Navigating medical cost sharing can be complex and confusing. Sedera, one of the major health share organizations, aims to simplify this process by fostering a community-based approach to sharing medical bills.
Understanding the processes of sharing medical costs with Sedera
Your journey of sharing medical costs as a Sedera member begins with receiving medical services. As a member, you’ll present yourself as a “cash pay” patient, which means medical providers bill you directly, as opposed to billing an insurance company. Following the receipt of these bills, you then organize them and submit copies through the online needs submittal process in Sedera’s member portal. Relevant medical bills and any proof of payments made toward the Initial Unshareable Amount (IUA) should be included.
Upon submission, Sedera’s team of medical bill negotiators, as explained on their FAQ page, may engage with your healthcare providers to discuss the appropriate payment for the services rendered. If the negotiators deem it necessary, they might attempt to negotiate the billed amounts. Sedera then reviews the need and administers a process wherein community funds are shared with you (minus your IUA), so you can settle your medical bills.
Being a member means you have access to a supportive community, but ultimately each member is responsible for their own medical expenses. As they state, “Members always remain responsible for their medical expenses.”
Sedera’s Timeline for Meeting Sharing Needs
Sedera typically meets sharing needs between 14-60 days from the company’s receipt of bills and required information. If the needs submittal process and submission of necessary documentation is complete, and no financial negotiations with a provider are ongoing, a need will usually be shared within 14-30 days. However, larger bills may necessitate a longer negotiation period.
Navigating Sedera’s medical cost sharing arrangement
To become part of the Sedera community, you will need to enroll, which can be broken down into just a few steps:
- Selecting an IUA and membership type. They offer different memberships for individuals/families and workplace teams.
- Agreeing to Sedera’s membership guidelines. Different membership types have different guidelines, and they can all be found here.
- Setting up a medical cost sharing account. Sedera has partnered with an FDIC-insured bank to create and maintain dedicated individual accounts for each member, rather than pooling all funds into one account that members can’t see.
As a member, you will contribute a monthly membership fee to the community. When an eligible medical need arises, it’s opened on the member portal. As a cash pay patient, you pay your doctors directly, offering you the freedom to choose your doctors without out-of-network concerns. After receiving care, you upload your itemized bills to the member portal under the related eligible need.
You’ll need to meet your IUA, the amount you are committed to paying without community help, for the need to become fully shareable. After meeting the IUA for a particular need, shared funds are used for all further eligible medical bills related to that specific need. Importantly, Sedera’s IUA does not reset annually. Moreover, a member’s IUA is limited to three per membership year, after which the IUA becomes $0 for any additional eligible needs.
Being part of the Sedera community means navigating a medical cost sharing system that places the power in the hands of its members. From the point of receiving medical care to meeting the IUA and finally sharing the need with the community, the process is designed to be transparent, manageable, and supportive. Whether it’s negotiating medical bills, understanding the timeline for sharing, or knowing the intricacies of Sedera’s medical cost sharing system, members are not alone. Sedera highlights their member services team, which makes the process of sharing medical costs not just a financial decision, but a community experience.
