CrowdHealth Member Guide

Everyone Hates Member Guidelines

We know, we know. Member guidelines, user handbooks, terms and conditions. They’re the worst. Well, not the worst. Your old health insurance is the real worst. But guidelines and fine print can be exhausting to navigate, too. This is why we’re starting here with making your CrowdHealth Member experience better, refreshing…different.

Here, you'll find what you need to know about being a Member of the CrowdHealth Community. We’ve condensed your Member Guide from the usual 150 pages down to the clear, user-friendly, brief, easy-to-navigate information you’ll find below.

Who You Are

Savvy, Generous You

You, our newest CrowdHealth Member, are a perfect addition to our growing Community. You’re here because you care about your health, are committed to helping your Community thrive, and are looking for a new way to get the care you need without breaking the bank.

You want something you can trust that’s simple to use and frees you from the shackles of a failed health insurance system. Well, kick up your feet and stay a while. You’re in a new Community now, and we’re so glad you’re here.

Currently, the CrowdHealth Community is not open to people with a history of smoking/tobacco use (defined as daily use for a period of three months or more) or over certain weight thresholds. We are committed to helping as many people as possible through our Community-powered healthcare solution, and we look forward to expanding our Memberships to include individuals with more varied health backgrounds in the future.

You and the CrowdHealth Community

CrowdHealth Members are here for each other. We know there is power in numbers and that together, we can achieve something bigger, better, and altogether different than if we tackled the complexity and unaffordability of health care costs alone. We care abundantly for each other, and that’s good news for all of us.

 To help the whole Community thrive, you and your fellow Members can count on one another to:

· Fulfill your monthly subscription and contributions, timely and consistently.

· Believe that highest cost does not indicate best care, being open to considering high-quality health care clinicians who can offer a better price for the care you need.

· Avoid illegal activity and only submit legitimate, medically necessary bills for Community funding.

· Care about your own health and that of the people around you, proactively engaging with your health and wisely spending on your health care costs.

· Trust your Community to help fund your health expenses while understanding that ultimately, each Member is responsible for his or her own medical bills.

We’re so glad you’ve joined us. This Community is better with you in it!

Who We Are

Here For You

CrowdHealth is founded and run by people who think and feel like you. We’ve been exhausted by our experiences with health insurers, so we set out together to create a new and better way. We know insurance is complex, expensive and lonely, so we’ve reimagined a different solution with you in mind—one that’s all about Simplicity, Affordability, Community and Quality.

Simplicity: No More Health Plan Confusion

We’ve already established that the fine print of insurance policies is confusing and frustrating. That’s why CrowdHealth is committed to Simplicity in each health care experience for every Member, which means:

The More You Lean on Us, The More You Benefit.

When you start your health care journeys through the CrowdHealth app, you get the most from your Membership – the best value, the simplest payment process, and the support of your Care Advocate along the way.

No Plans.

Your Membership is simple and easy to understand, month after month. No insurance hassles, just quick payments to clinicians for their services and fast funding for your and your fellow Members' healthcare needs.

No Networks.

Whether you see your favorite doctor, or we find one for you, we want you to experience high-quality care at a fair price. We’ll also help you find hospitals and outpatient facilities that have your best interest in mind.

No Paper, No Hassles.

Your CrowdHealth contributions and medical bill submissions are always digital. And, when you get a paper bill in the mail from a doctor, just scan it in our handy app. We’ll handle the rest of the process for you.

Affordability: Helping You Save Money

You also know that healthcare can be incredibly expensive. Here, the CrowdHealth Community is built on a commitment to Affordability and the belief that the best health care doesn’t have to be the priciest.

The CrowdHealth platform helps Members like you save money through things like:

Up to 60% Savings.

The CrowdHealth Community's cash pay approach lets you get high-quality care for up to 60% less than the insurance sticker price.

Quick Payments.

Through CrowdHealth’s smooth digital process, funding from the Member Community happens fast, for Members and clinicians alike.

Cash Pay Status.

You’re freed from ID cards and group numbers as a cash pay patient now.

