I was somewhat taken aback that one of my favorite commentators, both broadcast and podcast, with impeccable credentials and a no-bullshit attitude, would read a commercial that could potentially disadvantage some members of his audience in a time of extreme need. I would think that the commentator would have been more sensitive to the issue of medical healthcare coverage given his recent treatment for cancer and the need for adequate medical insurance for himself and his family.
There is a growing trend to use a crowdfunding model to simulate medical insurance. And, several reputable groups have benefited their members over the years. However, you assume the ultimate risk – especially with newer companies without a large member base and a history of competent operation.
It’s not medical insurance…
The promoted product is positioned as an inexpensive alternative that may substitute for medical insurance. Of course, it is not insurance that is regulated by federal and state strict laws. In times of financial stress, it is not subject to having actuarially-computed reserves to meet projected medical reimbursements. And they do not participate in insurance commissions risk pools to protect against company defaults.
The scheme is ingenious. Use crowdsourcing to pay the medical bills of community members. But, instead of relying on donations, require members to pay into the system as if they were paying premiums.
Compared to healthcare insurance premiums, the cost appears modest.
And carries a $500 deductible.
And a $25/month subscription…
Q: What do you mean by monthly subscription?
A: In addition to the amount contributed to the Community each month, every Member pays a $25 monthly subscription. This covers our operational costs so every penny of your monthly contribution goes directly to reduce the healthcare costs of the [redacted] Community.
Terms and conditions apply…
Q: Does my [redacted] Membership satisfy a state or federal individual insurance mandate?
A: No, your [redacted] Membership does not satisfy a federal or state individual Minimum Essential Coverage (MEC) mandate. If you live in a state (e.g. California, District of Columbia, Massachusetts, New Jersey, Rhode Island, Vermont) with a state-level individual MEC mandate, you are responsible for securing that coverage independently from your [redacted] Membership.
Q: What about big health events?
A: There is no maximum amount of health care costs you can share with the Community. The [redacted] platform is designed to maximize the probability that all Members’ eligible bills can be funded in full each month. You can learn more in the Member Guide.
Q: What are some examples of treatments and procedures that are not eligible for funding by the Community?
A: To protect the Community from excessive expenses, [redacted] certain conditions and treatments are limited or excluded from funding by the Community—things like alternative treatments, fertility, preexisting conditions over a certain cost, and anything medically unnecessary. Memberships currently don’t include mental health care or vision and dental, but we look forward to expanding what can be funded by the Community as we grow. You can learn more in the Member Guide.
Q: What if I have a pre-existing condition?
A: For pre-existing health conditions, you are responsible for all costs associated with the condition(s) in the first year. The Community will contribute up to $25K to bills related to pre-existing condition(s) in the second year, $50K in the third, and $100K in each year after. Prescriptions for your pre-existing conditions are not subject to the 120-day limit but are subject to the annual pre-existing condition maximums outlined above. You can learn more in the Member Guide.
Q: Do you accept everyone?
Almost! The Community is not currently open to tobacco users (defined as daily use for a period of 3 or more months, past or present) or those who weigh over 260/300 pounds (female/male). We want the [redacted] Community to be a place for anyone looking to improve their health and contribute through the Member Community, so we hope to add an option for people with more varied health histories soon.
Whether you see your favorite doctor, or we find one for you, we want you to experience high-quality care at a fair price. We’ll also help you find hospitals and outpatient facilities that have your best interest in mind.
[OCS: It should be noted that there is no guarantee that your physician or the nearest medical facility will negotiate prices, especially for admissions through the emergency room. Unlike insurance companies that negotiate capitated costs, there do not appear to be such arrangements in place using this plan although the company may assist you in the negotiation.]
What is the definition of eligible?
Plans sold on the US health insurance marketplace deny an average of 17% of in-network claims annually, which dramatically increases the healthcare cost burden to American families. [redacted] has not denied or left a single bill unfunded for an eligible expense submitted by an active Member of the Community.
Of course, the offering company covers itself with caveats that protect the company and its officers…
- Fulfill your monthly subscription and contributions, timely and consistently.
