How to Make the Most of Your Sedera Medical Cost Sharing Membership
Whether you recently joined Sedera or have been a Member for years, we’re so glad to have you in the Sedera Medical Cost Sharing Community! We’re committed to providing a best-in-class healthshare experience. We want you to feel empowered to confidently navigate your healthcare as a cash pay patient. It’s also important to understand your responsibilities as a Member of the Community.
Below is some information that will help you make the most of your Sedera Membership. If you’re not yet a Sedera Member, here are some important questions to ask when choosing a healthshare.
Transitioning from health insurance to Medical Cost Sharing
Being a Member of a free market healthshare is different from insurance. It’s not just more affordable, it brings transparency about your medical costs and the support of a Community that is there to help you shoulder your medical burdens.
There are new terms and processes to learn. And, there’s newfound empowerment to experience when you transition from health insurance to medical cost sharing — sometimes called a “healthshare” or health sharing.
Medical cost sharing as a way — and we think a better way — to pay for your large medical costs will feel unfamiliar at first. There’s no need to worry — Sedera Member Services is available to help you every step of the way. And, unlike health insurance where you may never talk to the same person twice, at Sedera you’re a valued Community Member. You’re never just a number and we know you by name.
Sedera Medical Cost Sharing is not insurance
Sedera is a nonprofit Medical Cost Sharing Community that offers a non-insurance approach for managing large and unexpected medical expenses. Sedera Members belong to a Community of individuals who are active and engaged participants in their healthcare decision-making. They are dedicated to a healthy lifestyle and united by shared values.
What are some differences between health insurance and medical cost sharing?
There are important differences between health insurance and medical cost sharing. These include how you choose your providers and how you manage your relationship with your doctor. There are differences in how you pay your medical bills. Plus, you’ll learn the cost of non-emergent healthcare before receiving it, so you don’t get budget-busting surprise bills.
No network restrictions
Sedera Members have freedom of choice rather than provider network restrictions. Members can choose their doctors and providers based on personal preference, best value, reasonable cost, and convenience.
Sedera’s Medical Concierge service helps locate physicians and providers in your area who are cash pay friendly and offer reasonable, value-driven rates for care. This service is free with your Sedera membership.
A Sedera Membership goes where Members go when they have a Need, worldwide!
24/7 Telemedicine is available so Members can access care from anywhere.
Cash pay instead of insurance billing
Being a cash pay patient, sometimes called “self-pay,” means that you pay cash for your medical care. Cash pay doesn’t mean that you must use actual “cash” to pay for the care. You can also use credit cards, debit cards, and checks, depending on what works best for you.
Instead of your provider billing a 3rd party insurance company (that decides the cost of your care and what care is “covered”) you pay the provider directly. This allows your doctor or other providers to treat your health concerns based on their medical expertise. You’ll know the cost of your care ahead of time and many physicians offer a cash pay discount for services.
As a Sedera Member, you can see the breakdown of exactly how the funds from your monthly contribution are used. Your Monthly Contribution statements and Medical Cost Sharing bank account statements can be accessed through your Member Portal.*
*The Member Portal with access to Monthly Contribution statements and Medical Cost Sharing bank account statements is available for Members who have completed the upgrade to the PLUS Membership platform.
Medical Cost Sharing terms that you need to know
Below are some key terms and comparisons between Medical Cost Sharing and health insurance terms. A full list of terms is in the Membership Guidelines.
Medical Cost Sharing is sharing of large, unexpected medical costs through a membership-based Community.
Membership Guidelines are what every Member is asked to read and sign, acknowledging that they understand how sharing and the Sedera Community functions.
Initial Unshareable Amount (IUA) is the amount Members are required to pay per injury, illness, or medical event without help from the Community. Instead of an insurance “deductible” that applies per year, you have an Initial Unshareable Amount (IUA) that you are responsible for per separate medical incident. There is a max out-of-pocket of three IUAs per Membership year.
Monthly Contribution is the amount paid monthly by each household with an active Sedera Membership for sharing with the Community.
A Need is one or more medical bills caused by injury, illness, or a medical event to an eligible Member. Instead of “submitting a claim,” you will open a Needs Case.
Share/Sharing is when the Medical Cost Sharing Community steps in to give toward the costs of a Member’s shareable medical Need. Instead of medical expenses being “covered,” they are determined if they are Shareable based on the Membership Guidelines.
These are health insurance terms that don’t apply to Sedera Medical Cost Sharing
Submit a claim
Sedera Members are actively engaged in their healthcare
Sedera Members are actively engaged in their healthcare. They don’t rely on a “middleman” or 3rd party to tell them how they will receive their care or where they can receive it. They also don’t have to cross their fingers and simply hope for the best as they wait for bills to arrive. However, with this freedom of choice and price transparency comes additional responsibility.
Manage communications with physicians and other providers.
Actively shop for value-driven pricing.
Seek the cash pay cost of care up front.
Request and obtain itemized bills.
Submit all required documentation to their Member portal.
Pay their providers directly after receiving shared funds from the Community.
These actions help drive quality care and affordability. Using providers and scheduling procedures with fair pricing (not over-inflated) also helps protect the Community and facilitate the sharing of Needs. Sedera Member Services provides multiple tools to help Members make value-driven choices on our Cash Pay Marketplace.