Negotiating for You.

When you get saddled with an unexpected need and big bill, we will step in for you and negotiate it down to a fair price. We’re on your team and with you all the way.

Community: Better Together

CrowdHealth is built by people who care, for people who care. Navigating your health shouldn’t feel like an isolated battlefield where you don’t know who you can trust. It should be a transparent, trustworthy Community you can count on. That’s why we’re committed to helping our Members through:

Community-Funded Care.

You trust the Crowd to fund your expenses, and your contributions fund theirs, month after month.

Mindful Members.

When you make smart spending choices about your health care, you and the whole Crowd save money. When others spend mindfully, you benefit, too.

Personalized Support.

Your CrowdHealth Care Advocates are here when you need us.

We’ll always be transparent with you and the CrowdHealth Community, and we’re committed to growing together as we care abundantly for each other.

Quality: Only the Best for You

You deserve the best: the best care from the doctors you want to see, the best support through each health journey, the best technology to save you time and stress. CrowdHealth Members experience Quality every day through:

Comprehensive, National Care Quality Scores.

Search the app to see how docs in your area measure up on both quality and price, and pick the one that’s the best fit for you.

Real Member Care.

Support isn’t a buzzword here. We mean it when we say you’ll have a Member experience you love.

Innovative Technology.

We’re building the best app and technology resources to make your life easier, and it will just keep getting better.

How CrowdHealth Works

No, It’s Not Health Insurance – and Why That’s a Good Thing

You matter, so your Member experience matters. It’s important that CrowdHealth Members understand their Membership and how it differs from health insurance.

One of the biggest questions we get is, “How is CrowdHealth so much cheaper than other health insurance?” And the answer is simple: CrowdHealth isn’t health insurance.

Because the CrowdHealth Community is designed and funded differently than health insurance, we have different priorities (like putting you, our Member, first!). It's not insurance — it's a platform that helps you find and fund your healthcare outside the insurance system, with personalized support along the way — so we get to do things differently. That means there are some new but simple parts of your Membership we want you to make you sure understand.

Why is Health Insurance So Expensive?

How is CrowdHealth So Affordable?

FOLLOW THE MONEY

Health Insurance has very little incentive to reduce costs. In fact, they make more money when you are sick than when you are healthy.

On average, 80% of your monthly insurance premium goes toward the healthcare costs of customers.

The CrowdHealth Community is incentivized to help you stay healthy because we want everyone's monthly contributions to be as low as possible.

With CrowdHealth, 100% of your monthly contribution goes to directly fund and reduce the healthcare costs of the Member Community.

DENIED CLAIMS VS RELIABLE SUPPORT

Plans sold on the US health insurance marketplace deny an average of 17% of in-network claims annually, which dramatically increases the healthcare cost burden to American families.

CrowdHealth has not denied or left a single bill unfunded for an eligible expense submitted by an active Member of the Community.

CONTRACTS VS FREEDOM

Health Insurance has very little power to negotiate with big hospital systems, so their network contracts are very expensive.

CrowdHealth can help you find quality care but has no restrictive doctor networks -- you can go where you want for your care. Since the Crowd pays in cash, hospitals are more willing to negotiate fair prices with us. 

examples

Knee surgery

Dropdown icon

Knee surgery price for major insurer, Cincinnati, OH

$35,000

Knee surgery price for CrowdHealth, Cincinnati, OH

$22,000

(40% less than major insurer)

Colonoscopy

Dropdown icon

Colonoscopy price for major insurer, Austin, TX

$3,600

Colonoscopy price for CrowdHealth, Austin, TX

$1,200

(66% price reduction)

Laparoscopic Hysterectomy

Dropdown icon

Laparoscopic hysterectomy price for major insurer, Milwaukee, WI

$13,017

Laparoscopic hysterectomy price for CrowdHealth, Milwaukee, WI

$9,037

(30.6% price reduction)

ADMINISTRATION

On average, $200 a month is spent by health insurers on administration.

