SUBMITTING A MEDICAL NEED REQUEST

WHAT IS A MEDICAL NEED REQUEST?

Medical expenses that result from an illness or injury may have their costs shared with the Zion Health community. In order to share medical costs, members must submit a medical need request.

Expenses related to the same medical condition, including those for separate incidents, will be shared as one request, and eligible expenses paid toward this medical need request will accumulate toward the member’s initial unshareable amount (IUA). At Zion Health, members can submit a medical need request when medical expenses exceed their IUA.

HOW DO I SUBMIT A MEDICAL NEED REQUEST?

STEP ONE

Visit ZionHealth.org/need-request/ and fill out the information requested in the form. Medical need requests must be completed within six months of the treatment date. You will be asked to answer the following questions in the description of your request:

  • In your own words, what happened?
  • When did you first start showing symptoms or require treatment?
  • Are you currently on any medication for the condition? If yes, what is the condition(s)?
  • What were your dates of service?
  • Are follow-up appointments excepted for this medical Need?
  • What is the name and contact information of your provider(s)?

Additionally, please provide any bills (itemized is best) related to the medical need request and detailed receipts of any IUA payments made directly to providers.

STEP TWO

Pay the IUA directly to your medical provider. We recommend applying the IUA payment(s) to your most expensive bill(s) first. Immediately after paying your medical provider, submit detailed receipts to needs@zionhealth.org. For additional direction, contact Zion Heath by email or by phone at (888) 920-9466.

FREQUENTLY ASKED QUESTIONS

What should I expect after submitting a medical need request?

Once your request is submitted, you should expect the following:

  • A confirmation email with any additional instructions from Zion Health.
  • The determination of sharing eligibility for your medical expenses within the Zion Health community.
  • Member Care email updates about status changes, provider payments, reimbursements, and/or any missing medical information.
  • An Explanation of Sharing (EOS) sent both to you and your medical provider(s). This document explains the amount that Zion Health will pay and what you, the member, are responsible for paying.

Zion Health may ask you to contact any uncooperative medical providers. Many providers are used to working with patients directly and are more receptive to patient requests. If this is the case, Zion Health will reach out to you.

What documents might I need to provide relating to my medical need request?

FOR ELECTIVE SURGERIES & PRE-MEMBERSHIP MEDICAL CONDITIONS
prior medical history is required from your medical provider(s). You must provide a HIPAA form signed by you or your guardian (Zion Health will send an email asking for a digital signature).

IF YOU HAVE A PLANSTIN COPAY PLAN
proof of copay payments is required in order for expenses to count towards the IUA. Submit copay receipts related to your medical need request.

IF YOUR MEDICAL PROVIDER IS NOT WILLING TO SEND STANDARD CLAIM FORMS
service codes are required. Provide itemized receipts with CPT codes from your medical provider. Request your provider for a “detailed itemized statement with self-pay discounts.

FOR A MATERNITY NEED REQUEST
comprehensive pricing is required. Collect “global package” pricing from your OB/GYN and hospital of choice.

How do I get the lowest possible price if my medical expenses do not exceed my IUA?

  1. Do not present your ID card to the provider.
  2. Opt as a self-pay patient for discounts at the time of service.
  3. Pay the provider directly for services.
SUBMIT A NEEDS REQUEST