- Believe that highest cost does not indicate best care, being open to considering high-quality health care clinicians who can offer a better price for the care you need.
- Avoid illegal activity and only submit legitimate, medically necessary bills for Community funding.
- Care about your own health and that of the people around you, proactively engaging with your health and wisely spending on your health care costs.
- Trust your Community to help fund your health expenses while understanding that ultimately, each Member is responsible for his or her own medical bills.
You trust the Crowd to fund your expenses, and your contributions fund theirs, month after month.
[OCS: Trust may be the wrong word. Like many similar faith-based health communities, I would suggest the word “faith” -- because you cannot trust a company who claims you are responsible for your medical bills regardless of the reimbursement they may pay to your healthcare provider.]
What Else Does “It’s Not Insurance” Mean for Me?
We have developed systems and processes that allow the Community to absorb very large medical expenses; however, we are not insurance, and therefore we cannot guarantee that your medical bills will be paid. Ultimately, Members are responsible for their own medical bills.
And the commentator and platform are also protected…
Credible media outlets and commentators often hide behind disclaimers.
11. Disclaimers. THE SITE, THE MATERIALS ON THE SITE, AND ANY PRODUCT OR SERVICE OBTAINED THROUGH THE SITE IS PROVIDED “AS IS” AND WITHOUT WARRANTIES OF ANY KIND, EITHER EXPRESS OR IMPLIED. TO THE FULLEST EXTENT PERMISSIBLE PURSUANT TO APPLICABLE LAW, [NAME REDACTED], ITS SUPPLIERS, ADVERTISERS, SPONSORS AND AGENTS DISCLAIM ALL WARRANTIES, EXPRESS OR IMPLIED, WITH RESPECT TO THE SITE, THE MATERIALS, AND ANY PRODUCT OR SERVICE OBTAINED THROUGH THE SITE, INCLUDING, WITHOUT LIMITATION, IMPLIED WARRANTIES OF TITLE, NON-INFRINGEMENT, ACCURACY, MERCHANTABILITY, AND FITNESS FOR A PARTICULAR PURPOSE, AND ANY WARRANTIES THAT MAY ARISE FROM COURSE OF DEALING, COURSE OF PERFORMANCE OR USAGE OF TRADE. [NAME REDACTED] DOES NOT WARRANT, ENDORSE, GUARANTEE, OR ASSUME RESPONSIBILITY FOR ANY PRODUCT OR SERVICE ADVERTISED OR OFFERED BY A THIRD PARTY THROUGH THE SITE OR ANY HYPERLINKED SITE, OR FEATURED IN ANY BANNER OR OTHER ADVERTISING. YOUR USE OF THE SITE AND ANY MATERIALS PROVIDED THROUGH THE SITE ARE ENTIRELY AT YOUR OWN RISK.
The program may work until it doesn’t. That’s the risk you accept on blind faith since you are ultimately responsible for your medical bills. I am not commenting on the company’s offering, only using it to illustrate the type of issues you should consider before investing in a program that involves healthcare.
For those wanting to research the topic, look for Healthcare Ministries, which are much the same thing with a religious component, and where donations might be tax-deductible.
Listen to the Better Business Bureau: Investigate BEFORE you invest.
Be safe and be well.
“Nullius in verba.”-- take nobody's word for it!
“Beware of false knowledge; it is more dangerous than ignorance.”-- George Bernard Shaw
“Progressive, liberal, Socialist, Marxist, Democratic Socialist -- they are all COMMUNISTS.”
“The key to fighting the craziness of the progressives is to hold them responsible for their actions, not their intentions.” – OCS "The object in life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane." -- Marcus Aurelius “A people that elect corrupt politicians, imposters, thieves, and traitors are not victims... but accomplices” -- George Orwell
“The key to fighting the craziness of the progressives is to hold them responsible for their actions, not their intentions.” – OCS
"The object in life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane." -- Marcus Aurelius
“A people that elect corrupt politicians, imposters, thieves, and traitors are not victims... but accomplices” -- George Orwell