Communicating with physicians and other providers
When scheduling an appointment or procedure, Members let their providers know that they are cash pay patients. This is also a good time to ask what the cash pay discount is for services. In many cases, this can be a significant savings over the rates provided when billing health insurance.
When asked for health insurance information or a membership card, Sedera Members answer that they don’t have insurance and don’t have a membership card. There’s really no need to explain beyond that. However, if it’s the first time you’ve visited that office or provider, you can expect the insurance question to be asked several times.
If you’ve used Sedera’s Member Services Concierge to request help on locating a cash pay friendly provider, or, you’re talking with a Direct Primary Care practice, they’ll be familiar with the term “cash pay patient” or “self-pay.” Sedera Members also have access to Savvos, the nation’s largest cash pay marketplace for outpatient surgery and more.
As a cash pay patient, you’ll ask for itemized bills for any care you receive. You’ll also ask for upfront estimates for a procedure. In some cases, the provider may request prepayment, or a minimum payment before providing care. If this happens, contact Member Services for help handling this type of request and the potential for up-front sharing from the Community.
It’s important to only make the minimum upfront payment. This allows Sedera to negotiate the price if it’s inflated. And, for all medical bills submitted for sharing, the bills need to be itemized with a breakdown of the charges.
Opening a Needs Case instead of “submitting a claim”
It’s important to open a Needs case as soon as you anticipate having a medical expense that will exceed your chosen Initial Unshareable Amount (IUA). The sooner that you do this, the sooner you can be connected with a Needs Coordinator who will confirm Sharing eligibility based on the Membership Guidelines.
Your Needs Coordinator will also communicate important information regarding your next steps. You can open a Needs Case in the Member portal.
Paying your medical bills directly
As a Member of Sedera, you will be paying your providers directly as a cash pay patient. This contrasts with health insurance, which acts as a 3rd party between you and your providers. Having a middleman like insurance creates administrative burdens for providers and can increase the cost of care.
Paying your bills when you have health insurance:
Your provider submits fees for services based on the agreed-upon rates set by the health insurance company.
The insurance company pays the provider on your behalf.
You are billed for any costs (like a deductible) that are determined to be your responsibility under your insurance plan.
There’s a lack of transparency in this system — you may not know how high those costs are going to be.
Paying your bills with Sedera Medical Cost Sharing:
Sedera does not act as a “middleman” or 3rd party.
Members are responsible for presenting themselves as cash pay patients.
They learn the cash pay price before receiving non-emergent care.
They get itemized bills for their eligible medical costs.
They submit those bills via their Member portal to the Community for sharing.
After receiving Community funds for their eligible shared Need, they pay their providers directly.
This system provides transparency, empowers Members to take control of their healthcare, and prevents budget-busting surprise medical bills.
Understanding the Sedera Membership Guidelines
All Members are required to read through the Membership Guidelines. Here you will learn about shareable conditions, pre-existing conditions, and other important information including:
Community Ethical Beliefs and Principles
Process and Administration
Needs Sharing Commitments
Medical Cost Sharing Terms
The Guidelines contain a wealth of information. If you have a question about whether a specific medical cost would be Shareable, you can find information quickly by doing a search for keywords using CTRL (for PC) or COMMAND (for Mac) + F on your keyboard. For example, if you want to find out about Sharing eligibility for a mammogram, you can search for “mammogram” as the keyword and that will bring you directly to the relevant information in the Membership Guidelines.
Be prepared — Know what to do in case you have a medical incident
An unexpected medical event or even a planned procedure can be a very stressful time. Don’t wait until you need Community support before learning how your Sedera Membership works. You’ll want to have a good understanding of what’s shareable, what isn’t, how to contact Member Services, open a Need and submit bills. Knowing “How to Sedera” ahead of time will make it easier for you to focus on your health. Here’s some helpful information on what to do if you have an urgent medical event.
Some additional tips to help you become Sedera savvy:
Before you open a Needs Case, go through the Tutorial. This will help you get a feel for what the process looks like, what questions you need to answer and practice submitting bills.
Take time to read these helpful articles. They provide answers to some of the most frequently asked questions about being a cash pay patient, submitting a Needs Case, and Medical Cost Sharing.
If you do have a medical incident, reach out to Member Services as soon as is safely possible. This will give us time to gather the required information and go through the necessary steps. To have the best experience, it’s essential to communicate with us as soon as possible. Also keep us informed of any questions, concerns, or updates in a timely manner.
The Needs team can assist with questions that are not urgent or time-sensitive via a booked call on their personal calendar. Generally, communication will be via email. Be sure to check your email regularly so you don’t miss any important requests for more information or updates to your Needs Case. You can also view updates directly in your Member Portal.
Medical cost sharing is not health insurance. Instead, it’s an innovative way to pay for large, unexpected medical expenses that provides affordability, cost transparency, and freedom of choice. Members also have the peace of mind that comes from a shared faith in the power of Community to help shoulder each other’s large and unexpected medical burdens.
With Sedera, you never have to feel like you’re alone on your healthcare journey. The expert advisors on our Member Services team are available and happy to answer any questions, every step of the way.
We’re here for you, whether you’re celebrating a health victory or a new member of the family, or maybe dealing with a stressful medical incident. You’re part of a Community and you have a Member Services team ready to help you make the most of your Sedera membership.
SEDERA, INC. DOES NOT PROVIDE MEDICAL ADVICE. The information contained herein is for informational and/or educational purposes only and is not intended or implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.