CrowdHealth spends just $25 per Member, per month on administration.

LOBBYING

Health Insurance pays for more lobbying than any other industry.

CrowdHealth spends $0 of your monthly contribution on lobbying.

What Else Does “It’s Not Insurance” Mean for Me?

We have developed systems and processes that allow the Community to absorb very large medical expenses; however, we are not insurance, and therefore we cannot guarantee that your medical bills will be paid. Ultimately, Members are responsible for their own medical bills.

There's more detail on this concept here. For even more information, see What Do You Do with My Money? and What Do You Do with Big Bills? below.

One Low, Monthly Total

One low, monthly total keeps your Membership affordable while helping the Community fund Members’ health expenses each month. Here’s what CrowdHealth Members contribute each month:

Ages 0 - 5

$225
/month

INCLUDES

$25
SUBSCRIPTION
$200
CONTRIBUTION
$500
MEMBER
Commitment*
*Amount paid by Member per unique health event before expenses are eligible for funding by the Community.

Ages 6 - 54

$175
/month

INCLUDES

$25
Subscription
$150
contribution
$500
MEMBER
Commitment*
*Amount paid by Member per unique health event before expenses are eligible for funding by the Community.

Ages 55 - 64

$325
/month

INCLUDES

$25
SUBSCRIPTION
$300
CONTRIBUTION
$500
MEMBER
COMMITMENT*
*Amount paid by Member per unique health event before expenses are eligible for funding by the Community.

Contribution Details

The per-Member contributions by age above are monthly maximums. If you and the Community spend less in a given month, your monthly contribution can be lower than these numbers. When you make healthy and smart spending choices, you and the whole Member Community benefit together. Even when large expenses (>$10,000) are incurred, these bills are paid over time, helping keep monthly Member contributions low.

When you or someone in your family moves into a new category (like when your five-year-old turns six—they grow up so fast!), the new contribution amount will take effect on the first of the month following the Member's birthday.

Health Events and Member Commitments

The CrowdHealth Community operates without the burden of an annual health insurance deductible. Insurance deductibles can mean you pay $3,000, $5,000, or even $10,000+ in health expenses for your family (on top of those high monthly premiums) before your coverage kicks in at all. But with CrowdHealth, your Membership means you’re cared for right from the start.

With each health event, Members commit to paying the first $500. A health event is any unique health scenario that comes up for a Member and includes all the expenses related to it. It could be something big, like a knee surgery (which might entail doctor's visits, the surgery itself including facility and anesthesia, physical therapy, and pain meds) or something minor, like one of your kids needing to see the pediatrician for a lingering cough or cold.

For many health events, your bill(s) will total much less than $500 – for example, a standard doctor’s visit and prescription are likely to cost you less than $200 for an event. But, for larger events, like the knee surgery example above, your commitment is to pay the initial $500, and all expenses over $500 will be submitted to the Crowd for funding.

More good news is that the Community waives the $500 Member Commitment for an annual wellness visit (including basic labs) with a primary care practitioner or pediatrician per Member to make sure you can get the preventative care you need.

Securely Processed

All Member contributions and monthly subscriptions will be made monthly by ACH or credit card through industry-standard third-party payment platforms. See our Privacy Policy for more information on how your money and information are protected and handled.

Free Trials

If you signed up for your Membership using  a promotional code and/or are utilizing a free trial, CrowdHealth is waiving your contribution during those months. However, all responsibilities as outlined in this Member Guide still apply.

Transparent Revenue Streams

Some of the main factors in rising healthcare costs are the mismatched incentives built into the system’s financial structure: health insurance companies profit off a percentage of customer premiums, so they may make more money by hiking up prices. Through CrowdHealth’s new platform, we’ve intentionally established these two revenue sources that align our incentives 100% with the goals of the Community:

1. Your monthly subscription of $25 per Member covers the company expenses. Since CrowdHealth doesn’t make money as a percentage of your monthly contribution, we have no interest in raising your contribution amounts each month or denying funding of Members’ bills to increase our own profits. We are here to help you and the CrowdHealth Community save, always.

