Table of Contents
Everyone Hates Member Guides
We know, we know. Member handbooks, user guidelines, terms and conditions. They’re the worst. Well, not the worst. Health insurance is the real worst. But guidelines and fine print can be exhausting to navigate, too. So, we’re starting here with making your CrowdHealth Member experience refreshingly simplified and different, in a good way.
Here, you'll find what you need to know about being a Member of CrowdHealth.
What is CrowdHealth?
Finding and funding the health care you need shouldn’t feel isolating or overwhelming. so together with our Members, CrowdHealth is changing your health care experience.
Your CrowdHealth Membership provides you a platform, Community, and toolkit to help you find and fund your health care outside the insurance system, with personalized support along the way.
As a CrowdHealth Member, you participate in the healthcare system as a self-pay patient, cutting out the health insurance middleman. While you maintain the ultimate responsibility for paying your own medical bills, you can expect to pay for the smaller expenses on your own and to submit your larger medical expenses to the Crowd for funding. In turn, you’ll be invited to help crowdfund other Members’ larger medical expenses, too.
At CrowdHealth, Members have access to lower medical costs through the power of consumerism and self-pay while avoiding outrageous health insurance premiums, deductibles, and out-of-pocket maximums. With CrowdHealth, you can save thousands of dollars every year while experiencing real health care freedom.
CrowdHealth is a Caring Community
At CrowdHealth, you’re not alone.
CrowdHealth is building a Crowd of people like you – savvy, generous, and responsible -- to support one another in accessing and paying for health care.
Your Care Advocate provides caring, personalized support throughout your health care journey, like finding fairly priced, high-quality care options while guiding you through the administration and logistics of the healthcare system.
CrowdHealth is Access to Care
CrowdHealth helps you access to the care you need, when you need it.
It can be hard to find a doctor you can trust, and even harder to see them when you’d like. CrowdHealth offers access to a robust virtual care platform, available 24/7 through the app, or your Care Advocate can help you find a provider to see in-person.
If you’ve already got a favorite doc, that’s great! There are no doctor networks to limit you here. And, your Membership gets you access to discounted prescription pricing, all at your fingertips through the CrowdHealth mobile app.
CrowdHealth is Crowdfunding
Each month, Members pay a subscription to be part of the Crowd and make an affordable deposit into a crowdfunding account. As health expenses from Members arise, CrowdHealth communicates these needs among the Crowd. Then, CrowdHealth facilitates the crowdfunding of expenses by inviting Members to voluntarily give -- from the money you’ve already deposited into your accounts -- to fund the bills of other Members.
Who is the Crowd?
The power of CrowdHealth is our vibrant, health-conscious and generous group of Members, a.k.a. “The Crowd.” Together, we’re achieving something bigger, better, and altogether different than if we tackled the complexity and unaffordability of health care costs alone.
Our Members are savvy and generous, like-minded and health aware, responsible and accountable. If that’s you, you’re really going to like it here!
(On the flip side, if you’re looking for a way to “work the system” and mooch off others without being generous yourself… keep looking. You’ll feel out of place in the Crowd.)
The Crowd comprises Members from babies through age 64 who provide biometric values and health history information upon joining. The Crowd welcomes Members with varied health histories while giving transparent, specific terms for how care for previously documented or diagnosed conditions are funded. All these details are in place so Members can be confident about who and what your dollars are funding.
Savvy and Generous
You’ve probably joined the Crowd because you’ve been failed by the legacy health insurance system and are tired of paying too much for your health care. As a savvy Member, you’re looking for the best service at a great price and are too smart to be fooled by healthcare players who don’t have your best interest in mind.
Through your generosity, you keep up with your monthly crowdfunding account deposits to help fund health care for the Crowd. When you need help with your bills, your fellow generous Members will help fund your care, too.
