Member Guide

LAST UPDATED: 5/1/24

View the summary of recent changes here.

Everyone Hates Member Guides

We know, we know. Member handbooks, user guidelines, terms and conditions. They’re the worst. Well, not the worst. Health insurance is the real worst. But guidelines and fine print can be exhausting to navigate, too. So, we’re starting here with making your CrowdHealth Member experience refreshingly simplified and different, in a good way.

Here, you'll find what you need to know about being a Member of CrowdHealth.

What is CrowdHealth?

Finding and funding the healthcare you need shouldn’t feel isolating or overwhelming. so together with our Members, CrowdHealth is changing your healthcare experience.

Your CrowdHealth Membership provides you a platform, Community, and toolkit to help you find and fund your healthcare outside the insurance system, with personalized support along the way.

As a CrowdHealth Member, you participate in the healthcare system as a self-pay patient, cutting out the health insurance middleman. While you maintain the ultimate responsibility for paying your own medical bills, you can expect to pay for the smaller expenses on your own and to submit your larger medical expenses to the Crowd for funding. In turn, you’ll be invited to help crowdfund other Members’ larger medical expenses, too.

At CrowdHealth, Members have access to lower medical costs through the power of consumerism and self-pay while avoiding outrageous health insurance premiums, deductibles, and out-of-pocket maximums. With CrowdHealth, you can save thousands of dollars every year while experiencing real healthcare freedom.

CrowdHealth is a Caring Community

At CrowdHealth, you’re not alone.

CrowdHealth is building a Crowd of people like you – savvy, generous, and responsible -- to support one another in accessing and paying for healthcare.

Your Care Advocate provides caring, personalized support throughout your healthcare journey, like finding fairly priced, high-quality care options while guiding you through the administration and logistics of the healthcare system.

CrowdHealth is Access to Care

CrowdHealth helps you access the care you need, when you need it.

CrowdHealth offers access to a robust virtual care platform, available 24/7 through the app.

We can help you find quality, cash-pay friendly care in your area, or if you’ve already got a favorite doc, that’s great too! There are no doctor networks to limit you here, just a request that all Members shop smart for their care.

And, your Membership gets you access to discounted prescription pricing, all at your fingertips through the CrowdHealth mobile app.  

CrowdHealth is Crowdfunding

Each month, Members pay a Membership Fee to be part of the Crowd and commit to helping crowdfund their fellow Members’ bills when asked. As health expenses from Members arise, CrowdHealth communicates these needs among the Crowd. Then, CrowdHealth facilitates the crowdfunding of expenses by inviting Members to voluntarily give to help fund the medical bills of other Members.

Who is the Crowd?

The power of CrowdHealth is our vibrant, health-conscious and generous group of Members, a.k.a. “The Crowd.” Together, we’re achieving something bigger, better, and altogether different than if we tackled the complexity and unaffordability of healthcare costs alone.

Our Members are savvy and generous, like-minded and health aware, responsible and accountable. If that’s you, you’re really going to like it here!

(On the flip side, if you’re looking for a way to “work the system” and mooch off others without being generous yourself…  keep looking. You’ll be out of place in the Crowd.)

The Crowd comprises Members from babies through age 64 who provide biometric values and health history information upon joining. The Crowd welcomes Members with varied health histories while giving transparent, specific terms for how care for previously documented, diagnosed, or symptomatic conditions are funded. All these details are in place so Members can be confident about who and what your dollars are funding.

Savvy and Generous

You’ve probably joined the Crowd because you’ve been failed by the legacy health insurance system and are tired of paying too much for your healthcare.  As a savvy Member, you’re looking for the best service at a great price and are too smart to be fooled by healthcare players who don’t have your best interest in mind.

Through your generosity, you keep up with your monthly commitment to help fund healthcare for the Crowd. When you need help with your bills, your fellow generous Members will help fund your care, too.

CrowdHealth uses Generosity Scores and Health Cost Ratings to operate in a transparent way. Your Generosity Score reflects your crowdfunding activity, while your Health Cost Ratings show how reasonable the prices are for the care you receive. To learn more about how these features help you and the Crowd find and fund your healthcare in a different way, see “How CrowdHealth Works” below.

Like-Minded and Health Aware

CrowdHealth Members have like minds in seeking something trustworthy, simplified, and freeing -- a new solution that is changing the game and is bigger than fighting for healthcare freedom on your own.

And, by being health aware, you know that staying engaged with your own health helps not just you but the Crowd as a whole, too. Males over 260 lbs and females over 220 lbs are not able to participate in CrowdHealth.

Responsible and Accountable

CrowdHealth Members are responsible and accountable to each other, which lets us care abundantly for each other. That’s good news for all of us.

To help the entire Crowd thrive, you and your fellow Members can count on one another to:

• Ensure that your Membership Fee is paid in a timely and consistent manner.
• Participate when asked to crowdfund fellow Members’ bills.
• Trust that you can get the best care without paying the highest price, and be willing to choose high-quality clinicians near you who charge reasonable and fair prices.
• Only submit legitimate, medically necessary bills for crowdfunding within 6 months of the date of service barring extenuating circumstances.
• Care about your own health and that of the people around you, proactively engaging with your health and spending wisely on your own healthcare.
• Trust the Crowd to help fund your health expenses while understanding that ultimately, each Member is responsible for your own medical bills.

We’re so glad you’ve joined us. The Crowd is better with you in it!

CrowdHealth’s Guiding Principles

CrowdHealth is founded and run by people who think and feel like you. healthcare can feel complex, expensive, and lonely, so we’ve reimagined a different solution with you in mind, embracing the guiding principles of Simplicity, Affordability, Community, and Quality.

Simplicity: No More Health Plan Confusion

The fine print of insurance plans – in-network vs. out-of-network coverage, deductibles, copayments, and out-of-pocket maximums – is confusing and frustrating. That’s why CrowdHealth is committed to Simplicity in each experience, for every Member, with:

Three Simple Steps.

1. Let CrowdHealth know about a new health event and/or upcoming medical visit, and let us help you navigate care before scheduled or expensive procedures.
2. Fund the first $500, a.k.a. your Member Commitment, of each health event yourself.
3. Upload medical bills and receipts through the app, and let CrowdHealth submit your eligible expenses over $500 per event to the Crowd for funding.

Technology that Works for You.

When you start your healthcare journeys through the CrowdHealth app, you get the most from your Membership – the best value, the simplest payment process, and the support of a Care Advocate, who’s here to walk with you from scheduling to bill payment and everything in between.

Quick, Simple Funding.

Through CrowdHealth’s smooth digital process, crowdfunding by the Member Community happens fast, making things easier both for Members and for the clinicians who provide your care.

We strive to send eligible crowdfunding requests to the Crowd as soon as reasonably possible. Members have two days to approve or deny each request. CrowdHealth will promptly transfer approved funding requests to the receiving Member’s crowdfunding account.

Affordability: Helping the Crowd Save Money

Healthcare can be incredibly expensive. Here, the Crowd is built on a commitment to Affordability and the belief that the best care doesn’t have to be the priciest. That means:

You Use the Power of Consumerism.

Members participate in the healthcare system as self-pay patients. This lets you access high-quality care for less than the insurance sticker price. Our Members regularly benefit from self-pay discounts ranging from 25% to 85% off normal billed charges.

We Use the Power of Negotiation.

We leverage relationships with providers to offer pre-negotiated and bundled pricing options for your scheduled care. And, when you face an unexpected health event and a big bill comes with it, CrowdHealth and our partners can step in on behalf of you and the Crowd to negotiate it down to a fair price.

Community: Transforming healthcare, Together

CrowdHealth is built by people who care, for people who care. As a Member, you and the Crowd are:

Building the Future.

You want to be part of a new solution that gives you and your family a totally different experience, not a marginally better option than the health insurance you had before. With you and the Crowd, we’re building a better future and transforming healthcare as we grow.

Power in Numbers.

The problems of the American healthcare system – unfair pricing, hidden billing practices, mismatched incentives between patients and insurers – are too big for any of us to take on alone. But with CrowdHealth, you’re joining forces with Members and a team who are taking on the broken system with you.

Not Alone.

Navigating your health shouldn’t leave you feeling like you don’t know who you can trust. With the Crowd, your health journeys happen within a transparent, trustworthy Community you can count on.

Quality: Only the Best for You

Support isn’t a buzzword here, and you deserve the best. With personalized care navigation provided by a team of Member Care Advocates, we mean it when we say you’ll have a high-quality Member experience you love, through:

No Doctor Networks (Seriously)!

CrowdHealth does not limit your access to care through stifling doctor networks. You can keep seeing your favorite doc, or talk to a Care Advocate if you need help finding a new high-quality provider.

In the best interest of the Crowd, Members allow CrowdHealth to navigate planned procedures, whenever possible, to high-quality, cash-pay friendly docs, which saves money for you and your fellow Members. Read more about this in How CrowdHealth Works, below.

Healthcare Freedom.

At CrowdHealth, you’re free to get the care you need when you need it, without feeling locked into a burdensome insurance plan.

Technology that’s Always Improving.

We’re building the best app and resources to make your life easier, and it just keeps getting better.

How CrowdHealth Works

No, It’s Not Health Insurance – and Why That’s a Good Thing

One of the biggest questions we get is, “How is CrowdHealth so much cheaper than other health insurance?” And the answer is simple: CrowdHealth isn’t health insurance. It’s a platform, community, and toolkit to help you find and fund your healthcare outside the insurance system, including a healthcare crowdfunding platform for your big bills. This means your Membership is designed and funded differently than health insurance, and that CrowdHealth has different priorities (like putting you, our Member, first!).

We have developed systems and processes that allow the Community to fund medical expenses; however, your Membership is not insurance, and therefore CrowdHealth cannot guarantee that your medical bills will be funded. Ultimately, Members are responsible for their own medical bills.

What Members Pay

Membership Fee Payments and Monthly Crowdfunding Requests

Compared to painfully expensive insurance premiums, CrowdHealth Members pay a low Monthly Membership Fee to be part of the Crowd and commit to helping fund other Members’ medical bills each month. Membership Fee amounts are the same for everyone, and monthly crowdfunding maximums are different based upon anticipated healthcare needs of certain age groups. Here’s how it breaks down:

*Members can opt out of membership fees but will lose access to Care Advocacy, Negotiations, the CrowdHealth App (including virtual urgent care, virtual primary care, and virtual talk therapy). Members opting out of membership fees are required to mail in their bills for crowdfunding, which are subject to a 20% administrative fee. Please contact hey@joincrowdhealth.com if you would like this option.

More About Crowdfunding

The maximum monthly crowdfunding amounts listed above are not fixed and can be adjusted based on the actual spending of you and the Crowd. If you and the Crowd spend less in a given month, your total monthly crowdfunding request may be lower. Making healthy and smart spending choices benefits both you and the whole Crowd together.

At the beginning of every month we will provide an estimate of how much each member will be asked to contribute in that month. However, members might be asked to give slightly more or slightly less than the estimate, given the timing and dollar amount of the bills submitted for crowdfunding. Not all members will give the same amount each month but the variation will be small. 

When you or someone in your family turns 55, the maximum crowdfunding amount will increase to $270 on the first billing date following the birthday.