2. When you start your health journey through the platform, CrowdHealth can proactively get you a competitive price for the high-quality care you’re seeking.

⦁ For high-cost procedures, you may be eligible for an additional financial benefit in the form of a reduction or elimination of your Member Commitment if you save the Community money through a wise spending choice by using a high-quality, fairly priced clinician we help you find.

⦁ When you save big through the large discounts we negotiate for you, CrowdHealth also wins by earning a percentage (up to 20%) of what we helped you and the Community save. 

More About Your Member Experience

How to Use the Platform

For your health care to be eligible for funding by the CrowdHealth Community after your $500 Member Commitment is met, except for unscheduled urgent or emergency care, you must initiate your health journeys through the platform.

For this reason, we recommend you initiate all your planned care through the platform, regardless of whether it is expected to exceed your $500 initial Member Commitment. That way, for health events that escalate beyond your expectation, your care is eligible for Community funding, your bill payment process is kept simple, and our Care Advocates can be there to support you along the way.

Opening a new health event in the CrowdHealth app helps you utilize all the Membership resources available to you, like support from your Care Advocate throughout your health journey. And, if you need care that isn’t eligible for funding by the Community (more on that here), we will still work to negotiate great savings on your behalf.

If multiple Members of your family are involved in the same health event, like both kids getting the flu the same week (hang in there!), you’ll need to log separate visits to open separate health events for each person, and each person’s care will be subject to a separate $500 Member Commitment.

Online Platform and Mobile App

As soon as you sign up for your CrowdHealth Membership, you will be able to access your Member Portal through the website. You may download the CrowdHealth app at any time, but because our mobile app contains information and tools that are reserved for active Members only, you will not be able to log into the mobile app until the first day of your Membership. If you have any questions or issues with logging in or accessing your account, please contact us through the chat feature on the CrowdHealth homepage.

Cash Pay Patient Status

CrowdHealth isn’t insurance, so at any medical visit, you’ll say that you are an uninsured or "cash pay" patient.

Since all your planned health journeys will be coordinated using the CrowdHealth platform, we may be able to coordinate payment with your doctor before you arrive at your appointment, either through a discounted rate you will pay up front (and can submit to the Community for funding afterward if over $500), or through a voucher that will allow them to bill us after your visit.

For all unplanned (urgent or emergency) care, you will either receive the funding from the Community within a week or so of incurring those out-of-pocket costs beyond your $500 Member Commitment, or we’ll facilitate the payment afterward on your behalf when you submit your bill through the app.

Wellness Checks

Because the Community cares about your wellbeing and wants to encourage preventative health, your telemedicine through the CrowdHealth platform always goes to the Community for funding. The Community will also waive the $500 Member Commitment for one annual in-person wellness check, including a basic blood panel, per Member, with a primary care provider or your child’s pediatrician. That means bills for these visits can be submitted for funding by the Community without fulfilling your $500 initial commitment.

Please note that if during a well check, your doctor orders specialized diagnostics, imaging, or additional lab work related to your visit, that will initiate a new, separate health event and will be subject to the standard $500 Member Commitment.

Other preventative care/wellness checks, such as colonoscopies or gynecological exams and related tests, qualify as valid health events but are separate from the basic wellness visit described above. Expenses related to these wellness events can be submitted for funding by the Crowd when the initial $500 Member Commitment has been met.

Non-Emergency Care

For all non-emergency care, you'll log your visits through the app before you go, which lets your Care Advocate give you personalized care and support throughout the process.

For minor appointments, you will notify your doctor that you are a cash pay patient and pay the doctor at the time of your visit. For major non-emergency care, such as a scheduled surgery, CrowdHealth will negotiate the pricing for your procedure ahead of time. As always, you have the freedom to see the doctor of your choice, whether it’s one you already love or a new, high-quality, fairly priced practitioner we help you find.