The Crowd operates transparently through Generosity Scores, based on your crowdfunding activity, and health event ratings based on the fairness of the prices for Members’ care. Read more about how these are helping you and the Crowd find and fund your health care differently in “How CrowdHealth Works,” below.
Like-Minded and Health Aware
CrowdHealth Members have like minds in seeking something trustworthy, simplified, and freeing -- a new solution that is changing the game and is bigger than fighting for healthcare freedom on your own.
And, by being health aware, you know that staying engaged with your own health helps not just you but the Crowd as a whole, too.
Responsible and Accountable
CrowdHealth Members are responsible and accountable to each other, which lets us care abundantly for each other. That’s good news for all of us.
To help the whole Crowd thrive, you and your fellow Members can count on one another to:
- Fulfill your monthly subscription and crowdfunding account deposits, timely and consistently.
- Believe that highest cost does not indicate best care, and be open to considering high-quality clinicians who offer a better price for the care you need.
- Only submit legitimate, medically necessary bills for crowdfunding.
- Care about your own health and that of the people around you, proactively engaging with your health and spending wisely on your own health care.
- Trust the Crowd to help fund your health expenses while understanding that ultimately, each Member is responsible for your own medical bills.
We’re so glad you’ve joined us. The Crowd is better with you in it!
CrowdHealth’s Guiding Principles
CrowdHealth is founded and run by people who think and feel like you. Health care can feel complex, expensive, and lonely, so we’ve reimagined a different solution with you in mind, embracing the guiding principles of Simplicity, Affordability, Community, and Quality.
Simplicity: No More Health Plan Confusion
The fine print of insurance plans – in-network vs. out-of-network coverage, deductibles, copayments, and out-of-pocket maximums – is confusing and frustrating. That’s why CrowdHealth is committed to Simplicity in each experience, for every Member, with:
Three Simple Steps.
- Let CrowdHealth know about a new health event and/or upcoming medical visit.
- Fund the first $500, a.k.a. your Member Commitment, of each health event yourself.
- Upload medical bills and receipts through the app, and let CrowdHealth submit your expenses over $500 per event to the Crowd for funding.
Technology that Works for You.
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, who’s here to walk with you from scheduling to bill payment and everything in between.
Quick, Simple Funding.
Through CrowdHealth’s smooth digital process, crowdfunding by the Member Community happens fast, making things easier both for Members and for the clinicians who provide your care.
We work diligently to submit qualified crowdfunding requests to the Crowd within days of receiving the appropriate service and cost details, give the Crowd three days to approve or deny the request, then turn the funding around quickly after crowdfunding approval. This means Members get money for bills as soon as we can process them, and doctors get paid on time, too.
Affordability: Helping the Crowd Save Money
Health care can be incredibly expensive. Here, the Crowd is built on a commitment to Affordability and the belief that the best care doesn’t have to be the priciest. That means:
You Use the Power of Consumerism.
Members participate in the healthcare system as self-pay patients. This lets you access high-quality care for less than the insurance sticker price. Our Members regularly benefit from self-pay discounts ranging from 25% to 85% off normal billed charges.
We Use the Power of Negotiation.
We leverage relationships with providers to offer pre-negotiated and bundled pricing options for your scheduled care. And, when you face an unexpected health event and a big bill comes with it, CrowdHealth and our partners can step in on behalf of you and the Crowd to negotiate it down to a fair price.
Community: Transforming Health Care, Together
CrowdHealth is built by people who care, for people who care. As a Member, you and the Crowd are:
Building the Future.
You want to be part of a new solution that gives you and your family a totally different experience, not a marginally better option than the health insurance you had before. With you and the Crowd, we’re building a better future and transforming health care as we grow.
Power in Numbers.
The problems of the American healthcare system – unfair pricing, hidden billing practices, mismatched incentives between patients and insurers – are too big for any of us to take on alone. But with CrowdHealth, you’re joining forces with Members and a team who are taking on the broken system with you.
