The Texas Medical Association is telling physicians to be mindful of patients who have entered into an arrangement with health care-sharing ministries, which present themselves essentially as faith-based alternatives to health insurance.
In a health care-sharing ministry, people of a similar faith pool their resources to help pay each other’s medical costs. The ministries aren’t subject to the same requirements as insurance companies under the Affordable Care Act (ACA), and if they comply with certain stipulations, they’re not considered to be engaging in insurance under the Texas Insurance Code. Therefore, they’re not regulated in the same way as insurance companies.
But health care-sharing ministries could be attractive to consumers who don’t know the basic differences between them and traditional health insurance plans. The per-month payments for ministry arrangements are typically much lower than health plan premiums, says Genevieve Davis, TMA’s associate vice president of payment advocacy. And the repeal of the ACA’s individual mandate beginning in 2019 could make this kind of alternative coverage even more attractive to patients.
TMA recently asked the Texas Department of Insurance (TDI) to put out a notice reminding consumers that health care-sharing ministries are not insurance companies.
Among other issues to be aware of, physicians should recognize that ministries can deny medical care for treating a pre-existing condition.
“In other states they have been shut down due to concerns over their business practices,” Ms. Davis said. “There are a large number of entities in Texas offering these products. Some of them may have contracts with third-party administrators in Texas, which would require the patient to use only physicians and other health care providers that the ministries have deemed acceptable. Physicians need to realize that if they have a complaint concerning these entities, they will not have recourse with TDI.”
To identify a patient’s participation in a health care-sharing ministry, you or your staff should check closely whatever ID card the patient provides, Ms. Davis says. Any ID cards ministries distribute are required by state law to indicate clearly the participant is part of a health care-sharing ministry that isn’t an insurance company.
After examining the ID for this information, your practice can make a business decision about whether you want to file claims with and seek payment from one of these companies. You may want to consider having patients pay in full for the services and seek reimbursement from the ministry themselves.
Texas Medicine will take a closer look at health care-sharing ministries in future coverage. If you have additional questions about health care-sharing ministries, contact Ms. Davis at genevieve.davis[at]texmed[dot]org.