Each new illness or injury is considered one health event, so any subsequent care required for this illness – things like labs, radiology, follow-up visits, prescriptions, and referrals – are included as part of the event. You commit to paying the first $500 for each event, and any amount over $500 will be submitted to the Crowd for funding. It takes approximately five business days for the Crowd to fund those bills, keeping the process quick and smooth for you.

Emergency Care

For all unplanned urgent or emergency care, inform your Care Advocate as soon as possible about the health event, so we can guide you through your health journey and offer you the best Member support possible.

When receiving urgent or emergency care, state that you are a cash pay patient and ask to be billed after your care. Some urgent cares and emergency rooms may still require you to pay at the time of your visit. In either case, scan the bill (paid at visit, or unpaid and sent to you later) into the CrowdHealth app, and we will coordinate payment to your doctor and/or funding to you from the Community quickly and easily.

Prescriptions

For your prescriptions to be eligible for funding by the Community (after meeting your $500 per-event Member Commitment, and up to 120-day supply per event), you must use our prescription discount partner when purchasing. You will show your prescription benefits card at the pharmacy to get the best price, pay at checkout, and submit the prescription receipt through the app for funding by the Community.

Similarly, for all children’s immunizations, you must use a Vaccines For Children (VFC) provider in order for any related expenses to be eligible. See CrowdHealth Supports Growing Families below for more information.

Submitting Your Bills

For scheduled health journeys that you initiate in the CrowdHealth app, you will either receive a voucher to present in lieu of payment at your appointment, or you will pay out-of-pocket and quickly receive any funding from the Community. If you do receive a bill after an appointment, whether for care that was scheduled or unscheduled, just scan it into the CrowdHealth app, and we’ll coordinate the rest from there.

How It All Comes Together

To help you get a clearer idea of the Member experience, below is an example to walk you through the process.

A family of two parents in their late thirties, a toddler, and a six-year-old child contributes the following for a CrowdHealth Membership each month:

⦁ $100 ($25x4) for their monthly subscriptions, plus
⦁ a maximum of $650 ($200x1 + $150x3) in monthly contributions to the Community.

That’s $750 per month for their family, compared to the $1400 in health insurance premiums they were paying before (in addition to satisfying large deductibles before coverage kicked in, ongoing copays, and expensive coinsurance—yuck!).

Here’s what navigating a health event looks like for these Members:

The family ventures out for a hike one Saturday morning, and Dad takes a bad fall and hurts his knee. He’s in a good bit of pain, but it’s not an emergency, and it’s the weekend. Conveniently, he opens the CrowdHealth app, logs a new health event ("knee injury,") and requests a telemedicine appointment. The virtual doctor is available fast and, between a video evaluation and listening to Dad describe his symptoms, is able to diagnose a sprain.

The doctor writes a prescription for pain medication, so Dad goes to his neighborhood pharmacy and uses the CrowdHealth prescription discount tool to get a great price. He shows his digital RX card and pays for the prescription at checkout. The virtual doc also recommends a follow-up appointment in person, so Dad searches for an orthopedist in the CrowdHealth app and finds a five-star doctor that's in his area. When Dad arrives at his appointment, he lets them know he's a cash pay patient and pays for his visit at checkout.

Dad’s knee is starting to feel better as the swelling goes down, but the orthopedist says he’ll need a few sessions of physical therapy to be back to 100%. Dad uses the app again to search practitioners, picks a top-rated PT, and schedules the appointments he needs.

Four weeks later, he’s done with PT, and his knee is feeling great. He has scanned in the receipts for his prescription, orthopedist visits, and physical therapy sessions in the CrowdHealth app. His bills totaled $725 for the health event, so $225 (the event-related expenses beyond his initial $500 Member Commitment) has been submitted to the Crowd for funding, and he can expect to receive that funding within five days. Through the easy-to-use CrowdHealth platform, and thanks to the generous Member Community, Dad got the quality care he needed, right when he needed it.

What Else Should I Know About What Makes CrowdHealth Different?

Since we’re doing something different here, there are a few more things we want to make sure you know about your CrowdHealth Membership:

Minimum Essential Coverage (MEC)

Your CrowdHealth Membership does not satisfy a federal or state individual Minimum Essential Coverage (MEC) mandate.

