Participation is Voluntary
Monthly contributions are voluntary gifts and are not refundable. Each member is a self-pay patient who sends monthly contributions to assist other members who have medical expenses. Whether anyone chooses to share in another member’s medical expenses is totally voluntary. Giving a monetary gift to assist another member in the program does not create a legally enforceable right to receive funds for healthcare expenses. Whether or not any member receives assistance from other members for medical expenses, members are legally responsible for their own medical decisions and the expenses that may accrue as a result of their decisions. They remain ultimately responsible to pay their bill. As a voluntary sharing cooperative, we are constrained by finite resources no matter how many members we have.
MEMBER QUALIFICATIONS AND REQUIREMENTS
Members must be health conscious and wish to maintain their own health and advocate physical, mental and moral fitness as well as help others to do so. They must ascribe to the TEN COMMANDMENTS. Thus members must be able to walk a mile in 30 minutes, not use tobacco, not abuse alcohol or prescription drugs or use illegal drugs, comply with medical therapy for chronic illness.
Existing medical conditions disclosed on an application can help us make suggestions as to lifestyle changes that can improve the health of the individual and benefit the group as a whole. If, at any time, it is discovered that a Member did not submit a complete and accurate medical history on the Medical History Questionnaire, the member’s bills will not be eligible for payment and membership terminated. In such an event, any monies paid will not be refunded. Members may re-apply but acceptance is at the discretion of the Board.
Angels are either regular or prospective members or non-members who make additional payments to help members who are having financial difficulties making the monthly contribution.
Apply to be a Member
Make an appointment for the annual physical exam and submit the first month’s payment. If, on the day of the annual examination, you are not accepted as a member or a prospective member or if you decide you cannot agree with any of the tenants of the group, or if you do not agree to pay the additional fees required of prospective members to help reach agreed on goals, 50% of the initial payment will be returned. You may decide at any later time to leave the group but no monthly contributions will be returned.
MONTHLY SHARE AMOUNTS
The Monthly Payment Amount is determined by majority vote of the Board of Directors and is based upon the amount of bills submitted by members for payment, the amount needed to administer the Program, and the number of participating Members. The Monthly Share Amount may be revised upward or downward as determined by majority vote of the Board of Directors. Notice of such change will be made to the Members in a timely manner, but with no less than sixty (60) days notice.
MEMBER MEDICAL EXPENSES
In general, any medical expenses covered by Medicare may be covered. Home healthcare, Occupational, Speech, Respiratory therapy, Ambulance, Alternative medicine must be approved for sharing by a Doctor Hotline physician or The Houston Healthcare Initiative.
ALL Eligible Sharing amounts will be repriced to 110% of Medicare charges
Expenses NOT Eligible for Sharing
Members share a responsibility to each other to use the Doctor Hotline to avoid unnecessary services, hospitalizations, and shorten inpatient confinements, while improving quality of care and reducing expenses shared by the members.
Any disputes over eligible payments must be made in writing within 60 days from the date on the check or date of denial. Coverage will be reconsidered and answered within 60 days of receipt. If there is continued dispute both parties agree to binding arbitration. The three arbitrators will be physicians. Each party will choose their physician. The two physicians will then choose a third. The cost of arbitration will be borne by the losing party. The standard will be within reasonable medical probability.
Texas Code Title 8, K, 1681.001 Notice: This health care cooperative facilitates the payment of medical expenses and is not an insurance company, and neither its guidelines nor its plan of operation is an insurance policy. Whether anyone chooses to assist you with your medical bills will be totally voluntary because no other participant will be compelled by law to contribute toward your medical bills. As such, participation in the cooperative or a subscription to any of its documents should never be considered to be insurance. Regardless of whether you receive any payment for medical expenses or whether this cooperative continues to operate, you are always personally responsible for the payment of your own medical bills. Complaints concerning this health care cooperative may be reported to the office of the Texas attorney general.
MEMBER RIGHTS AND RESPONSIBILITIES
As a Member of Houston Healthcare Initiative you have certain rights and responsibilities. A. Member Rights. You have the right to:
You have the responsibility to: