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Guidelines - IV.K Sharing Appeal

A member who disagrees with a bill-sharing eligibility decision can appeal if the member believes:

  1. REDEEM HealthShare misread the medical records.
  2. REDEEM HealthShare misapplied the Guidelines.
  3. The member’s providers incorrectly recorded their medical history.
  4. The Guidelines do not address the member’s situation

After a review of the appeal by REDEEM HealthShare, if the member still disagrees with the decision, the member has 90 days to request a review by a member Appeal Panel composed of 7 to 13 REDEEM members. As part of this process, the member may submit a written position statement to the Panel. REDEEM HealthShare will hold a teleconference wherein the panel can ask questions of both the member and REDEEM HealthShare. A simple majority vote will carry the decision whether to share. The panel’s decision will be binding and non-appealable.

A member may appeal to the Institute for Christian Conciliation as explained below when it involves membership requirement issues related to payment of shares or member integrity (with respect to the submission and payment of medical bills). For all other questions concerning membership requirements, a member may appeal to the Samaritan Ministries Board of Directors who make the final, non-appealable decision.

A member must settle any other issue in accordance with the Rules of Procedure for Christian Conciliation™ of the Institute for Christian Conciliation. (Complete text of the Rules is available at www.aorhope.org/rules or by contacting ICC at icc@aorhope.org) However, if both REDEEM HealthShare Ministry and you agree, you may submit the dispute 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 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 sharing appeal methods will be the sole remedy for any civil controversy or claim arising out of your relationship with REDEEM HealthShare and expressly waive your right to file a lawsuit in any civil court against REDEEM HealthShare Ministry, its employees, members, associate members, and directors, for such disputes, except to enforce an arbitration decision obtained under conditions specified herein. This also includes deciding whether the dispute is part of this arbitration agreement or whether it must go through arbitration. Judgment upon an arbitration decision may be entered in any court otherwise having jurisdiction.

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 participate in a court proceeding about a dispute, neither give up their right to later demand arbitration to resolve the dispute.

For all civil matters of procedure and substance regarding any dispute or claim that comes within these mediation or arbitration requirements, the laws of the State of Illinois, and if applicable of the United States, will govern.