NEW Jewish HealthShare unitedrefuahhs.org

[as2]

They are not an insurance company, and are a lot more subjective with who they take. They also will not pay certain irregular costs (specialists during pregnancy, or pregnancy itself) which an insurance company would typically pay.

[shaulyaakov]

I'm sorry, this whole thing seems like a pyramid scheme.

[shaulyaakov]

They are not an insurance company, and are a lot more subjective with who they take. They also will not pay certain irregular costs (specialists during pregnancy, or pregnancy itself) which an insurance company would typically pay.

I thought after you're a member for like 6 months they do pay, assuming the couple is married?

[Zalc]

They are not an insurance company, and are a lot more subjective with who they take. They also will not pay certain irregular costs (specialists during pregnancy, or pregnancy itself) which an insurance company would typically pay.

They pay for both of those.
Only Catch is the pregnancy must start after you enroll.

They pay less as they are paying the uninsured cash rate that can be multiple times cheaper than insurance rates.

They also only cover costs up to 150-170% per CPT code of Medicare allowable, so if your provider charges more they will not share anything over that amount.

They also do not cover durable medical equipment nor ANY prescription medicine.

[Zalc]

I thought after you're a member for like 6 months they do pay, assuming the couple is married?

The Due date must be 10 months after enrollment.
They Only cover pregnancy if you are married.

[shaulyaakov]

They pay for both of those.
Only Catch is the pregnancy must start after you enroll.

They pay less as they are paying the uninsured cash rate that can be multiple times cheaper than insurance rates.

They also only cover costs up to 150-170% per CPT code of Medicare allowable, so if your provider charges more they will not share anything over that amount.

I thought it was the other way around that cash rates are more than insurance rates? My insurance EOB always shows the "discount".

[Zalc]

I'm sorry, this whole thing seems like a pyramid scheme.

Maybe. Maybe not.

They seem to be modeled after liberty Healthshare, and that's been around for ages with hundreds of thousands of members.

If you live in NY and gold level Obamacare coverage is 1400 a month before co-pays and deductibles etc...
Then paying them 320 seems very tempting.

[Zalc]

I thought it was the other way around that cash rates are more than insurance rates? My insurance EOB always shows the "discount".

Discount off of what?
They start inflated compared to cash.

I don't have a lot of experience with this...
Most of this is based off what I've read about other healthshares and asked these people

Is there anyone in the forums that is one of their 2,500 members who has experience and can talk about how this detail works, with United Refuah or any other healthshare?

[shaulyaakov]

Maybe. Maybe not.

They seem to be modeled after liberty Healthshare, and that's been around for ages with hundreds of thousands of members.

If you live in NY and gold level Obamacare coverage is 1400 a month before co-pays and deductibles etc...
Then paying them 320 seems very tempting.

Liberty has hundreds of thousands which means a bigger pool of cash at any given time.

This seems so small and that they don't want you to buy catastrophic seems risky. They can also just stop paying whenever they want, and as long as it wasn't fraudulent, seems like there's much less recource than with an insurance company.

[avromie7]

I thought it was the other way around that cash rates are more than insurance rates? My insurance EOB always shows the "discount".

The cash rate is significantly lower than the amount they bill insurance. They have different negotiated rates with each insurer, and they just bill much higher than that to make sure they don't underbill any insurance that has a high negotiated rate.

[as2]

I'm sorry, this whole thing seems like a pyramid scheme.

Not sure what's so hard to figure out...

I thought after you're a member for like 6 months they do pay, assuming the couple is married?

There is a set fee for pregnancies, within certain parameters. There are particular thing that are not covered when it comes to pregnancy. I don't know exactly what, I just know that there are things that would be covered by an insurance company, but aren't by them.


They keep their costs lower by limiting who they take, which in turn allows them to charge less. fairly simple concept.

[avromie7]

They can also just stop paying whenever they want, and as long as it wasn't fraudulent, seems like there's much less recource than with an insurance company.

Even if it is fraudulent, you can sue for as much as you want, but if there is no money you can't get anything. There is definitely much less recourse here than with an insurance company.

[avromie7]

There are particular thing that are not covered when it comes to pregnancy. I don't know exactly what, I just know that there are things that would be covered by an insurance company, but aren't by them.