If you’re 64 years old, we’ll be in touch with you before your next birthday about transitioning out of CrowdHealth. Your Membership ends when you turn 65.

Transparency in Crowdfunding

Your Monthly Membership Fee must be paid to be a Member, but choosing to help other Members pay their medical bills is voluntary. To help you understand who and what you’re being asked to fund, each Member receives a Generosity Score, and each crowdfunding expense receives a Health Cost Score. These factors determine whether a crowdfunding request is rated GREEN or RED.

Member Generosity Scoring

Member Generosity Scores are calculated based on the amount a Member has given in crowdfunding, compared to the total amount they have been asked to give.

If you agree to fund 100% of the fair-priced crowdfunding requests you receive, you will maintain a 100% Generosity Score. If you choose not to participate in funding other Members’ fair-priced bills, your Generosity Score will be affected by the proportion of what was requested of you versus what you gave. If you cancel your CrowdHealth Membership and decide to rejoin later, your previous Generosity Score will carry over to your new Membership.

A Generosity Score of less than 90% will lead to a RED rating of your crowdfunding request.

Health Cost Scoring

CrowdHealth’s pre-negotiation and navigation services help Members access quality care and ensure that crowdfunding requests reflect reasonable cash-pay pricing. If you need a surgery or other scheduled procedure, treatment, or diagnostic (including labs and imaging) we can compare estimates from other providers and offer competitive rates for high quality care.

If you pick a provider that charges more than 120% of the fair market price for the treatment or procedure, the expenses will receive a poor Health Cost Score and lead to a RED rating of your crowdfunding request.

Please note that Health Cost Scoring applies not just to large/expensive planned procedures, but also to smaller expenses like labs and imaging. Please contact your Care Advocate before having any scheduled diagnostic, lab, imaging, or other planned test done, and we will gladly connect you with a discount voucher for the same service in your area. Failure to notify CrowdHealth before costs over 120% of our discount options are incurred will result in a RED rating of these bills.

Staying GREEN

The following factors contribute to a GREEN crowdfunding request rating:

• The requesting Member has Generosity Score of 90% or above;
• Health costs for the request are within 120% of fair market rates, considering factors like:

1. Previously crowdfunded procedures in the Member’s regional market within the last year,
2. Third-party partner securing a single-case agreement (SCA), cash-pay bundle, or discount voucher,
3. No alternatives within 50 miles of home ZIP code for procedures under $25,000,
4. No alternatives within 1000 miles of home ZIP code for procedures equal to or more than $25,000,
5. Medically urgent, critically time-sensitive, or emergency event, or
6. Extenuating circumstances.

• In the case of travel to a provider navigated by CrowdHealth, all travel expenses including airfare, rental car/mileage, hotel, and food are eligible to be submitted to the Crowd.

If you are a generous Member, and your healthcare costs are in line with fair-market rates, your crowdfunding requests will be rated GREEN, which tells your fellow Crowd Members they can have peace of mind in funding your request.

Avoiding RED

Reasons an expense may receive a RED score include:

• The requesting Member has Generosity Score below 90%;
• Price is more than 120% of fair market rates, when compared to other options identified by CrowdHealth;
• Choosing a non-medically necessary option for care, without demonstrably better patient outcomes in comparison to other options for treatment, as determined by a third-party clinical review;
• Failure to take advantage of negotiated discount, e.g. due to Member negligence or unresponsiveness;
• Paying inflated prices for care through an insurance plan or toward a deductible; or
• Failing to cooperate with CrowdHealth in the negotiation of medical bills or failing to comply with negotiated payment terms.

If you are not generous to other Members in need, OR your healthcare costs are out of line with fair-market rates, your crowdfunding requests may be rated RED, which may cause fellow Crowd Members to hesitate in funding your request.

Members will not be penalized for denying crowdfunding requests rated RED.

Crowdfunding Request Settings

Most Members choose to help with every GREEN crowdfunding request, which makes things easy and keeps your Member Generosity Score at 100%.

The default settings for crowdfunding are to automatically approve GREEN requests and to automatically deny RED requests. You may change this setting during your sign-up, or contact our Help Desk to change your settings at any time.

If you choose to manually review crowdfunding requests, when you receive a crowdfunding request, you may approve or decline by responding directly to the request. Members have two days to respond to a request. After two days, green requests are automatically approved and red requests are automatically denied.

When you approve a crowdfunding request, your payment method on file will be charged for the approved amount.

Family Memberships

Family Memberships are available for families with four or more Members. To be eligible for a Family Membership, you must meet at least one of these conditions:

• A parent, under age 65, with three or more children, by legal and/or blood relation, who are under age 26;
• Two parents domiciled together, under age 65, with two or more children, by legal and/or blood relation, who are under age 26;
• A group of four or more siblings, by legal and/or blood relation, who are under age 26.

Member Commitments Instead of Deductibles

The Crowd exists without the burden of an annual health insurance deductible.

Insurance deductibles can mean you pay $3,000, $5,000, or even $10,000+ in health expenses for your family, on top of those high monthly premiums, before your coverage kicks in at all.  After your deductible is met for the year, you may continue to pay a percentage of the costs up to an out-of-pocket maximum that’s much higher than your deductible. Ouch!

CrowdHealth is different. Your Membership means you commit to your fellow Crowd Members that you’ll pay your $500 Member Commitment for each valid health event, and we’ll ask the Crowd to fund the rest of the eligible expenses. There is no maximum limit to the amount of bills you can submit for crowdfunding as a CrowdHealth Member.

What Do You Mean by “Health Event”?  