If you live somewhere (e.g. California, District of Columbia, Massachusetts, New Jersey, Rhode Island, Vermont) with a state-level individual MEC mandate, you are responsible for securing that coverage independently from your CrowdHealth Membership. Links to more information about these mandates are below.

If you have a MEC health plan, you are expected to utilize this coverage for all eligible care before submitting bills to CrowdHealth.

State Information about MEC Mandates:

California
Washington, DC

Massachusetts

New Jersey

Rhode Island

Vermont

Taxes

Your monthly Member contribution is a voluntary contribution toward a Membership that facilitates the funding of fellow Members’ medical bills. It is not a health insurance premium, nor is it a contribution to a health care sharing ministry, so it is not subject to these tax breaks. Your monthly subscription and Community contribution are post-tax disbursements.

Legal Action

The ability to pursue fair health care costs on your behalf as a cash pay patient is an important part of how CrowdHealth operates and cares for the Member Community. In the case that a healthcare provider bills an unfair amount and is unwilling to negotiate with us, CrowdHealth requires our Members to give us the right to pursue legal action against that provider on behalf of you and the CrowdHealth Community.

Access to Your Health Records

When you submit a health event through your CrowdHealth Membership, you agree to give us access to your health records upon request. This helps protect you and the Community by providing important context about your medical history and helping validate your bills.

What Do You Do with My Money?

Every month, the contribution you send in does not come to CrowdHealth. Instead, it goes to a secure, industry-standard third party, who maintains a separate account for each Member. See our Privacy Policy for more information on our trusted third-party partners.

The contributions you send will be used to fund the Community’s bills. When you have a medical bill, the money in your account will be used to fund your bill first, with the remaining balance being shared pro rata by the Community.

Canceling Your Membership

CrowdHealth Memberships represent voluntary participation in a Community that funds each other's health expenses each month. Subscription payments and contributions to the Crowd are made on a monthly basis, and you may cancel your Membership at any time.

If you choose to leave the CrowdHealth Community after having a major health expense that is being paid over time, any unpaid balance of that bill is your responsibility upon leaving the Community. In the unlikely event that you choose to leave CrowdHealth and there is a small balance of funds in your account after all submitted bills are paid, these funds will be returned to you within 30 days of your Membership termination.

What Do You Do with Big Bills?

The CrowdHealth platform is designed so all Members’ eligible bills can be paid in full each month. We still want to be prudent with a plan for months where the Community’s bills exceed the money in from contributions, so CrowdHealth utilizes a secure third-party to direct payments to the clinicians who provide our Members care.

For big, planned bills (like expensive surgeries), we’ll negotiate the cost to a 30-60% discount before the procedure event happens. For big emergency bills, we’ll negotiate them after the fact and pay them over 12, 24, or 36 months. So, a huge $500,000 bill after a cardiac arrest and hospital stay could come down to $240,000, divided by 24 months and 5000 Community Members, and amount to just $2 of funding from Member contributions per Member each month over the two-year payment period.

What Happens If a Member Misses a CrowdHealth Membership Contribution?

We understand that unexpected changes to your income or other life circumstances can affect your ability to keep your subscription and monthly contributions current. Our Care Advocates are here to help you navigate those situations within 30 days of missing a contribution to the Community. If after 30 days, you are unable to make up your missed contribution, any bills you submit to the Community until your contributions are made current will be considered for funding last, after bills for all other Members whose contributions are up-to-date have been funded by the Crowd.

Caring Abundantly

When you join the CrowdHealth Community, you’re there for your fellow Members in their time of need. And, each month you follow through with your contributions, you’re supporting the very people who will step up for you when you have your own health events. We call it caring abundantly, and we believe it’s a beautiful thing. When we each give a little, we find there’s plenty for all.

For You

As a Member of CrowdHealth, you have access to the tools and support you need to lead the healthy, thriving lifestyle you desire. We are pro-wellness, pro-family, and pro-Community…pro-you!