Navigating your health shouldn’t leave you feeling like you don’t know who you can trust. With the Crowd, your health journeys happen within a transparent, trustworthy Community you can count on.
Quality: Only the Best for You
Support isn’t a buzzword here, and you deserve the best. With personalized care navigation from Care Advocates, we mean it when we say you’ll have a high-quality Member experience you love, through:
No Doctor Networks (Seriously)!
CrowdHealth does not limit your access to care through stifling doctor networks. You can keep seeing your favorite doc, or talk to your Care Advocate if you need help finding a new high-quality provider.
Health Care Freedom.
At CrowdHealth, you’re free to get the care you need when you need it, without feeling locked into a burdensome insurance plan.
Technology that’s Always Improving.
We’re building the best app and resources to make your life easier, and it just keeps getting better.
How CrowdHealth Works
No, It’s Not Health Insurance – and Why That’s a Good Thing
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. It’s a platform, community, and toolkit to help you find and fund your health care outside the insurance system, including a health care crowdfunding platform for your big bills. This means your Membership is designed and funded differently than health insurance, and that CrowdHealth has different priorities (like putting you, our Member, first!).
We have developed systems and processes that allow the Community to fund medical expenses; however, your Membership is not insurance, and therefore CrowdHealth cannot guarantee that your medical bills will be funded. Ultimately, Members are responsible for your own medical bills.
What Members Pay
Subscription Payments and Monthly Crowdfunding Deposits
Compared to painfully expensive insurance premiums, CrowdHealth Members pay a low monthly subscription to be part of the Crowd and make a monthly deposit to an individual crowdfunding account, which is used at the Member’s discretion to crowdfund other Members’ medical expenses. Subscription amounts are the same for everyone, and monthly deposit amounts are different based upon anticipated health care needs of certain age groups. Here’s how it breaks down :
Families of 4 to 8
More About Crowdfunding Accounts
The deposit amounts above are monthly maximums. If you and the Crowd spend less over a period of several months, your monthly crowdfunding deposit may be lower than these numbers. When you make healthy and smart spending choices, you and the whole Crowd benefit together. Even when large expenses are incurred, these bills are negotiated and can be paid over time by Members, helping keep monthly Member deposit amounts 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 monthly deposit amount will take effect on your first billing date following the Member’s birthday.
If you’re 64 years old, we’ll be in touch with you before your next birthday about transitioning out of CrowdHealth. Your Membership ends when you turn 65.
Crowdfunding Requests and Member Generosity Scores
While you must pay your monthly subscription fee to keep your Membership active, your participation in crowdfunding other Members’ bills is always voluntary.
Most Members choose to fully participate in each crowdfunding request, which keeps things simple and keeps your Generosity Score at 100%. When you receive a crowdfunding request, you may agree or decline to contribute from your accrued deposits by responding directly to the crowdfunding request. Non-responses to crowdfunding requests after three days will be treated as approvals.
To encourage transparency and generosity among the Crowd, Members receive a Generosity Score based on participation in crowdfunding requests.
When you receive a crowdfunding request, you aren’t being asked to make an additional deposit; rather, we’re asking for your approval to apply some of the funds already deposited in your crowdfunding account toward the requesting Member’s health event. If you agree to fund 100% of the crowdfunding requests you receive, you will maintain a 100% Generosity Score. If you choose not to participate in funding other Members’ bills, your Generosity Score will be affected by the proportion of what was requested of you versus what you gave.
Members who are asked to crowdfund your bills will be able to see your Generosity Score at the time of your request. Members will not be penalized for denying crowdfunding requests from Members with a Generosity Score below 90%.
Family Memberships are available for families with four or more Members. To be eligible for a Family Membership, you must meet at least one of these conditions:
- A parent, under age 65, with three or more children, by legal and/or blood relation, who are under age 26;
- Two parents domiciled together, under age 65, with two or more children, by legal and/or blood relation, who are under age 26;
- A group of four or more siblings, by legal and/or blood relation, who are under age 26.