A health event is any unique health scenario that comes up for a Member and includes all the expenses related to it. It could be something big, like a knee surgery (which might entail doctor’s visits; the surgery itself including physician’s fees, facility, and anesthesia; physical therapy; and pain meds) or something minor, like one of your kids needing to see the pediatrician for a sore throat.

With each valid health event, Members pay the first $500 as your Member Commitment. For many health events, your bill(s) will total much less than $500 – for example, a standard doctor’s visit and prescription are likely to cost you less than $200 for an event. But, for larger events, like the knee surgery example above, you’ll pay the initial $500, and all valid expenses over your Member Commitment will be submitted to the Crowd for funding.

For health events lasting longer than twelve months (starting with the original date of service for the visits and bills in the event), the $500 initial Member Commitment will reset in the thirteenth month.

Our Commitment to Revenue Transparency

Some of the main factors in rising healthcare costs are the mismatched incentives built into the system’s financial structure: health insurance companies profit off a percentage of customer premiums, so they can make more money by hiking up prices.

CrowdHealth is different. We have intentionally established our revenue to align with our incentives 100% with the goals of the Crowd, and we’re committed to being transparent about it.

CrowdHealth receives revenue from Members’ Monthly Membership Fees. Since CrowdHealth doesn’t make money as a percentage of crowdfunding, we have no interest in denying the crowdfunding of Members’ bills to increase our profits. We are here to help you and the Crowd save, always.

Using Your Membership

Membership Basics

Membership Accounts and Crowdfunding Bank Accounts

CrowdHealth Primary Members will have both a Membership Account and a Crowdfunding Bank Account in order to be an active Member of CrowdHealth. Your Membership Account involves the information you enter during the online signup process. Your Crowdfunding Bank Account is an FDIC insured bank account that enables the sending and receiving of crowdfunded monies between Member crowdfunding accounts and for the payment of healthcare services. 

Getting Oriented

Because CrowdHealth is different, we want to make sure Members understand the tools that help you navigate your healthcare without insurance. To help you get the most out of your Membership, CrowdHealth requires the Primary Member to complete a short New Member Orientation video and quiz.

Notifying Us of Your Events

For your healthcare to be eligible for funding by the Crowd after your $500 Member Commitment is met, except for unscheduled urgent or emergency care, you must initiate your health events through the CrowdHealth mobile app or Member Portal. You do so by creating a health event that reflects the Member involved and the type of event, or by contacting a Care Advocate via email or using the CrowdHealth Mobile App. A Care Advocate will assist you and gather additional information to help you through your health event.

Members should initiate all planned care through the platform, regardless of whether it is expected to exceed the $500 Member Commitment. That way, your bill payment process is kept simple, and your Care Advocate can support you along the way, Even if you need care that isn’t eligible for crowdfunding (more on that here), we can still help navigate you to fair prices and high-quality care.

If multiple Members of your family are involved in the same health event, like both kids getting the flu the same week (hang in there!), you’ll need to log separate visits to open separate health events for each person, and each person’s care will be subject to a separate $500 Member Commitment.

Choosing Your Doctor

CrowdHealth does not participate in a provider network. You can see your existing doctors, or let your Care Advocate know if you need help finding a new one.

For your healthcare to be eligible for crowdfunding, it must be performed by a licensed or board-certified practitioner. 

To uphold the integrity of the crowdfunding process on behalf of the Crowd, Members should not knowingly or repeatedly visit a medical practitioner who is unreasonable or unfair in their billing rates and practices.

Submitting Your Bills & Receipts

When you receive a bill, scan it into the CrowdHealth app and attach it to your health event. If your bill needs to be negotiated, we’ll coordinate with our partners to help you get the best discounts.

Once your bill has been paid, attach the corresponding receipt or proof of payment in the app, and we will review and submit approved bills for crowdfunding quickly and easily.

Handling Big Bills

The CrowdHealth platform is designed to maximize the probability that all Members’ eligible bills can be fully crowdfunded.

For big, planned expenses (like surgeries), CrowdHealth can pre-negotiate the cost to a 30-80% discount before the procedure even happens. Always contact your Care Advocate before a scheduled surgery to allow time for this negotiation.

For emergency expenses, CrowdHealth provides specialized post-negotiation support to work down balances before they are paid, sometimes up to 95% off. Contact the Member Care Team before you pay a big bill for emergency care, so we can help.

Online Platform and Mobile App Access

As soon as you sign up for your CrowdHealth Membership, you can download and log into the CrowdHealth mobile app and will be able to access your Member Portal through the website. Because our app and portal contain information and tools that are reserved for active and oriented Members, you will not be able to utilize the full app functionality until your Membership start date. Please note that without access to our app via a smart device, you will not be able to utilize certain features of your CrowdHealth Membership.

If you have any questions or issues with logging in or accessing the Member Portal or the CrowdHealth mobile app, please email us hey@joincrowdhealth.com.

Self-Pay Patient Status

CrowdHealth isn’t insurance, so you do not have an ID card, Member number, or benefits group to submit on patient intake or other insurance-type forms.  At any medical visit, you’ll just indicate that you are an uninsured, or "self-pay," patient.

Health Event Specifics

Virtual Care

Because the Crowd cares about your well-being and wants to encourage access to high-quality healthcare when you need it, virtual visits – including services like virtual urgent care, virtual primary care (VPC), and virtual talk therapy (including teen talk therapy) -- through the CrowdHealth platform are part of your Membership. For virtual primary care and virtual urgent care, payment is required at the time of service and these visits are fully fundable once you submit your receipt. For virtual talk therapy, there is no upfront payment required. CrowdHealth will automatically generate a crowdfunding request for your virtual talk therapy visits.

