Eligibility Requirements for Sharing When Seeing a Medical Specialist
Introduction
REDEEM® HealthShare Ministry memberships include visits to specialists. Members must adhere to these eligibility requirements for sharing.
Specialist visits are subject to the Annual Unshareable Amount and if applicable, your Co-Share.
Information
The following are eligibility criteria for seeing a specialist:
- The condition, injury, or illness must have developed after the start of your membership. If you are a new member, there are sharing limits for the first 90 days.
- You must submit all properly coded and documented bills within 12 months of the date of specialty visit service using the online submission tool. For more information, see Submit a Medical Bills.
- The services or items in the bill must be within the scope of licensing and ordered or provided by:
- Medical Doctor (M.D.)
- Doctor of Osteopathy (D.O.)
- Naturopathic Doctor (N.D.)
- Nurse Practitioner (N.P. or A.P.R.N.)
- Physician Assistant (P.A.)
- Doctor of Podiatric Medicine (D.P.M.)
- Dentist (D.D.S or D.M.D.)
- Midwife (if certified)
- Ophthalmologist
- Chiropractor
- All medical tests and treatments must take place at:
- Hospital
- Ambulatory center
- Clinic
- Doctor’s office
- Diagnostic facility
- Independent facility
- Residential setting (only for home births, hospice care, and pre-approved home health).
- Skilled nursing and Rehabilitation facility
As a member of REDEEM HealthShare, reading and understanding the Sharing Guidelines is important.