For families of more than eight people, please contact us for more information on a Membership that can fit your family’s needs.
Member Commitments Instead of Deductibles
The Crowd exists 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. And after your deductible is met for the year, you may continue to pay a percentage of the costs up to an out-of-pocket maximum that’s much higher than your deductible. Ouch!
CrowdHealth is different. Your Membership means you commit to your fellow Crowd Members that you’ll pay your $500 Member Commitment for each Valid Health Event, and we’ll ask the Crowd to fund the rest. There is no maximum limit to the amount of bills you can submit for crowdfunding as a CrowdHealth Member.
What Do You Mean by “Health Event”?
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 physician’s fees, facility, and anesthesia; physical therapy; and pain meds) or something minor, like one of your kids needing to see the pediatrician for a sore throat.
With each health event, Members pay the first $500 as your Member Commitment. 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, you’ll pay the initial $500, and all expenses over your Member Commitment will be submitted to the Crowd for funding.
For health events lasting longer than twelve months, the $500 initial Member Commitment will reset in the thirteenth month.
Our Commitment to Revenue Transparency
Some of the main factors in rising health care costs are the mismatched incentives built into the system’s financial structure: health insurance companies profit off a percentage of customer premiums, so they can make more money by hiking up prices.
CrowdHealth is different. We have intentionally established our revenue to align with our incentives 100% with the goals of the Crowd, and we’re committed to being transparent about it.
CrowdHealth receives flat payments through Members’ monthly subscription payments and account closure fees when a Membership is canceled. Since CrowdHealth doesn’t make money as a percentage of your monthly crowdfunding account deposits, we have no interest in raising your deposit amounts each month or denying the crowdfunding of Members’ bills to increase our own profits. We are here to help you and the Crowd save, always.
Using Your Membership
Because CrowdHealth is different, we want to make sure Members understand the tools that help you navigate your health care without insurance. To help you get the most out of your Membership, CrowdHealth requires the account holder (Primary Member) to complete a short New Member Orientation call with your Care Advocate.
Notifying Us of Your Events
For your health care to be eligible for funding by the Crowd after your $500 Member Commitment is met, except for unscheduled urgent or emergency care, you must initiate your health events through the CrowdHealth mobile app or Member Portal. You do so by creating a health event that reflects the Member involved and the type of event (wellness, injury, illness, pregnancy, or other), or by contacting your Care Advocate directly. Your Care Advocate will assist you and gather additional information to help you through your health event.
Members should initiate all planned care through the platform, regardless of whether it is expected to exceed the $500 Member Commitment. That way, for health events that escalate beyond your expectation, your care is eligible for crowdfunding, your bill payment process is kept simple, and your Care Advocate can support you along the way, Even if you need care that isn’t eligible for crowdfunding (more on that here), we can 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.
Choosing Your Doctor
CrowdHealth does not participate in a provider network. You can see your existing doctors, or let your Care Advocate know if you need help finding a new one.
For your health care to be eligible for crowdfunding, it must be performed by a licensed or board-certified practitioner.
To uphold the integrity of the crowdfunding process on behalf of the Crowd, Members should not knowingly or repeatedly visit a medical practitioner who is unreasonable or unfair in their billing rates and practices.
Health Event Scores
CrowdHealth provides transparent health event scores for major scheduled health events. Our pre-negotiation services help Members access quality care and ensure the funding amounts requested from the Crowd are fair.
If you need a surgery or other scheduled procedure/treatment, we can compare estimates from multiple providers and offer competitive rates for high quality care. If you choose a provider that is outside the fair market rate for the service, that information will be included with your crowdfunding request as a Health Event Score, which may affect how other Members participate in funding your health event.
Choosing not to fully fund an overpriced event with a poor Health Event Score will not impact your Generosity Score.
