Important Member Info: Understanding Pre-Notification

January 9th, 2018

Liberty HealthShare is not an insurance company. We are a ministry that facilitates the sharing of medical costs among the people who participate in this voluntary community. The funds come from our members, not corporate coffers. For this reason, we often remind our members to join us in doing everything they can to reduce the often outrageous costs associated with healthcare. As an organization, our commitment is to provide the information and tools our members need so they can accomplish this.

Certain testing, treatments, procedures, and surgeries are known to have a large range of possible prices, which makes it easy for some providers to employ unreasonable billing practices. Most patients don't realize this, especially if they have previously used a third-party payer for medical costs. One of the most important processes by which we assist members with these interactions is through Pre-Notification of Medical Expense and our Member Stewardship Advisory Program (MSAP). The MSAP staff assist members by researching lower-cost options for care at comparable facilities with the same quality of care.

Liberty HealthShare does not share in medically unnecessary interventions, so we strongly suggest that you familiarize yourself with section IV. C. 19, Pre-Notification of Medical Expense (a component of the Member Stewardship Advisory Program) of the Sharing Guidelines document (pages 18-20). Liberty HealthShare members are expected to review this information and understand how it impacts sharing in their medical costs. Questions can be directed to the Member Services department at 855-585-4237.

Here is a summary of how Pre-Notification and the MSAP work, practically:

  1. A sharing member visits his or her physician or another healthcare provider.
  2. The physician or provider prescribes a treatment, testing, procedure, or surgery listed on page 19 of the Sharing Guidelines. To be eligible for cost sharing, pre-notification is required for these interventions.
  3. The member calls the Pre-Notification phone line (888-604-4337) immediatelyupon learning of the above-mentioned treatment or testing and informs the Pre-Notification staff of the specific need. Advance notice is expected, and at least 7 days notice is preferred (except in case of emergency). It is the responsibility of the sharing member to make sure the pre-notification staff is contacted. If the medical provider offers to make the call, the member should still confirm this has been done. Liberty HealthShare's relationship is with the member, not the medical provider.
  4. Liberty's Pre-Notification staff requests medical records and reviews them to determine medical advisability and eligibility.
  5. The member is notified of the Pre-Notification staff's determination of medical advisability and eligibility. Please remember, a determination of medical necessity by Pre-Notification staff does not necessarily equate to a medical cost's eligibility for sharing. As always, we expect our members to review and understand Liberty HealthShare's Sharing Guidelines so that expectations concerning the sharing of medical expenses are realistic and correct. Questions should be referred to the Member Services department, which can be reached at 855-585-4237.
  6. If the care or testing is eligible for sharing, MSAP processing begins.
  7. If MSAP staff are successful in finding a provider/facility to perform the treatment, testing, procedure, or surgery at a lower cost, the member is notified, findings are discussed, and introductions are made so the member can schedule his or her care.

Keep in mind that the MSAP is also available for procedures and tests outside those that require pre-notification. When in doubt, call the Pre-Notification phone line (888-604-4337) to ensure you are getting the best quality care for the lowest, most reasonable cost.

As Liberty HealthShare members, we all share in the responsibility of carefully stewarding our health and the finances of this community. By joining Liberty, you have made a choice for freedom. With that choice comes the power and the responsibility to be a wise consumer where the costs of your healthcare are concerned. We appreciate your attention to this important component of your Liberty membership.