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SE IL and SW IN | I have had the privilege of doing the finances of two different catastrophic health events with Coventry Insurance. Both times, after the diagnosis, the patient was assigned a case manager, and all procedures and treatments were approved by her under the guidelines of the procedural manual. The medical team understood that they were free to proceed with a plan outlined in the Mayo Clinic protocol for that diagnosis but received approval before each procedure or treatment.
After services were rendered a bill arrived showing the total amount, the negotiated reduction by the insurance company ( 30-40%), amount paid by insurance and amount due by patient. In this instance there was no cap.
In the procedural manual mentioned above there were contingencies for every imaginable scenario including the protocol to terminate a failing treatment plan. I think the question that most here are asking is "is there a procedural manual for these health share programs, and what does it say?'
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