Submitting Your Bills & Receipts
When you receive a bill, scan it into the CrowdHealth app and attach it to your health event. If your bill needs to be negotiated, we’ll coordinate with our partners to help you get the best discounts.
Once your bill has been paid, attach the corresponding receipt or proof of payment in the app, and we will review and submit approved bills for crowdfunding quickly and easily.
Handling Big Bills
The CrowdHealth platform is designed to maximize the probability that all Members’ eligible bills can be fully crowdfunded.
For big, planned expenses (like surgeries), CrowdHealth can negotiate the cost to a 30-60% discount before the procedure even happens. Always contact your Care Advocate before a scheduled surgery to allow time for this negotiation.
For unplanned health events, CrowdHealth can negotiate post-service and help you take advantage of a hospital’s payment plan over 12, 24, or 36 months. So, a huge $500,000 bill after a cardiac arrest and hospital stay can be negotiated down to $240,000, divided by 24 months and 5000 Members, which results in an amount of just $2 of crowdfunding per Member per month over the two-year period.
Online Platform and Mobile App Access
As soon as you sign up for your CrowdHealth Membership, you can download and log into the CrowdHealth app and will be able to access your Member Portal through the website. Because our app and portal contain information and tools that are reserved for active and oriented Members, you will not be able to utilize the full app functionality until your Membership start date. Please note that without access to our app via a smart device, you will not be able to utilize certain features of your CrowdHealth 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 or email email@example.com.
Self-Pay Patient Status
CrowdHealth isn’t insurance, so you do not have an ID card, Member number, or benefits group to submit on patient intake or other insurance-type forms. At any medical visit, you’ll just indicate that you are an uninsured, or"self-pay," patient.
Health Event Specifics
Because the Crowd cares about your wellbeing and wants to encourage access to high-quality health care when you need it, virtual visits – including services like virtual urgent care, virtual primary care (VPC), and virtual talk therapy -- through the CrowdHealth platform are part of your Membership with no additional cost to you.
CrowdHealth Members can submit up to $300 for ONE basic wellness event per year to be crowdfunded. This wellness event can be utilized for any one of the following, performed by a licensed or board certified practitioner:
- primary care wellness exam/physical, including naturopathy;
- pediatric well-child visits;
- direct primary care (DPC) membership fee;
- annual female gynecological exam and labs;
- dental exam, including cleaning and X-rays; or
- vision exam.
The Crowd waives the $500 Member Commitment for ONE annual wellness event per Member (ages three and over). Annual wellness spending beyond this $300 crowdfunding threshold will be funded by the Member.
Please note that if after a basic wellness event, your doctor orders specialized diagnostics, imaging, additional lab work, or other follow-up care related to your visit, that will initiate a new, separate health event and will be subject to the $500 Member Commitment.
Other preventive care, such as colonoscopies and mammograms, are valid health events and are separate from the basic wellness event described above. Expenses related to these wellness events can be navigated by your Care Advocate and submitted for crowdfunding when the $500 Member Commitment has been met.
Given the frequency of recommended well checks for our littlest Members, health events for Newborn and Children’s Wellness are treated differently up to three years of age. See “Caring For Your Family” below.
Scheduled (Non-Emergency) Care
For all non-emergency care, you'll log your visits through the mobile app or Member portal before you go, which lets your Care Advocate give you personalized care and support throughout the process.
For minor appointments, notify your doctor that you are a self-pay patient and pay the doctor at the time of your visit.
If your doctor requests labs, imaging, or other follow-up care, please get the orders from your doctor at your appointment and send them to your Care Advocate, who can help you navigate the next steps with high-quality care and fair pricing.
For major non-emergency care, such as a scheduled surgery, you must contact your Care Advocate in advance. In order to validate potentially expensive and/or complex health events on behalf of the Crowd, CrowdHealth may engage a trusted third-party to provide clinical review and/or pre-negotiation services for procedures and treatments. A failure to notify your Care Advocate before your scheduled health event, which prevents CrowdHealth from performing appropriate due diligence and preparation for funding on behalf of the Crowd, may impact your health event’s eligibility for funding.