Annual Wellness

CrowdHealth Members can submit up to $300 for ONE basic wellness event per year to be crowdfunded. This wellness event can be utilized for any one of the following, performed by a licensed or board-certified practitioner:

• primary care wellness exam/physical, including naturopathy from a qualified practitioner;
• pediatric well-child visits;
• direct primary care (DPC) membership fee;
• annual female gynecological exam and labs;
• dental exam, including cleaning and X-rays; or
• vision exam and corrective lenses.

The Crowd waives the $500 Member Commitment for one annual wellness event per Member (ages three and over). Annual wellness spending beyond this $300 crowdfunding threshold will be funded by the Member. 

Please note that if after a basic wellness event, your doctor orders specialized diagnostics, imaging, additional lab work, or other follow-up care related to a new concern or acute condition identified at your wellness visit, that will initiate a new, separate health event and will be subject to the $500 Member Commitment.

Certain other preventive care, e.g. colonoscopies and mammograms, are valid health events and are separate from the basic wellness event described above. Expenses related to these wellness events can be navigated by your Care Advocate and submitted for crowdfunding when the $500 Member Commitment has been met. Beyond these specific diagnostics and the single annual wellness visit benefit, all other preventative care is the full responsibility of the Member and is not eligible for crowdfunding. Talk to your Care Advocate about how to make the most of your annual wellness benefit.

Your wellness visit must be completed by December 31 to apply for that calendar year.

Given the frequency of recommended well checks for our littlest Members, health events for Newborn and Children’s Wellness are treated differently up to three years of age. See “Caring For Your Family” below.

Scheduled (Non-Emergency) Care

For all non-emergency care, you'll log your visits through the mobile app or Member portal before you go, which lets your Care Advocate give you personalized care and support throughout the process.

For minor appointments, notify your doctor that you are a self-pay patient and pay the doctor at the time of your visit.

If your doctor requests labs, imaging, or other follow-up care, please get the orders from your doctor at your appointment and send them to your Care Advocate, who can help you navigate the next steps with high-quality care and fair pricing.

For major non-emergency care, such as a scheduled surgery, please contact a Care Advocate in advance. To validate potentially expensive and/or complex health events on behalf of the Crowd, CrowdHealth may engage a trusted third party to provide clinical review and/or pre-negotiation services for procedures and treatments. A failure to notify CrowdHealth before your scheduled health event, which prevents CrowdHealth from performing appropriate due diligence and fair price comparison, may impact your Health Cost Score or eligibility for funding.

Emergency & Urgent Care

For all unplanned urgent or emergency care, inform your Care Advocate as soon as possible about the health event, so we can guide you through your health journey and offer you the best Member support possible.

When receiving urgent or emergency care, state that you are a self-pay patient and ask to be billed after your care. CrowdHealth can facilitate negotiation on your behalf for emergency room bills before you pay them. 

Prescriptions

For your prescriptions to be eligible for crowdfunding, you must use your prescription discount when purchasing. You will show your RX discount card (accessible through your Member profile in the app) at the pharmacy to get the best price, pay at checkout, and submit the prescription receipt through the app for crowdfunding.
Prescription drug costs eligible for crowdfunding are generally limited to a 120-day supply per valid health event.

Children’s Immunizations

For all children’s immunizations, you must use a Vaccines For Children (VFC) provider for any related expenses to be eligible for funding as part of the valid health event. Learn more under “Caring for Your Family,” below.

How It All Comes Together

To help you get a clearer idea of the Member experience, below is an example to walk you through the process.

A family of four (two parents in their thirties, a toddler, and an elementary schooler) pays $50 per person each month to be part of the Crowd. This month, their crowdfunding requests totaled $322, meaning they’re spending $522 to be part of the Crowd and saving over $900 compared to the $1500 in health insurance premiums they were paying before (in addition to satisfying large deductibles before their coverage kicked in, plus ongoing copays and expensive coinsurance—yuck!).

Here’s what navigating a health event looks like for these Members:

The family ventures out for a hike one Saturday morning, and Dad takes a bad fall and hurts his knee. He’s in a good bit of pain, but it’s not an emergency, and it’s the weekend. Conveniently, he opens the CrowdHealth app, logs a new health event, and requests a virtual urgent care appointment. The virtual doctor is available fast and, between a video evaluation and listening to Dad describe his symptoms, diagnoses a sprain.

The doctor writes a prescription for pain medication, so Dad goes to his neighborhood pharmacy and uses the CrowdHealth prescription discount tool to get a great price. He shows his digital RX card and pays for the prescription at checkout. The virtual doc also recommends a follow-up appointment in person, so Dad contacts a Crowdhealthcare Advocate, who helps him find a high-quality, fairly priced orthopedist in his area. When Dad arrives at his appointment, he lets them know he's a self-pay patient and pays for his visit at checkout.

Dad’s knee is starting to feel better as the swelling goes down, but the orthopedist says he’ll need a few sessions of physical therapy to be back to 100%. Dad gets a referral from his doctor for a highly-regarded PT and calls the office to ask for a cash pay estimate before he schedules. He sends the pricing to the Care Advocate, who confirms it’s a reasonable price for his care, then schedules the appointments he needs.

Four weeks later, he’s done with PT, and his knee is feeling great. He has scanned in the receipts for his prescription, orthopedist visits, and physical therapy sessions in the CrowdHealth app. His bills totaled $725 for the health event, so $225 (the event-related expenses beyond his initial $500 Member Commitment) is submitted for crowdfunding. Through the easy-to-use CrowdHealth platform, with support from the Care Advocate, and thanks to the generous Member Community, Dad got the quality care he needed right when he needed it.

