OneShare deemed Judy Stewart’s 2020 colonoscopy a “diagnosis of pre-existing conditions,” according to OneShare.
PHOENIX — As the cost of health care rises, many Arizonans have turned to Christian health care 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 stock ministries largely regulate themselves. An East Valley couple learned the hard way why such deals can lead to unusually high bills.
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‘It’s a ball of confusion’
Judy Stewart belonged to OneShare Health, a company based in Texas. Health costs increased in 2020 and Judy claimed OneShare owed her $5,500 for services she paid for beyond her $5,000 annual deductible and an additional $18,000 for a colonoscopy she received.
“It was a routine colonoscopy and the previous one was five years ago,” Judy said.
OneShare denied their refund requests.
Judy and her husband, Jim, spent months filing appeals and trying to get explanations.
“Many times your call is disconnected. They assure you that they will 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 they were denied colonoscopy coverage because they submitted their paperwork too late.
“And then we appealed it, and then we got another letter saying it was pre-existing,” Judy said.
The Stewarts asked in writing and by phone why the procedure fell on a pre-existing condition and received no answer.
OneShare is not required to reimburse colonoscopy
After 12 News contacted OneShare on behalf of the Stewarts, the company provided additional medical documentation showing that OneShare was justified under its agreement with the Stewarts not to cover the colonoscopy.
When Judy had a colonoscopy in 2015, she was diagnosed with diverticulitis, a condition that causes inflammation in the digestive tract. Judy’s 2020 colonoscopy was therefore considered by OneShare to be a “diagnosis of pre-existing conditions,” according to OneShare.
Judy is expected to pay the $18,000 bill to Kingman Regional Medical Center for the colonoscopy.
“Make sure if you’re signing up for one of these Christian ministries, make sure you don’t have a pre-existing condition,” he 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 by unplanned expenses and realize that there is no government agency that has authority over businesses.
“These health care sharing ministries are not subject to any regulation governing insurance companies, so benefits are not required. There are no solvency requirements. There is no additional room,” said Larry Levitt, vice president of 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 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 about its programs and that applications are awarded fairly.
“While all member complaints are important and we always have room to improve our service, we believe that 127 complaints in three years does not accurately reflect the overall satisfaction of our tens of thousands of members who have made hundreds of thousands of requests for share that resulted in nearly $160 million in shares being facilitated during this time,” Combs said in the email.
OneShare paid a $54,600 surgery bill
Combs said the “requests to share” process is discussed in detail during the sign-up process and made available to members online.
“Some medical conditions, for example those conditions that existed prior to membership, are not eligible for sharing,” Combs said in the email. “To share applications that may not be eligible, we work to obtain and review all relevant medical records before making a final decision because it is not a decision we make lightly.”
OneShare also has “robust procedures” for members to appeal decisions, Combs said.
After reviewing the Stewarts’ case, OneShare agreed Friday to pay for a visit related to a wrist injury, calling it “carelessness” on the part of the company.
Combs also stated in the email that OneShare paid for a knee replacement based on precertification records.
“However…additional records we received indicated that the right knee problem was a pre-existing condition,” Combs wrote. He said OneShare paid $54,613 “for this ineligible expense” but did not request a refund for the overpayment.
Although the Stewarts acknowledge that OneShare is not required to cover colonoscopy, they say they don’t feel the company was transparent when they joined.
“It almost seems like an oxymoron to use this company masquerading as a Christian health care consortium,” said Jim Stewart.
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