This portion of the membership protects members in case of an accident, injury, illness, etc., that can’t be managed by a Virtual Healthcare Physician. There are three levels that members can choose between $1000, $2500 or $5000.

It is called the Initial Unshareable Amount (IUA). What that means is that the member pays the first $XXXX ($1000, $2500 or $5000) of any medical incident, and the community of members shares 100% of the remaining cost above that point for all eligible medical expenses and there is no lifetime cap on that. For example, if someone is diagnosed with something like cancer, the member will pay $1000 towards that cancer incident. Then the community of members will share 100% of the remaining eligible medical expenses above that point. That includes all the doctor visits, specialists, chemotherapy, radiation, physical therapy, x-rays, labs, medications, you name it. It will include all costs for all those items, as part of that one incident.

Unlike traditional methods that we are used to, the initial unshareable amount is for the entire duration of that incident. If that cancer incident needs to continue treatment into a second or third year, the member does not have to repay that $1000 again now that it is suddenly a new year. They only have to pay that one time.

Let’s talk about the worst-case scenario.  An individual and family memberships are responsible for a maximum of three separate incidences per year, only if they ever have that many. So, at the $1000 initial unshared amount level, that could be $1000 x 3 equaling $3000. This is important to understand.

Alternative care is becoming more prevalent and relevant to members. If a member has a medically diagnosed issue that can be treated less invasively, less costly, or more efficiently with alternative, naturopathic, or holistic solution, the member can submit a treatment plan from the doctor. If it is pre-approved and meets the guidelines, the member’s expenses may be shared or a portion thereof, instead of being forced down the traditional healthcare path. These unique scenarios are handled on a case-per-case basis and there are limitations.

Althought not required, members will have access to a second opinion program. When a member is diagnosed with something significant, they are always encouraged to get a second opinion. By doing that, it gives the member access to some of the nation’s top doctors. The second opinion company is a 3^rd party entity; therefore, they have no vested interest in the outcome.  There is no extra cost to the member to get that second opinion. By going through that process, the member is likely to be rewarded by having their Initial Unshareable Amount reduced by $250. So, at that $1000 IUA level, that could be reduced to $750 for that specific incident.

If or when a member has a larger medical incident or need, they do not show any card. They just show up. The Care Concierge Team has already negotiated the cash price and assisted with the appointments. If a member finds the referral themself, they simply go in and tell the doctor they are a self-pay patient. By doing so, they will typically get a 30-50% discount straight off the top of the retail rate. Sometimes the discount is greater and sometimes it is less than that. It depends on the provider’s fee schedule. However they will not receive any additional financial rewards provided by the sharing organization when members use the Care Concierge Team.

Most people would say, well that’s great but what if I have an emergency, end up in the ER and the bill is $10,000!  In that situation you are going to do the same thing. You are going to tell them you are a self-pay patient and you are going to pay your portion, the $1500, as a deposit and then you ask them to bill you for the rest. As soon as you have that bill in hand, you need to upload it into the system and call your Care Concierge Team for assistance. Once the medical cost sharing service has that bill, they will actually go to work on your behalf negotiating those rates down as low as possible. When they reach an agreement with the hospital or doctor, they will pay the hospital or doctor with that money. So, it is a very simple process that maintains the patient/doctor relationship.

The beauty of how this functions as a cash-pay patient is that it gives you the ability to seek out your chosen doctor or hospital, anywhere in the country. If you travel internationally and you get sick or injured, you will likely have to pay the full amount before you leave that country.  You must then submit the eligible medical expenses in English and in US dollars. The costs will be shared just like any other eligible medical incident within the US.

That is the basic overview of the membership. There are different versions which you can discuss with your MPB Healthcare Advisor. The initial set-up and administrative fees are $125. The monthly membership fees vary by family size, chosen Initial Unshareable Amount (IUA) and tobacco use or not.

Since this is different than what most folks are used to, you will have access to the Care Concierge Team to assist you. They will answer questions about any aspect of your membership.  You will not be alone.  You will have support every step of the way.

If this sounds like a good fit for you, or you would simply like to learn more, please contact your MPB Healthcare Advisor.