Emergency & Urgent 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 self-pay patient and ask to be billed after your care. CrowdHealth can facilitate negotiation on your behalf for emergency room bills before you pay them.
For your prescriptions to be eligible for crowdfunding, you must use your prescription discount benefit when purchasing. You will show your RX discount card (accessible through your Member profile in the app) at the pharmacy to get the best price, pay at checkout, and submit the prescription receipt through the app for crowdfunding.
Prescription drug costs eligible for crowdfunding are generally limited to a 120-day supply per valid health event.
For all children’s immunizations, you must use a Vaccines For Children (VFC) provider in order for any related expenses to be eligible for funding as part of the valid health event. Learn more under “Caring for Your Family,” below.
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 $695 for a CrowdHealth Family Membership each month. They’re saving over $700 compared to the $1400 in health insurance premiums they were paying before (in addition to satisfying large deductibles before their coverage kicked in, plus 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, and requests a virtual urgent care appointment. The virtual doctor is available fast and, between a video evaluation and listening to Dad describe his symptoms, diagnoses 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 contacts his Care Advocate, who helps him find a high-quality, fairly priced orthopedist in his area. When Dad arrives at his appointment, he lets them know he's a self-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 asks his Care Advocate for help finding a high-quality, fairly priced PT, then 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) is submitted for crowdfunding. Through the easy-to-use CrowdHealth platform, with support from his Care Advocate, and thanks to the generous Member Community, Dad got the quality care he needed right when he needed it.
When you join the Crowd, you’re there for your fellow Members in their time of need. And, when you make your crowdfunding account deposits each month, 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.
Caring 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 want to see the Crowd flourishing, meaning you receive the care you need without fear of how you’ll pay for it. CrowdHealth takes the guesswork out of how health care gets funded, and our exceptional Care Advocates are here to help you every step of the way.
Caring for Your Family
Maternity and Newborn Care
Member maternity care that is eligible for crowdfunding includes your whole pregnancy through your baby’s birth and beyond. The three phases of your pregnancy care represent three separate health events, each with a $500 Member Commitment:
- prenatal care,
- labor and delivery, and
- postpartum care.
Your child’s standard newborn wellness care (birth until six months old) is a separate health event from maternity and is included in the baby’s Membership when added as a new Member after birth. If your baby gets sick, the illness or injury will be treated as a separate health event from this newborn wellness health event.
Please note that if you’re pregnant before you join as a Member, determined by your due date compared to your Membership start date, your maternity care is not eligible for crowdfunding, and your baby cannot join the Crowd until six months of age.
Adding Children by Birth
For pregnancies conceived after a parent is an active Member of CrowdHealth, a new baby may be added to your Membership within 30 days of joining your family for his/her health events to be eligible for funding retroactively, starting at the date of birth.
For pregnancies conceived before a parent is an active Member of CrowdHealth, a baby may be added to your Membership at six months of age, effective at the start of the next billing cycle.
Please see “Maternity and Newborn Care” above for more on these health events.
Adding Children by Adoption
You may add an adopted child to your Membership within 30 days of joining your family for health expenses to be eligible for funding retroactively, starting at the child’s birth date or the start of your next billing cycle.
Adding Additional Family Members
The addition of family members (e.g. children over six months old, spouse, etc.) to a primary Member's account may be initiated at any time. These added Memberships will be active at the start of the next billing cycle.
Children’s Wellness Visits and Vaccinations
For children conceived and born or added to a family by adoption after one or both parents join CrowdHealth, standard newborn wellness care (birth until six months old) is treated as one health event with one $500 initial Member Commitment. Existing children in a CrowdHealth Member family are eligible for Membership after they turn six months old.