Caring Abundantly

When you join the Crowd, you’re there for your fellow Members in their time of need. And, when you help crowdfund other Members’ expenses each month, you’re supporting the very people who will step up for you when you have your own health events. We call it caring abundantly, and we believe it’s a beautiful thing. When we each give a little, we find there’s plenty for all.

Caring for You

As a Member of CrowdHealth, you have access to the tools and support you need to lead the healthy, thriving lifestyle you desire.

We want to see the Crowd flourishing, meaning you receive the care you need without fear of how you’ll pay for it. CrowdHealth takes the guesswork out of how healthcare gets funded, and our exceptional Care Advocates are here to help you every step of the way.

Caring for Your Family

Maternity and Newborn Care

Member maternity care that is eligible for crowdfunding includes your whole pregnancy through your baby’s birth and beyond. All three phases of pregnancy care (prenatal, labor and delivery, and postpartum) are represented in a single Global Pregnancy health event with a $3000 Member Commitment. 

Your child’s standard newborn wellness care (birth until six months old) is a separate health event from maternity and is an eligible health event for the baby when added as a new Member after birth. If your baby gets sick or has complications at birth, the illness or injury will be treated as a separate health event from this newborn wellness health event.

Please note that maternity expenses for a pregnancy with an expected delivery date less than 300 days after the mother’s Membership start date are not eligible for crowdfunding, and the baby cannot join the Crowd until six months of age. Pregnancies that are in question regarding this timeline may require a third-party clinical review before they are eligible for funding. 

Adding Children by Birth

For pregnancies that are eligible for crowdfunding, a new baby may be added to your Membership within 30 days of joining your family for his/her health events to be eligible for funding retroactively, starting at the date of birth.

For pregnancies that are not eligible for crowdfunding, a baby may be added to your Membership at six months of age, effective at the start of the next billing cycle.

Please see “Maternity and Newborn Care” above for more on these health events.

Adding Children by Adoption

You may add an adopted child to your Membership within 30 days of joining your family for health expenses to be eligible for funding retroactively, starting at the child’s birth date or the start of your next billing cycle.

Adding Additional Family Members

The addition of family members (e.g. children over six months old, spouse, etc.) to a primary Member's account may be initiated at any time. These added Memberships will be active at the start of the next billing cycle.

Children’s Wellness Visits and Vaccinations

For children conceived and born or added to a family by adoption after one or both parents join CrowdHealth, standard newborn wellness care (birth until six months old) is treated as one health event with one $500 initial Member Commitment. Existing children in a CrowdHealth Member family are eligible for Membership after they turn six months old.

For children ages six months until three years, your child’s wellness checks are treated as a single health event with one $500 Member Commitment. Starting at age three, your child’s annual visits will be treated like basic annual Member wellness events. For Members of any age, all illnesses or injuries will be treated as separate health events from wellness visits.

Please note that you must utilize the Vaccines For Children (VFC) program or a similar community clinic/vaccine discount program in order for any expenses related to your child’s vaccinations to be eligible for crowdfunding. For more information on how to find a Vaccines for Children clinic in your area, contact a Care Advocate or visit this link.

Caring for The CrowdHealth Community

The CrowdHealth Community is committed to crowdfunding the healthcare Members need without wasting funds on unnecessary or unproven treatments. This means some things, which are outlined in the table below, are not eligible for crowdfunding. To consistently offer the best care and support possible to the Crowd, we may still assist you in negotiating care that is not eligible for crowdfunding.  

Any disputes that arise related to a health event’s eligibility for crowdfunding will be decided by an independent third party hired to represent the Crowd. If necessary, a three person panel comprised of CrowdHealth Members will reassess the decision and determine if the Member Guide is being applied accurately. We believe you have each other’s best interests in mind, and we are grateful for the caring Crowd we’re building together.

Excluded Procedures and Treatments

Alternative therapies

Alternative therapies: Acupuncture, maintenance chiropractic care, exercise programs, experimental and/or unproven  treatments or diagnostics (e.g. GI mapping, thermography, colonics), some genetic screenings and testing, massage therapy, medical marijuana/CBD, nutritional/dietary treatment or supplements, physical therapy and occupational therapy (if not ordered by a doctor as part of a valid health event), speech therapy, regenerative treatments, or complications from ineligible treatments.

Chiropractic care when being used to treat musculoskeletal injuries is eligible. Care from a chiropractor for medical issues outside of musculoskeletal injuries might require a Clinical Review to determine eligibility.
‍
​​Holistic and naturopathic treatments must be performed by a licensed and/or board-certified medical practitioner whose credentials are recognized in the state of service. Prepayments for multi-visit memberships and other treatment plans are not eligible for crowdfunding. Members should seek only the treatment necessary to treat their conditions and should submit each individual bill and payment after the time of service in order for it to be reviewed for crowdfunding.

Cosmetic procedures

Breast implants, hair loss treatment, weight loss programs, surgery, or other treatments (including prescriptions, etc.), and any other non-medically necessary cosmetic procedure, or complications from ineligible treatments

Mental health

ADD/ADHD, counseling/talk therapy (except for virtual talk therapy provided through the CrowdHealth app), diagnostic neuropsychological testing, psychiatric treatment, rehabilitation facilities and expenses (e.g. addiction, eating disorders), or complications from ineligible treatments

Personally assumed risk

Injuries or conditions indirectly or directly attributable to gross negligent acts, hazardous activities, under the influence of drugs or alcohol, or illegal acts; injury resulting from failure to comply with medical advice, injury from war/armed conflict, or self-inflicted injury, or complications from ineligible treatments.

Hazardous activities include hazardous sporting activities (including, but not limited to, motorcycle racing, off-road vehicle competitions, hang gliding, parasailing, skydiving, drag racing, motocross racing, road racing, sporting stunts, and mixed martial arts [MMA]); lighting self on fire, swimming during a lightning storm, swimming with sharks, trying to break a world record by holding breath underwater, training aggressive predators (e.g. tigers, lions), prostitution, walking home in the dark on a freeway, and using recreational drugs.

