above. Pre-notification (step
one above) does not guarantee that your expenses will be shared. Please contact customer service to verify
eligibility for sharing.
Health Excellence Select 100% up to $1 million after AUA
Accidents
Chiropractic Services
(accidents are investigated for other party liability)
Limit 12 visits per Calendar Year
Accidents Involving
Recreational Vehicles
Ambulance Services
brought to you by
Find out more – www.MyLibertyHealthShare.com
Become a Provider - www.AcceptingProvider.com
MEDICAL COST SHARING SUMMARY- Continued…
Diagnostic X-ray and
Laboratory Services
Emergency Room Hospital
And Physician Services
Inpatient/Outpatient/Independent lab (outside lab)
(Routine treatment excluded)
Home Health Care
Hospital Services
Limit 30 days per Incident
Inpatient: Daily Room and Board limited to the average
semi-private room rate.
Maternity Care
Physician Office Services
Normal delivery (including physician charges, office visits,
hospital charges and birthing centers) cesarean section
and/or complications treated as new incident with new
per incident limits
Per incident visit. All other physician office services
included per incident. (Charges billed by a physician if
performed in the physician’s office: injection, surgery, lab,
x-ray, special diagnostic interpretation.)
Prescription Drugs
Surgery
Per incident (charges must occur within 45 the days
before or after any related medical incident)
Surgeon, Assistant Surgeon and Anesthesiologist Services.
Inpatient/Outpatient services. Outpatient surgery facility
Therapy
Limit 20 visits per Calendar Year
(Combined with Speech, Respiratory, Physical,
Occupational Therapy)
All Other Eligible Expenses
(Unless limited by the guidelines)
Naturopathic and/or Alternative Treatments
Treatment provided by a Naturopath or other practitioner of alternative treatments is eligible for sharing if such
treatment meets the following criteria: A- It treats a medically diagnosed condition. B- It is less invasive than
conventional medical treatment for the diagnosed condition. C- It is less costly than conventional medical treatment
and is expected to prevent more costly future conventional treatment. D- It is presented for prior approval to Liberty
HealthShare™ and the member agrees to any alteration of the treatment plan made by Liberty HealthShare™.
Health Excellence Select 100% up to $1 million NO AUA
Preventative Screening
Mammograms, Pap smears, PSA tests, Screening
Colonoscopies Limit: 1 every 2 years; 1 per year over 50
Wellness
Babies 0-1 one year – well baby checkups including
vaccinations. Adults 1 year and older includes labs, x-rays
(one per membership year)
Find out more – www.MyLibertyHealthShare.com
Become a Provider - www.AcceptingProvider.com
brought to you by
Dear Doctor and Other Healthcare Providers:
Thank you for your decision to accept Liberty HealthShare members into your service and billing system based on
the following reimbursement rates as shown on this signature form. Upon your signature and submission, Liberty
HealthShare Inc will expedite reimbursement(s) to the Provider within the agreed upon payment time period. For
questions, please contact Kimberly Pantoya, Provider Liaison, at 855-585-4237 ext. 1170.
Authorized Signature
Office Name:
Provider Tax ID:
Mailing Address:
Street:
City:
Phone:
Fax:
State:
Contact Persons Name:
Physician-Related
Office Visits:
Inpatient-Related
Services:
OutpatientRelated Services:
Zip:
Position:
Payment shall be reimbursed at Medicare rate plus 50% for prevailing area where
service is rendered within 30 days of billing receipt.
Payment shall be reimbursed at Medicare rate plus 60% for prevailing area where
service is rendered within 30 days of billing receipt.
Payment shall be reimbursed at Medicare rate plus 70% for prevailing area where
service is rendered within 30 days of billing receipt.
Authorized Signature
Date
Print Name
Title
By signature above, I approve the reimbursement schedule for all Liberty HealthShare, Inc. members as
billed by my office according to the following terms:
1. Provider agrees to accept the adjusted price for the services rendered, and to not bill the patient or other
responsible party for the discounted amount, if any.
2. Provider may bill the patient or other responsible party for any “Ineligible for Sharing” (denied) amounts
related to the services rendered.
3. All reimbursements are per the terms and conditions of the patient’s healthshare program guidelines.
After signing this form, please FAX to: Kimberly Pantoya at 216-456-8115, OR scan and attach to an
email and send to [email protected]
It’s BETTER for You, It’s BETTER for Your Patients,
It’s BETTER for Your Practice and It’s BETTER for the Country
As An Accepting Provider… You may participate in the Health Excellence Select
comprehensive health sharing program in 1 of 2 ways:
1. Accepting Provider – you agree to accept the Liberty HealthShare reimbursement
schedule from participating Health Excellence Select members.
2. Provider Affiliate – you want to capitalize on Health Excellence Select’s
comprehensive Health Sharing program in your practice to increase your patient
base and improve your bottom line.
The Provider Affiliate platform is a NO Cost “Health Sharing Patient Awareness Program”
that assists in communicating the benefits of Health Excellence Select and Liberty
HealthShare to your Patients. As a Health Excellence Select Provider Affiliate, you will
be equipped with a unique “Health Sharing Patient Awareness Program” Blueprint
created by the Health Excellence Select team, tailored to meet the needs of your practice.
Your “Patient Awareness Program” may include:
Join Us Today
(855) 816-4650x404
Find out more – www.AcceptingProvider.com
For More Information Call – (855) 816-4650x404 or email [email protected]