Before a Planned Procedure: A HealthShare Sharing Request Checklist

A planned surgery, imaging appointment, or preventive visit can bring up practical questions: When should you use the Member Portal? What should you ask the provider for? What records should you keep?

This checklist is designed to help current HealthShare members prepare for nonemergency care. It is not a determination of whether a particular service is eligible for sharing. HealthShare is not insurance, and medical expenses are considered eligible for sharing only when they meet the current Member Guidelines and receive a final eligibility determination.

Start the Sharing Request Before Nonemergency Care When You Can

The current Member Guidelines say that Sharing Requests are submitted through the Member Portal on a per-member, per-medical-need basis. Most nonemergency requests, including surgical procedures and preventive care, should be submitted before the date of service.

Starting early gives you time to organize the information connected to the care you are planning. It does not guarantee that an expense will be eligible for sharing or replace the final review under the Member Guidelines.

Make a Simple File for the Medical Need

Before the appointment, collect the information you already have. A simple folder—digital or paper—can make follow-through much easier.

• The provider or facility name and contact information
• The scheduled date of service and the reason for the visit
• Any referral, order, estimate, treatment note, or instructions from the provider
• Itemized bills and statements as they become available
• Receipts and proof of payments you make toward the medical need
• Details of any other insurance, group plan, government assistance, or similar benefit that may apply

The Guidelines state that itemized bills and statements, supporting documents, and proof of IUA payment may be requested during the process. Keep originals or clear digital copies. This is also useful if a provider’s billing office sends documents on a different schedule than the appointment itself.

Talk With the Provider’s Billing Team Early

HealthShare members may use any licensed healthcare provider in the United States or Puerto Rico. If you do not have other insurance through any source, identify yourself to the provider as a self-pay patient and ask about the self-pay price or available discounts. The Member Guidelines encourage members to communicate about costs and discounts as soon as possible.

Ask the billing office for an itemized estimate when one is available. After care is provided, request the original, itemized bill and statement rather than relying only on a payment receipt or a generic balance summary.

Contact the Member Needs Team Before Planned Treatment

For nonemergency medical treatment, the current Member Guidelines direct members to contact their Member Needs processor before treatment. Depending on the situation, this may allow prompt payment at the time of service or help with cost discussions.

Use that conversation to confirm the process and ask what documentation may be needed. Do not treat a provider recommendation, an estimate, or an early conversation as a final eligibility decision. Medical necessity and eligibility are evaluated under the current Member Guidelines.

Understand How the IUA Fits Into the Process

The Initial Unshareable Amount (IUA) is the amount a member is responsible for before associated eligible medical expenses may be shared. The current individual membership choices are $1,250, $2,500, and $5,000.

For a particular medical need, the IUA and related documentation have their own timing requirements. The current Guidelines generally require the IUA to be paid within six months of the date of service for expenses to be considered for sharing. Save receipts and communicate with the Member Needs processor if there is a timing question. Paying an IUA does not by itself determine that an expense is eligible for sharing.

Submit and Follow Up After Care

Open the Sharing Request through the Member Portal as soon as possible. The current Guidelines say that the request, original itemized bills, and statements must generally be submitted within six months of the date of service. Additional documents, such as medical records, receipts, or proof of payment, may be requested.

If you have other insurance, workers’ compensation, liability insurance, a group plan, government assistance, or similar benefits, disclose them with the request. Those sources are considered first, and any remaining eligible expenses may then be considered for sharing.

Watch the Member Portal Walkthrough

For a visual overview of the portal steps, watch the Sharing Request walkthrough. Portal labels and screens can change, so use the current Member Portal and Member Guidelines for your own request.

The Best Next Step Is Clear Documentation

For a planned procedure, the most helpful habit is simple: start early, keep itemized documents, communicate about self-pay pricing when appropriate, and use the Member Portal process promptly. If you are unsure how a current medical need is handled, refer to the Member Guidelines and contact Member Support or your Member Needs processor for the facts that apply to your situation.

Sources

• [Official Member Guidelines](https://zionhealthshare.org/how-it-works/member-guidelines/)
• [Official Glossary of Terms](https://zionhealthshare.org/disclosures/glossary-of-terms/)
• [Official Frequently Asked Questions](https://zionhealthshare.org/how-it-works/faq/)