An independent third party hired to represent the Crowd has the full discretionary authority to determine if an activity is considered hazardous.
‍In the spirit of CrowdHealth, this exclusion is not here to be a loophole for denying the crowdfunding of expenses from health events that result from Members living active, normal lives. Rather, it's to keep people from being idiots and, say, lighting themselves on fire, diving into a pool of hungry sharks, etc., then expecting the Crowd to fund it.

Prescriptions

Experimental drugs, high-cost therapeutics, injectable epinephrine, orphan drugs, weight loss drugs, and any prescriptions or vaccines purchased without the CrowdHealth discount tool, or complications from ineligible treatments

Reproductive Health

Adoption, abortion, contraceptives, fertility/infertility treatment, impotence treatment, pregnancy conceived before Membership was active (incl. prenatal, labor/delivery, and postpartum maternal care, congenital/hereditary conditions for baby, first six months of infant healthcare, or treatment for complications [e.g. ectopic or miscarriage]), gender reassignment procedures and treatments, surgical sterilization, or complications from ineligible treatments

Vision and Dental

Dental care; including, but not limited to care received from a dentist, dental hygienist, dental assistant, etc, (except as a qualifying annual wellness event), non-ophthalmologic eye care, including but not limited to care received from an optometrist, optometry assistant, etc, (except as a qualifying annual wellness event), or complications from ineligible treatments.

Other

Custodial (nurse or similar) care when not treating illness or injury, euthanasia, food or infant formula, healthcare charges incurred before you were a Member, international air ambulances/medical evacuations, late fees or billing irregularities due to patient negligence, over the counter medicines and personal comfort devices, subacute care or skilled nursing care, and any other non-medically necessary service or treatment or complications from ineligible treatments

Previously Documented, Diagnosed, or Symptomatic Conditions

The Crowd welcomes Members with varied health backgrounds. However, there are limitations on funding health events related to conditions that have been Previously Documented, Diagnosed, or Symptomatic.  This includes conditions such as asthma, congenital conditions (except for children who become CrowdHealth Members at birth), diabetes, genetic disorders, heart conditions, sleep apnea, and any other medical condition which was Previously Diagnosed, Documented, or Symptomatic.  This is not an exhaustive list.

Those conditions that have been Previously Documented, Diagnosed, or Symptomatic within five (5) years of joining CrowdHealth are eligible for limited funding starting in the third year of Membership. This includes any condition that was diagnosed, symptomatic, suspected, or has required treatment. Specifically, any condition, illness, or injury that was Previously Documented, Diagnosed, or Symptomatic is not eligible for funding in years one and two of Membership, and a maximum crowdfunding limit of $25,000 per year related to these conditions applies in years three and following.

High cholesterol and high blood pressure are not subject to these Previously Documented, Diagnosed, or Symptomatic Condition limitations.

More Membership Details

Since we’re doing something different here, there are a few more things we want to make sure you know about your CrowdHealth Membership.

Minimum Essential Coverage (MEC)

Since your CrowdHealth Membership is not insurance or health coverage, it does not satisfy any federal or state individual Minimum Essential Coverage (MEC) mandate under the Affordable Care Act (ACA).

If you live somewhere (e.g. California, District of Columbia, Massachusetts, New Jersey, Rhode Island, Vermont) with a state-level individual MEC mandate, you are responsible for securing coverage to satisfy those mandates independently from your CrowdHealth Membership. Links to more information about these mandates are below.

If you have a MEC health plan, you are expected to utilize this coverage for all eligible care before submitting bills to CrowdHealth.

State Information about MEC Mandates:

California
Washington, DC
Massachusetts
New Jersey
Rhode Island
Vermont

Other Coverage

To avoid unfairly burdening the Crowd with unnecessary bills, Members must pursue payment from applicable payor sources (e.g. car insurance, MEC, worker's comp, etc.) for health events before submitting any remaining medical expenses for crowdfunding.

If you have health insurance in addition to your CrowdHealth Membership (e.g. car, home, or health insurance, MEC, worker's comp, government aid, financial assistance, etc.) talk to a Care Advocate about how to be a smart consumer for your expenses.

Taxes

Your Monthly Membership Fee and all crowdfunding participation represent voluntary participation in a Membership that facilitates the funding of fellow Members’ medical bills. These should not be considered as a health insurance premium, nor should they be considered as contributions to a healthcare sharing ministry. These amounts are not tax-deductible. Please consult a tax professional for guidance on any tax-related questions. 

Legal Action

The ability to pursue fair healthcare costs on your behalf as a self-pay patient is an important part of how CrowdHealth operates and cares for the Crowd. In the case that a provider bills an unfair amount and is unwilling to negotiate with us, CrowdHealth requires Members to give us the right to pursue legal action against that provider on behalf of you and the Crowd.

Access to Your Health Records

When you join CrowdHealth, you agree to give specific individuals at CrowdHealth and our partners access to your health records upon request.

In the instance of a telemedicine visit or a health event, CrowdHealth may receive information such as the following from your medical practitioner(s): patient name, date & time of appointment/call, outcome or diagnosis, prescriptions, etc.

We reserve the right to request medical records, which are used to assist with care navigation and to protect you and the Crowd by providing important context about your medical history and helping validate your bills. Members are required to execute HIPAA authorizations to allow CrowdHealth and our partners to access this private information. Failure to do so may delay or limit your care navigation and/or the crowdfunding of your health event.