Medical expenses for Maternity ending in a delivery by cesarean section that is Medically necessary because of complications are eligible for sharing up to the per incident limit per pregnancy (whether for a single or multiple birth pregnancy), subject to the applicable Annual Pre-Shared Amount and Pregnancy Fee.
Needs for Maternity ending in a natural delivery but with complications that threaten the life of the mother or infant and requiring care or services not normally rendered at the time of delivery are eligible for sharing up to the per incident limit per pregnancy (whether for a single or multiple birth pregnancy) subject to the applicable Annual Pre-Share Amount and Pregnancy Fee.

It clearly says they cover pregnancy complications.

[avromie7]

ETA: Their definition of pregnancy complications is very limited, I'm not sure if anything else would be covered

Complications of Pregnancy are conditions in evidence before the Pregnancy ends: acute nephritis, ectopic Pregnancy; miscarriage; nephrosis; cardiac decompensation; missed abortion; hyperemesis gravidarum; and eclampsia of Pregnancy.

[4yourinfo]

I'm sorry, this whole thing seems like a pyramid scheme.

It's not a " Ponzi scheme" it's basically like an insurance company (it may be even better as they weed out alot of risk (but have additional - as Jews have more babies)) a Ponzi scheme needs the next guy to continue as they are supposably making money - which in actuality they are not, so they take the new guys money and use it as their "profit money.. insurance/sharing is (supposed to be) sustained by their current enrollment - they charge a premium based on risk and they pool that money and use it for everyones bills - they don't need a new enrolle to keep them afloat...
That being said - United Refuah keeps to their terms the question is what is their terms...
#1 They only pay 150-170% of the Medicare allowance which means if you go to a doctor and the doctor charges double that you will be stuck with the extra $$ for example you go to a doctor and the doctor charges 3k dollars and the Medicare allowance is only 1500 United Refuah will only pay out 80 percent of the 1500 you will owe 20 percent plus the 1500 dollars. So the question is will your doctor(s) give you a cash rate that equals the Medicare allowance? Many doctors do not have such an option they have one rate and unless you have insurance there are NO discounts - hence you will be stuck with a large bill! Also  keep in mind a doctor may not even take you as a patient if you say "you don't have insurance only sharing" as they don't accept "self paying" patients. Hospital's will also not give you a good cash rate which would get you covered under the "Medicare allowance" unless you apply for and are eligible for "charity care" you can get stuck with huge bills from hospital's as I'm not sure they knock down the price otherwise...
If you have a baby there is a 1500 dollar fee it works different than an insurance company which has a deductible of 1500 - as United Refuahs fee only goes towards covered charges meaning towards the 80% they cover, unlike an insurance company where the deductible goes towards the copay too for example if you were to get a bill from a doctor for 1500 dollars and your insurance company has a 20% copay and 1500 dollar deductible, you would pay the 1500 bill and you have met your deductible. With United refuah after you pay the 1500 only 80% of the 1500 went towards your deductible as 20 percent they don't cover and you are still going to owe 300  dollars towrds your deductible! (It's a fee and not a deductible)
Also when you have a baby - with insurance, the doctor bills the insurance after the birth - as per their negotiation with the insurance company. So if you have a deductible it will only be used once. However, without any negotiation you will have bills in calendar year 1 and bills from the same doctor that go into calendar year 2 you will have to use your 1k dollar deductible twice for both calendar years!
Basically, United Refuah can be a great value (and there are even some added benefits compared to a regular insurance policy as you are basically eligible to see any doctor in the USA (I think) as long as they take you (you'll only be covered the Medicare allowance..) If you manage to find the right doctors and labs that will charge you their "allowed charges" and are eligible for "charity care" at hospital's you will do pretty good - it will definitely take work on your part...
But if you want to "keep your doctor" and choose which doctors you want to go to you may not have much coverage...

[yelped]

I spoke to someone in United Refuah, and told him that most people don't know how much their doctors charge and how much of the allowed Medicaid percentage the bill would be for, and that this uncertainty makes people wary of United Refuah. He said that they're slowly building a network of doctors with whom they have agreements who would bill them directly so the patient doesn't have to worry about unexpected high bills. You can contact them to have them try working with your doctor to add them to their "network".

