Judy Stewart’s 2020 colonoscopy was considered by OneShare to be “diagnostic for conditions that are pre-existing”, according to OneShare Health.
PHOENIX — As the cost of medical care rises, many Arizonans have turned to Christian healthcare ministries instead of traditional health insurance. Members who share a similar faith make monthly contributions and submit medical bills for reimbursement.
But unlike insurance companies, health share ministries largely regulate themselves. An East Valley couple learned the hard way why those agreements can lead to unusually high bills.
RELATED: Why do Arizona’s election results take days, not hours?
‘It’s a ball of confusion’
Judy Stewart belonged to OneShare Health, a company based out of Texas. Health costs mounted in 2020 and Judy claimed OneShare owed her $5,500 for services she paid beyond her annual $5,000 deductible and an additional $18,000 for a colonoscopy that she received.
“It was a routine colonoscopy and the previous one was five years ago,” Judy said.
OneShare denied her requests for reimbursements.
Judy and her husband, Jim, spent months filing appeals and trying to get explanations.
“A lot of times your call is disconnected. They assure you that they’re going to take care of it. They never do,” Judy said.
Jim said the couple’s odyssey of making phone calls and sending emails and letters amounted to “a ball of confusion.”
OneShare eventually told the Stewarts in writing that coverage for the colonoscopy was denied because they submitted their paperwork too late.
“And then we appealed it, and then we got another letter back that said it was pre-existing,” Judy said.
The Stewarts asked in writing and by phone why the procedure fell under a pre-existing condition and did not receive an answer.
OneShare is not obligated to reimburse for the colonoscopy
After 12 News contacted OneShare on the Stewarts’ behalf, the company provided additional medical documentation showing that OneShare was justified under their agreement with the Stewarts not to cover the colonoscopy.
When Judy received a colonoscopy in 2015, she was diagnosed with diverticulitis, a condition that causes inflammation in the digestive tract. Therefore, Judy’s 2020 colonoscopy was considered by OneShare to be “diagnostic for conditions that are pre-existing”, according to OneShare.
Judy is expected to pay the $18,000 bill to Kingman Regional Medical Center for the colonoscopy.
“Make sure if you are signing up with one of these Christian ministries, make sure you don’t have a pre-existing condition,” she said.
Health policy experts said the Stewarts’ frustration is an example of what can happen to people after joining a Christian health care consortium. They may feel burdened with unplanned expenses and realize there’s no government agency that has authority over the companies.
“These healthcare sharing ministries are not subject to any regulations that govern insurance companies, so there are no required benefits. There are no solvency requirements. There’s no oversite,” said Larry Levitt, Vice President at the nonprofit Kaiser Family Foundation.
As of last week, the Better Business Bureau showed 127 complaints against OneShare Health over three years. Many people complained about a lack of coverage and poor customer service.
In an email to 12 News, OneShare Chief Legal Officer Buddy Combs said the company works to ensure its members are well-informed of its programs and that requests are adjudicated fairly.
“While every member complaint is important and we always have room to improve our service, we believe 127 complaints over three years does not accurately reflect the overall satisfaction of our tens of thousands of members who have made hundreds of thousands of sharing requests resulting in nearly $160 million in sharing facilitated during this time,” Combs said in the email.
OneShare paid a $54,600 surgery bill
Combs said the process for “sharing requests” are discussed in detail during the enrollment process and made available to members online.
“Some medical conditions—for example, those conditions which existed prior to membership—are not eligible for sharing,” Combs said in the email. “For sharing requests which could be ineligible, we work to obtain and review all relevant medical records before making a final decision because it is not a decision we take lightly.”
OneShare also has “robust procedures” in place for members to appeal decisions, Combs said.
After reviewing the Stewarts’ case, OneShare agreed on Friday to pay for a visit associated with a wrist injury, calling it an “oversight” by the company.
Combs also stated in the email that OneShare paid for a knee replacement based on pre-certification records.
“However… additional records we received indicated that the right knee issue was a pre-existing condition,” Combs wrote. He stated that OneShare paid $54,613 “for this ineligible expense” but did not request an overpayment refund.
Even though the Stewarts acknowledge that OneShare is not obligated to cover the colonoscopy, they say they don’t feel the company was transparent when they joined.
“It almost seems like an oxymoron to use this company posing as a Christian healthcare consortium,” Jim Stewart said.
Up to Speed
Catch up on the latest news and stories on the 12News YouTube channel. Subscribe today.