For children ages six months until three years, your child’s wellness checks are treated as a single health event with one $500 Member Commitment. Starting at age three, your child’s annual visits can be treated like basic annual Member wellness events. For Members of any age, all illnesses or injuries will be treated as separate health events from wellness visits.
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 crowdfunding. For more information on how to find a Vaccines for Children clinic in your area, contact your Care Advocate or visit this link.
Caring for The CrowdHealth Community
The CrowdHealth Community is committed to crowdfunding the health care Members need without wasting funds on unnecessary or unproven treatments. This means some things, which are outlined in the table below, are not eligible for crowdfunding. To consistently offer the best care and support possible to the Crowd, we may still assist you in negotiating care that is not eligible for crowdfunding.
Any disputes that arise related to a health event’s eligibility for crowdfunding will be decided by an independent third party hired to represent the Crowd. We believe you have each other’s best interest in mind, and we are grateful for the caring Crowd we’re building together.
Excluded Procedures and Treatments
Excluded Treatment / Condition Examples
Acupuncture, chiropractic treatment, complications from ineligible treatments, exercise programs, experimental/unproven treatments, some genetic screenings and testing, massage therapy, medical marijuana/CBD, nutritional/dietary treatment or supplements, physical therapy (if not ordered by a doctor as part of a valid health event), occupational therapy, speech therapy, regenerative treatments
Breast implants, hair loss treatment, weight loss programs or surgery, and any other non-medically necessary cosmetic procedure
ADD/ADHD, counseling/talk therapy (except for virtual talk therapy provided through the CrowdHealth app), 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
In the spirit of CrowdHealth, this exclusion is not here to be a loophole for denying the crowdfunding of expenses from health events that result from Members living active, normal lives. Rather, it's to keep people from being idiots and, say, lighting themselves on fire, diving into a pool of hungry sharks, etc., then expecting the Crowd to fund it.
Experimental drugs, high-cost therapeutics, injectable epinephrine, maintenance medications for chronic conditions beyond the annual preexisting condition terms, orphan drugs, and any prescriptions or vaccines purchased without the CrowdHealth discount tool
Adoption, abortion, 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 eye care
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
Previously Documented or Diagnosed Conditions
The Crowd welcomes Members with varied health backgrounds. However, there are limitations on funding health events related to conditions that have been Previously Documented or Diagnosed. This includes conditions such as 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 medical condition which was Previously Diagnosed or Documented. This is not an exhaustive list.
Those conditions that have been Previously Diagnosed or Documented within five (5) years of joining CrowdHealth are eligible for limited funding. This includes any condition that was diagnosed, symptomatic, suspected, or has required treatment. Specifically, any condition, illness, or injury that was Previously Diagnosed or Documented is not eligible for funding in years one and two of Membership, and a maximum crowdfunding limit of $25,000 per year related to these conditions applies in years three and following.
More Membership Details
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)
Since your CrowdHealth Membership is not insurance or health coverage, it does not satisfy any federal or state individual Minimum Essential Coverage (MEC) mandate under the Affordable Care Act (ACA).
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 coverage to satisfy those mandates 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:
To avoid unfairly burdening the Crowd with unnecessary bills, Members must pursue payment from any other payor sources (e.g. car insurance, MEC, etc.) for health events before submitting remaining medical expenses for crowdfunding.
Your monthly subscription fee and crowdfunding account deposit represent voluntary participation in 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.
The ability to pursue fair health care costs on your behalf as a self-pay patient is an important part of how CrowdHealth operates and cares for the Crowd. In the case that a provider bills an unfair amount and is unwilling to negotiate with us, CrowdHealth requires Members to give us the right to pursue legal action against that provider on behalf of you and the Crowd.
Access to Your Health Records
When you join CrowdHealth, you agree to give specific individuals at CrowdHealth and our partners access to your health records upon request.