We want to see the CrowdHealth Community flourishing, meaning you receive the care you need without fear of how you’ll pay for it. CrowdHealth takes the guesswork out of how healthcare gets funded, and our exceptional team of Care Advocates is here to help you every step of the way.

For Your Family

CrowdHealth Supports Healthy Moms

Member maternity care that is eligible for funding by the Crowd includes your whole pregnancy, from conception through birth: prenatal care, labor/delivery, and postpartum care. Newborn care is a separate health event from maternity but is included in the baby’s Membership when added as a new Member after birth.

Please note that if you’re pregnant before you join as a Member, determined by your due date compared to your Membership activation date, your maternity care is not eligible for funding by the Community, and your baby’s health care will not be eligible either until six months after birth. If you have any question that you are already pregnant, please consider an alternative to CrowdHealth. We want to care well for you and your family, but the Community cannot fund maternity care for new Members who join knowing they are already pregnant with a plan to bring these significant medical costs to the Community soon after joining.

CrowdHealth Supports Growing Families

You can add a new baby or adopted child to your Membership within 30 days of their joining your family for their health expenses to be eligible for funding retroactively, starting at the date of birth or the date they joined your family.

For ages 0-30 months, your child’s wellness checks are treated as a single health event with one $500 Member Commitment. After your child’s 2.5-year checkup, his or her annual visits will have the $500 Member Commitment waived as part of our ongoing initiative to encourage Member wellness. For Members of any age, illnesses or injuries not associated with wellness checks will be treated as separate health events.

Please note that you must utilize the Vaccines For Children (VFC) program in order for any expenses related to your child’s vaccinations to be eligible for funding by the Community. For more information on how to find a Vaccines for Children clinic in your area, contact your Care Advocate or visit the following link.

For The CrowdHealth Community

The CrowdHealth Community is committed to funding the healthcare Members need without wasting contributions on unnecessary or unproven treatments. This means some things are not eligible to be submitted to the Community for funding, which are outlined in the table below. To consistently offer the best care and support possible to the CrowdHealth Community, we will still work to negotiate fair medical costs for care that is outside your Membership when possible.

Beyond what is clearly outlined here, any disputes that arise related to the Community funding eligibility of treatments or procedures submitted by active Members will be determined by a vote from other Members of the CrowdHealth Community. We believe you have each other’s best interest in mind, and we are grateful for the caring Community we’re building together.

Fully Excluded Procedures and Treatments

Category

Excluded Treatment / Condition Examples

Alternative therapies

Acupuncture, chiropractic treatment, complications from ineligible treatments, euthanasia, exercise programs, experimental/unproven treatments, functional medicine (unless practiced by a licensed MD), some genetic screenings and testing, massage therapy, medical marijuana/CBD, naturopathic treatment, nutritional/dietary treatment or supplements, occupational therapy, speech therapy

Cosmetic procedures

Breast implants, hair loss treatment, weight loss programs or surgery, and any other non-medically necessary cosmetic procedure

Mental health

ADD/ADHD, counseling / talk therapy, diagnostic neuropsychological testing, psychiatric treatment, addiction rehabilitation

Personally assumed risk

Injuries or conditions resulting from gross negligent acts, hazardous activities, or illegal acts; injury resulting from failure to comply with medical advice, injury from war/armed conflict, or self-inflicted injury

Prescriptions

Experimental drugs, high-cost therapeutics, injectable epinephrine, maintenance medications for chronic conditions beyond the annual pre-existing condition terms, orphan drugs, and any prescriptions or vaccines purchased without the CrowdHealth discount tool

Reproductive Health

Adoption, abortion, doula services, fertility/infertility treatment, impotence treatment, pregnancy conceived before Membership was active (incl. prenatal, labor, delivery, and postpartum maternal care, congenital/hereditary conditions for baby, and first six months of infant health care), sex change procedures and treatments, surgical sterilization

Vision and Dental

Dental care, non-ophthalmologic optical (eye) care

Other

Custodial (nurse or similar) care when not treating illness or injury, food or infant formula, health care charges incurred before you were a Member, late fees or billing irregularities due to patient negligence, over the counter medicines and personal comfort devices, subacute care or skilled nursing care, and any other non-medically necessary service or treatment

Limited Eligibility Procedures and Treatments

The CrowdHealth Community welcomes Members with preexisting conditions. The Community applies a five-year timeline prior to Membership to defining preexisting conditions, which include any medical condition that existed prior to joining CrowdHealth, including those that are diagnosed, symptomatic, suspected, or have required treatment.

