Member Eligibility Verification | Liberty HealthShare

Bill Status

DOS - Date Of Service

Created Date - The date we received the medical expense

Processed Date - The date we processed the medical expense

Charged Amount - The total amount billed

Member Eligibility

Expiration Date - The day the member is no longer effective.

AUA - Annual Unshared Amount.
The amount of medical expense eligible for sharing must exceed an annual accumulative amount assigned for each single, couple or family membership. The annual amount shall be calculated upon each member’s Enrollment Activation Date until his or her next annual renewal date or program level change. All eligible medical expenses that exceed the applicable AUA shall then be subject to the program limits per incident selected by the member.

Wellness
Liberty HealthShare encourages our members to see their Primary Care Physician or provider yearly to maintain their health and well-being. After the first two months of membership, an annual preventative wellness visit and related lab work for which there are no medical symptoms or diagnosis in advance are eligible for sharing, up to a maximum of $400 of the fair and reasonable charges as determined by Liberty HealthShare and not subject to the AUA nor subject to guideline limitations for medical expenses $200 or less.

Well baby visits including immunizations are eligible for sharing within the first 13 months after birth and not subject to the AUA or the two-month waiting period.
Any new condition based on symptoms discussed during a preventative wellness visit and any additional diagnostics or labs that are ordered to determine treatment may be shareable according to Sharing Guidelines and are subject to the AUA.

Screenings

a. The following preventative screenings are not subject to the AUA:: i. Screening pap smears are eligible for sharing once every year.; ii. Screening mammograms, PSA tests, and Cologuard® are eligible for sharing once every two years up to and including age 49.; iii. Screening mammograms, PSA tests, and Cologuard® are eligible for sharing once every year for members 50 years of age and older.
b. The following screenings are eligible for sharing and are subject to the AUA:: i. Screening colonoscopies and bone density screenings; ii. Ultrasound/MRI/Thermogram screening conducted in lieu of a screening mammogram; iii. All diagnostic screenings

Sharing Program

Liberty Unite: Up to $1,000,000 (per incident) of fair and reasonable eligible medical expenses are shareable after AUA has been met. There is no co-share.
Liberty Connect: Up to $1,000,000 (per incident) of fair and reasonable eligible medical expenses are shareable after AUA has been met. Member pays a 15% co-share.
Liberty Essential: Up to $600,000 (per incident) of fair and reasonable eligible medical expenses are shareable after AUA has been met. Member pays a 25% co-share
Liberty Assist: Up to $100,000 (per membership year) of fair and reasonable eligible expenses are shareable after AUA has been met and secondary to Medicare Parts A and B.
Liberty Rise: Up to $50,000 (per membership year) of fair and reasonable eligible medical expenses are shareable after Unshared Amount per Visit has been met.

Medical Expenses Eligible for sharing	Unshared Amount Per Visit	Maximum Sharing Limit
Primary Care Physicians	$25	$750/year
Specialist Physicians	$40	$750/year
Urgent Care	$50	$500/year
Hospital Stays*	-	$1250/day
In-/Outpatient Surgeon Fees*	-	$1250/day
Emergency Room	$500	$1000/year
CT Scans	$200	$1250/day
MRI Scans	$200	$1250/day

Wellness Visits and Screenings

Wellness

Liberty HealthShare encourages our members to see their Primary Care Physician or provider yearly to maintain their health and well-being. After the first two months of membership, an annual preventative wellness visit and related lab work for which there are no medical symptoms or diagnosis in advance are eligible for sharing, up to a maximum of $400 of the fair and reasonable charges as determined by Liberty HealthShare and not subject to the AUA nor subject to guideline limitations for medical expenses $200 or less.
- a. Well baby visits including immunizations are eligible for sharing within the first 13 months after birth and not subject to the AUA or the two-month waiting period.
- b. Any new condition based on symptoms discussed during a preventative wellness visit and any additional diagnostics or labs that are ordered to determine treatment may be shareable according to Sharing Guidelines and are subject to the AUA.
Screenings

a. The following preventative screenings are not subject to the AUA:

i. Screening pap smears are eligible for sharing once every year.

ii. Screening mammograms, PSA tests, and Cologuard® are eligible for sharing once every two years up to and including age 49.

iii. Screening mammograms, PSA tests, and Cologuard® are eligible for sharing once every year for members 50 years of age and older.

b. The following screenings are eligible for sharing and are subject to the AUA:

i. Screening colonoscopies and bone density screenings

ii. Ultrasound/MRI/Thermogram screening conducted in lieu of a screening mammogram

iii. All diagnostic screenings

c. Liberty Select Program Exception: Preventative screenings are eligible for sharing and included in the $400 maximum per membership year for wellness visit, related lab work and screenings and not subject to the AUA.

To request access to check Member Eligibility, please enter the required information in the form below

Requestor's First Name

Provider Name

Membership #

Date of Birth

Requestor's Last Name

Provider NPI or Tax ID

Member Last Name

Member Zip Code

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