A member can appeal bill-sharing eligibility decisions with which they disagree if he or she believes:
• the medical records were misread, or
• the Guidelines were misapplied, or
• one or more of the member’s providers incorrectly recorded their medical history.
After a review by REDEEM™, if the member disagrees with REDEEM HealthShare's decision, the member has 90 days to request a review by a Member Appeal Panel established by REDEEM HealthShare, composed of seven to thirteen members. As part of this process, the member may submit a written position statement to the Panel. A teleconference will be held wherein the Panel can ask questions of both the member and REDEEM HealthShare. A simple majority vote will carry the decision to share or not.
Membership requirement issues related to your payment of shares or your integrity (with respect to the submission and payment of medical bills) may be appealed to the Institute for Christian Conciliation as explained below. All other questions regarding whether you meet membership requirements may be appealed to the Board of Directors who make the final, non-appealable decision.
Any other issue shall be settled in accordance with the Rules of Procedure for Christian Conciliation™ of the Institute for Christian Conciliation. (Complete text of the Rules is available at ICCpeace.com or by contacting ICC Peace at info@iccpeace.com). However, if both REDEEM HealthShare and you agree, the dispute may be submitted to a randomly selected panel of members instead. In all events, you will have available the same relief as a court could grant. REDEEM HealthShare will pay all of the arbitrator’s fees and costs unless the arbitration determines there was no reasonable basis for your complaint, in which case you will be responsible for the fees and costs.
You understand that these methods shall be the sole remedy for any civil controversy or claim arising out of your relationship with SMI and expressly waive your right to file a lawsuit in any civil court against REDEEM HealthShare, its employees, members, associate members, and directors, for such disputes, except to enforce an arbitration decision obtained under Sections XII.A or XII.B. This also includes any determinations as to whether the matter in dispute comes within this arbitration agreement or can be required to be arbitrated. If an arbitration decision has been made and anyone is failing to follow that decision, then in order to enforce the arbitration award under either Sections XII.A or XII.B, the decision may be entered only in the Circuit Court of Peoria County, Illinois.
Resolving disputes within the Body of Christ is always the command of Scripture and in the interest of all our members (MATT 18:15-20; 1 COR 6). Therefore, even if REDEEM HealthShare or a member participates to some extent in a court proceeding regarding a matter in dispute, this participation will not be forfeiting the ability to later demand that the dispute be resolved by these arbitration procedures.
For all civil matters of procedure and substance regarding any dispute or claim that comes within these mediation/arbitration requirements, the laws of the State of Texas, and if applicable of the United States, shall govern.