Protecting Your Personal Information

CrowdHealth understands that privacy is important to our Members. As such, CrowdHealth makes every attempt to keep your information, including personal health information, secure and protected. To learn more about how we protect your information, please email hey@joincrowdhealth.com.

In addition, for CrowdHealth to provide support for many of our services, we may ask Members to sign HIPAA authorization forms allowing for the release of protected health information to CrowdHealth from certain medical providers.  

Promotion Codes

If you signed up for your Membership using a promotional code, all responsibilities as outlined in this Member Guide still apply. Only one promotional code may be used per Member.

International Travel Policy  

The terms of your CrowdHealth Membership apply ONLY to urgent and emergency care outside the United States. However, please note that expenses relating to international air ambulances or medical evacuations are NOT eligible for crowdfunding.

Clinical Review

CrowdHealth may engage trusted partners to assist with clinical reviews for certain health events, like surgeries and major scheduled procedures/treatments. These clinical reviews help ensure high-quality outcomes for Members at the best value to the Crowd. Clinical review services include but are not limited to: clinical and medical appropriateness reviews, evaluating a health event for eligibility under the terms of a CrowdHealth Membership, and remote second opinions (RSOs). If CrowdHealth engages a third-party to review your event, you will be notified by our Care Advocacy team. Self-disclosed medical history is treated as an aspect of the Member's medical record and is subject to clinical review.

Costs related to clinical reviews are considered part of the health event costs and are eligible for crowdfunding.

Specialized Negotiation Support

CrowdHealth may engage trusted partners to provide specialized negotiation support for certain health events. This negotiation support is performed on behalf of the Crowd to assist in negotiating fair and reasonable charges for Member health events. These pre- and post-event negotiation services help ensure that CrowdHealth Members are not over-billed for care and that the Crowd’s funds are maximized for the benefit of all Members. If CrowdHealth engages our partner to assist in negotiating your event, you will be notified by our Care Advocacy team.

It is the Member's responsibility to respond to the CrowdHealth team and negotiation partners regarding information, updates, and action related to bill negotiation. If a Member is unresponsive in the negotiation process, including an unwillingness to explore reasonable discount options, and/or if a Member fails to take advantage of a negotiated discount during a designated time period resulting in a loss of discount, the bill's Health Cost Score may be impacted.

Because all bills remain the responsibility of the Member, there may be a rare scenario where a paid bill is negotiated to a lower price AFTER crowdfunding, resulting in a refund to the Member. In this case, the Member must, in good faith, return any refunded money to the Crowd, to be used for crowdfunding other Member’s health events.

Costs related to negotiation services are considered part of the health event costs and are eligible for crowdfunding.

Crowdfunding Account Management

Each month, your Membership Fee comes to CrowdHealth, and your crowdfunding flows through your Crowdfunding Bank Account to fund other Members’ bills. See our Terms of Service for more information on Crowdfunding Bank Accounts. 

Your CrowdHealth Membership is active after your bank account identity verification has been successful and your payment method has been successfully charged.

Your crowdfunding participation voluntarily funds medical bills for the Crowd. When other Members fund your bills, the crowdfunding will be transferred to your Crowdfunding Bank Account.

Missed Membership Fee Payments

To maintain an active CrowdHealth Membership, Members must keep Monthly Membership Fee payments current. If you fail to pay your Monthly Membership Fee on time, you will be notified, and your Membership will become inactive as of the day of the failed payment. Membership accounts with unpaid Membership Fee balances after 21 days will be terminated and subject to terms of cancelation outlined below (“Canceling Your Membership”).

Members who miss crowdfunding requests because of a temporary Suspended account status may be asked to make up crowdfunding by receiving additional requests that month.

Canceling Your Membership

You may cancel your Membership at any time. Cancelations are effective at the end of your current billing cycle. You must cancel 10 days prior to your next billing date to avoid being charged for the next month of your Membership.

If you decide to leave and want to rejoin CrowdHealth later, there is a minimum waiting period of six months (180 days) between your cancelation and the start of your new Membership. If you cancel your CrowdHealth Membership and decide to rejoin later, your previous Generosity Score will carry over to your new Membership.

Please Note: For your expenses to be eligible for crowdfunding, you must be an active Member both at the time the expense is incurred AND at the time the expense is sent to the Crowd for funding. 

Member Manifesto

1. I understand that CrowdHealth is not health insurance, and I think that’s a good thing!

2. I have fully read and understand this Member Guide that describes my CrowdHealth Membership and how it will help me pay for my healthcare costs, including my $500 Member Commitment for each health event and the specified limitations and exclusions set forth herein.

3. I understand that for my Membership to remain active, I must keep my Monthly Membership Fee payments current

4. I understand that my participation in the crowdfunding of the Community’s medical costs is voluntary, but my participation in funding others’ bills will affect my Generosity Score.

5. I understand that my health visits, except for unplanned urgent or emergency care, should be initiated through the CrowdHealth platform, or they may not be eligible for crowdfunding.

a. I understand that the ability to negotiate on my behalf as a self-pay patient is an important part of how CrowdHealth operates, so I agree to let my providers know I am a self-pay (uninsured) patient at each appointment.

b. If a medical practitioner of my choice bills me an unfair amount and is unwilling to negotiate, I give CrowdHealth the right to pursue legal action against that provider on my behalf.

6. I understand that both the Crowd and I benefit when Members make smart, mindful health and healthcare spending decisions.

a. To care for myself and my fellow Crowd Members, I commit to maintaining a healthy lifestyle, including abstaining from any illegal drug use or activities.

b. To uphold the integrity of the crowdfunding process on behalf of the Crowd, I commit to not knowingly or repeatedly visit a medical practitioner who is unreasonable or unfair in their billing rates and practices.