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Cash-Pay Fundamentals

In an era of higher health insurance deductibles, rising out-of-pocket costs, and fewer choices in health care, more people are taking matters into their own hands. The Sedera Health solution poses a viable alternative to the insurance dominated status quo. Together, we are building a new kind of community, one centered on healthy living and sharing the cost of medical care. In doing so, we are able to provide a high-end healthcare experience, delivering tremendous value for our members and their families.

Whether you are new to the Sedera community or an employer exploring medical cost-sharing options for your employees, we are here to help. We want you to feel confident as a cash-pay patient and make the best use of every service that comes with your Sedera membership.

What to Expect as a Cash-Pay Patient?

Medical cost-sharing programs are set up so members can contribute monthly funds to share each other’s medical bills. Instead of a deductible, there is an “Initial Unshareable Amount” or IUA for each medical event. The IUA is the member’s responsibility. After the IUA is met, the remainder of the costs pertaining to that illness or event is shared by the contributions of the community members. With medical cost sharing, there isn’t a provider network. There isn’t a third party coming between you and your doctor. You are a cash-pay patient. You can see any doctor you want who is willing to accept cash-pay patients.

How Does Cash-Pay Work?

At the time of service, you will disclose to medical providers (doctors, laboratories, clinics, hospitals, etc.) that you are a “cash-pay” patient.  Payment for care can be made at the point-of-service or the provider can send a bill directly to the member. The member then organizes their bills, completes a Need Processing Form (NPF) and submits the form plus copies of all related medical bills and proof of payments made towards the IUA to Sedera. Sedera will review the need and administer a process whereby community funds are shared with the member. Our team of medical bill analysts may contact the provider(s) to discuss the appropriate payment for the services that were performed and determine if negotiations are needed for the billed amounts.

As a medical cost-sharing organization, Sedera provides a new approach to paying for healthcare. Our cost-sharing model allows us to negotiate the right price for medical costs, savings we pass on to employers and their employees. Achieving a win-win scenario for both patients and providers assures a sustainable, long-term solution to the rising healthcare costs in America.