Interacting with providers

CHM has worked with more than 100,000 healthcare providers nationwide. However, it’s important you understand that as a CHM member your healthcare will be handled by you, the patient. This means that healthcare providers should bill you directly, after which you can submit your bills to CHM. Also, you have the flexibility of choosing any healthcare provider you wish; CHM does not have a provider network. To see a list of providers that other CHM members have recommended, click here.

1. Tell your healthcare providers that you’re a self-pay patient and would like to be billed directly

Work with providers to obtain itemized medical bills. An itemized bill contains: 1) the patient’s name; 2) the date of service; 3) the place of service; 4) the procedural (CPT) codes (or description of services rendered); 5) an itemized list of charges. Your CHM membership cards should not be presented as insurance cards and will confuse providers if presented as such. However, at all times carry your CHM membership card so you have your member number on hand when calling CHM.

 

2. Ask your provider for a discount

Insurance companies regularly negotiate prices and you can, too. It’s also in the provider’s best interest to grant a generous discount because it can mean they receive faster payment. Most CHM members are successful in getting discounts. If you have trouble getting a large discount (at least 40%), the CHM Member Advocate department has patient advocates who can coach you or even negotiate with your providers on your behalf.

3. Apply for any financial assistance available to you, even if you don't think you qualify

If you’re being treated at a hospital, ask to speak to a hospital financial counselor. Discounts and financial assistance are very important in keeping your monthly CHM costs low.

 

 

4. Please don't pay upfront (unless the bill is less than $1,000.)

If you pay upfront, negotiations cease and the opportunity to obtain any further discounts is lost.

5. Ask your provider to bill you directly

The bill should be itemized and should show any discounts or financial assistance you have received (and, ideally, any payments you have made). Tell the provider that the sooner you receive the bill, the sooner it can be shared by CHM.

 

6. If necessary, set up a payment plan with your providers

Even a small monthly amount will assure most providers that the bill(s) will be paid. CHM will then reimburse your eligible expenses.

 

7. Promptly pay your provider(s) when you receive funds from CHM

Treat as reimbursement from CHM any portion of the funds you have already paid to your provider(s).

 

8. Maternity only: at your first pre-natal checkup, ask for a prepayment agreement

Sometimes called a “Stork Package” or “global fee,” these rates often include all pre-natal and delivery charges at a reduced price. As soon as you have it, submit the agreement to the CHM office and submit any additional bills as “add-ons” to the original amount. Likewise, you can ask for a prepayment agreement from your hospital (be aware that hospital agreements don’t always include room and board charges). In most cases, submitting an agreement in a timely manner allows CHM to share your maternity bills by the time the baby is born. See our maternity page for more info, including a detailed maternity guide.

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