Medical expenses related to preexisting conditions are subject to the following limitations for funding by the Crowd, unless in the five years prior to Membership, the conditions have not demonstrated any signs/symptoms, have required no treatment/medication, and have not been suspected of returning based on your medical practitioner's evaluation: $0 in year 1, $25,000 in year 2, $50,000 in year 3, and $100,000 in years 4+.

Category

Excluded Treatment / Condition Examples

Preexisting conditions

Asthma, congenital conditions (except for children who become CrowdHealth Members at birth), diabetes, genetic disorders, heart conditions, high blood pressure, sleep apnea, and any other preexisting or previously diagnosed medical condition for which a Member requires ongoing treatment, observance, or maintenance

Prescription drugs

Prescription drug costs eligible for funding by the CrowdHealth Community are usually limited to a 120-day supply. For drugs used to treat preexisting conditions, this limit does not apply; however, the maximum total preexisting condition limit will apply.

Member Manifesto

1. I understand that CrowdHealth is not health insurance, and I think that’s a good thing!
2. I have fully read and understand this document that describes my new CrowdHealth Membership and how it will help me pay for my health care costs, including my $500 Member Commitment for each unique health event and the specified limitations and exclusions on certain treatments and prescriptions.
3. I understand that my participation in the monthly funding of the Community’s medical costs is voluntary, but my failure to make my monthly contributions will result in my subsequent bills being considered for funding last, after bills for all other Members whose contributions are up-to-date have been funded by the Crowd.
4. I understand that my health visits, except for unplanned urgent or emergency care, should be initiated through the CrowdHealth platform, or there is a risk they won't be eligible for funding by the Community.

a. I understand that the ability to negotiate on my behalf as a cash pay patient is an important part of how CrowdHealth operates and cares for the Community, so I agree to let my providers know I am a cash pay patient at each appointment.

b. I understand that I will get the most benefit from my CrowdHealth Membership when I see high-quality, fairly priced practitioners, but I reserve the right to see any doctor/clinician I want.

c. If a healthcare clinician of my choice bills me an unfair amount and is unwilling to negotiate, I give CrowdHealth the right to pursue legal action against that provider on my behalf.

5. I understand that both the CrowdHealth Community and I benefit when Members make smart, mindful health and healthcare spending decisions.

a. To care for myself and this Community, I commit to maintaining a healthy lifestyle, including abstaining from any illegal drug use or activities.

b. To protect the integrity of our Community funding process, I commit to not knowingly or repeatedly visit a healthcare practitioner who is unreasonable or unfair in their billing rates and practices.

c. To avoid unfairly burdening the Community with unnecessary bills, I agree to pursue payment from any other liable sources (e.g. car insurance, MEC, etc.) for relevant health events before submitting my remaining medical expenses to the Community.

6. I understand that CrowdHealth facilitates the funding of my health expenses through the generous Member Community.

a. I trust the Community to support me, but ultimately, I am responsible for my medical bills.

b. I understand that because CrowdHealth is not health insurance, there is no guarantee that my medical bills will be paid.

c. If I choose to leave the CrowdHealth Community after having a major health expense that is paid for over multiple months, any unpaid balance of that bill will be my responsibility upon leaving the CrowdHealth Community.

7. I understand that if I fail to abide by the commitments of this Member Manifesto and everything outlined in the Member Guide, including future versions which will be clearly communicated to me as a Member, I risk losing my Membership and may be unable to rejoin the Community in the future.