Skip to content
ENROLL Now
  • There are no suggestions because the search field is empty.

How are my bills reviewed?

Eligibility of medical bills is determined in accordance with your Impact Guidelines.

Every member chooses a Primary Responsibility Amount (PRA) that makes sense for their family and budget. This amount is similar to an insurance deductible and is the amount your family is responsible for paying before bills can be shared.

Once your PRA has been met and your co-share applied, your medical bills will be shared and paid by other members as per the eligibility criteria. Eligibility of medical bills is determined in accordance with your Impact Guidelines, your original application, and medical information regarding the incident.

Impact evaluates each sharing request under the Guidelines. At times, the validity of a Member’s request may be unclear. In these situations, Impact must then exercise discretionary judgment, on behalf of the entire Impact membership, to evaluate the request, using common sense and fairness as a guide. Medical records may also be required to aid in determining if sharing is eligible.

Impact is likely to deny a sharing request and possibly cancel membership where any of the following occurs:

  •  Pre-existing conditions were not disclosed during the application process;
  •  Relevant information appears to be obfuscated or changed during the sharing request process;
  • A member is abusive to Impact staff during the processing of a sharing request;
  • Failure to obtain requested medical records, fraudulent misrepresentation of,  and/or purposely withholding certain portions of medical records;
  •  Intentional violation of the guidelines, as determined by Impact, indicating that intent was apparently not accidental; 

Members are expected to fully cooperate with Impact in evaluating sharing requests, including with respect to obtaining medical records. Any costs incurred in obtaining necessary records or documentation are the responsibility of the Member.

Any Member who submits falsified documents or otherwise engages in deceptive practices will be subject to membership cancellation. The Member may request resolution via the Mediation and Arbitration provisions described in the Guidelines.