In the instance of a telemedicine visit or a health event, CrowdHealth may receive information such as the following from your medical practitioner(s): patient name, date & time of appointment/call, outcome or diagnosis, prescriptions, etc.
When a need clinical review or negotiation services, and a trusted Crowd partner is assisting us, you agree to give that trusted partner access to your health records.
We reserve the right to request medical records, which are used to assist with care navigation and to protect you and the Crowd by providing important context about your medical history and helping validate your bills. Members are required to execute HIPAA authorizations to allow CrowdHealth and our partners to access this protected information. Failure to do so may delay or limit your care navigation and/or the crowdfunding of your health event.
Protecting Your Personal Information
Although not subject to the Health Insurance Portability and Accountability Act (HIPAA), CrowdHealth understands that privacy is important to our Members. As such, CrowdHealth makes every attempt to keep your information, including protected health information, secure and protected. To learn more about how we protect your information, please email firstname.lastname@example.org.
In addition, for CrowdHealth to provide support for many of our services, we may ask members to sign HIPAA authorizations allowing for the release of protected health information to CrowdHealth from certain medical providers.
If you signed up for your Membership using a promotional code, all responsibilities as outlined in this Member Guide still apply. Only one promotional code may be used per Member.
International Travel Policy
The terms of your CrowdHealth Membership also apply to urgent and emergency care outside the United States. However, please note that expenses relating to international air ambulances or medical evacuations are NOT eligible for crowdfunding.
CrowdHealth may engage trusted partners to assist with clinical review for certain health events, like surgeries and major scheduled procedures/treatments. These clinical reviews help ensure high-quality outcomes for Members at the best value to the Crowd. Clinical review services include but are not limited to: clinical and medical appropriateness reviews, evaluating a health event for eligibility under the terms of a CrowdHealth Membership, and remote second opinions (RSOs). If CrowdHealth engages our partner to review your event, you will be notified by our Care Advocacy team.
Specialized Negotiation Support
CrowdHealth may engage trusted partners to provide specialized negotiation support for certain health events. This negotiation support is performed on behalf of the Crowd to assist in negotiating fair and reasonable charges for Member health events. These pre- and post-event negotiation services help ensure that CrowdHealth Members are not over-billed for care and that the Crowd’s funds are maximized for the benefit of all Members. If CrowdHealth engages our partner to assist in negotiating your event, you will be notified by our Care Advocacy team.
Because all bills remain the responsibility of the Member, there may be a rare scenario where a paid bill is negotiated to a lower price AFTER crowdfunding, resulting in a refund to the Member. In this case, the Member must, in good faith, return any refunded money to the Crowd, to be used for crowdfunding other Member’s health events.
The deposits you make will be used to crowdfund medical bills for the Crowd.
For your expenses to be eligible for crowdfunding, you must be an active Member both at the time the expense is incurred AND at the time the expense is sent to the Community for crowdfunding.
Missed Subscription Payments
To maintain an active CrowdHealth Membership, Members must keep monthly subscription payments current. If you fail to pay your monthly subscription on time, you will be notified, and your Membership will become inactive as of the day of the failed payment. Any accounts with unpaid subscription balances after 60 days will be terminated and subject to terms of cancelation outlined below (“Canceling Your Membership”).
Canceling Your Membership
CrowdHealth Memberships is voluntary. You may cancel your Membership at any time. Cancelations are effective at the end of your current billing cycle.
If you decide to leave and want to rejoin CrowdHealth later, there is a minimum waiting period of six months (180 days) between your cancelation and the start of your new Membership.
A maximum $250 account closure fee applies to any canceled or terminated Membership. Up to $250 will be drawn from the funds available in your Member account by CrowdHealth at the time of cancelation/termination. Any remaining funds in your Member account can be returned to you after 60 days.
Please remember: For your expenses to be eligible for crowdfunding, you
must be an active Member both at the time the expense is incurred AND at the time the expense is sent to the Community for crowdfunding.