[lakewood34]

I spoke to someone in United Refuah, and told him that most people don't know how much their doctors charge and how much of the allowed Medicaid percentage the bill would be for, and that this uncertainty makes people wary of United Refuah. He said that they're slowly building a network of doctors with whom they have agreements who would bill them directly so the patient doesn't have to worry about unexpected high bills. You can contact them to have them try working with your doctor to add them to their "network".

after being with them since inception i recently left them because of this exact concern.  if you cant get your provider to go to 150 percent of medicare you are responsible for the overage.
It is thousands of dollars a year cheaper then traditional insurance but that was my big worry having no cap on my liability because i don't know nor am i interested in knowing and negotiating every bill
to keep it within 150 percent of medicare
if they can build a network of doctors focused on the frum areas i would reconsider joining them again.

i dont think they charge 1500 dollars per pregnancy anymore

[shaulyaakov]

It's not a " Ponzi scheme" it's basically like an insurance company (it may be even better as they weed out alot of risk (but have additional - as Jews have more babies)) a Ponzi scheme needs the next guy to continue as they are supposably making money - which in actuality they are not, so they take the new guys money and use it as their "profit money.. insurance/sharing is (supposed to be) sustained by their current enrollment - they charge a premium based on risk and they pool that money and use it for everyones bills - they don't need a new enrolle to keep them afloat...
That being said - United Refuah keeps to their terms the question is what is their terms...
#1 They only pay 150-170% of the Medicare allowance which means if you go to a doctor and the doctor charges double that you will be stuck with the extra $$ for example you go to a doctor and the doctor charges 3k dollars and the Medicare allowance is only 1500 United Refuah will only pay out 80 percent of the 1500 you will owe 20 percent plus the 1500 dollars. So the question is will your doctor(s) give you a cash rate that equals the Medicare allowance? Many doctors do not have such an option they have one rate and unless you have insurance there are NO discounts - hence you will be stuck with a large bill! Also  keep in mind a doctor may not even take you as a patient if you say "you don't have insurance only sharing" as they don't accept "self paying" patients. Hospital's will also not give you a good cash rate which would get you covered under the "Medicare allowance" unless you apply for and are eligible for "charity care" you can get stuck with huge bills from hospital's as I'm not sure they knock down the price otherwise...
If you have a baby there is a 1500 dollar fee it works different than an insurance company which has a deductible of 1500 - as United Refuahs fee only goes towards covered charges meaning towards the 80% they cover, unlike an insurance company where the deductible goes towards the copay too for example if you were to get a bill from a doctor for 1500 dollars and your insurance company has a 20% copay and 1500 dollar deductible, you would pay the 1500 bill and you have met your deductible. With United refuah after you pay the 1500 only 80% of the 1500 went towards your deductible as 20 percent they don't cover and you are still going to owe 300  dollars towrds your deductible! (It's a fee and not a deductible)
Also when you have a baby - with insurance, the doctor bills the insurance after the birth - as per their negotiation with the insurance company. So if you have a deductible it will only be used once. However, without any negotiation you will have bills in calendar year 1 and bills from the same doctor that go into calendar year 2 you will have to use your 1k dollar deductible twice for both calendar years!
Basically, United Refuah can be a great value (and there are even some added benefits compared to a regular insurance policy as you are basically eligible to see any doctor in the USA (I think) as long as they take you (you'll only be covered the Medicare allowance..) If you manage to find the right doctors and labs that will charge you their "allowed charges" and are eligible for "charity care" at hospital's you will do pretty good - it will definitely take work on your part...
But if you want to "keep your doctor" and choose which doctors you want to go to you may not have much coverage...

Theponzi scheme element here is that if let's say they currently have 4k members. Suddenly, one of them gets a very expensive illness. Now, there's not enough money in the pool to pay for everyone else, so they need to go out a d recruit more members to increase the size of the pool so they can pay for the next person's illness.

[Zalc]

Theponzi scheme element here is that if let's say they currently have 4k members. Suddenly, one of them gets a very expensive illness. Now, there's not enough money in the pool to pay for everyone else, so they need to go out a d recruit more members to increase the size of the pool so they can pay for the next person's illness.

They currently have like 2.5k members.

That's probably under 4mm a year in dues after the 20%.

They claim that if a member has very high cost they can pay it over years... That and the 1mm per incident will protect them.

[Zalc]

after being with them since inception i recently left them because of this exact concern.  if you cant get your provider to go to 150 percent of medicare you are responsible for the overage.

i dont think they charge 1500 dollars per pregnancy anymore

Did you often have to change providers to meet their pricing criteria?

The added deductible for pregnancies in only removed for families (3 or more covered people)