When Geoff Perlman’s 20-year-old son broke his arm in December 2022, the bill was paid by strangers who chipped in to cover the costs.

And rather than paying a monthly premium to a health care company, Perlman writes a check each month, never exceeding $420 for his family of four, to foot strangers’ health care bills, covering part of a pregnancy for one family or chemotherapy for another.

Perlman, a 61-year-old tech CEO from Austin, Texas, is a member of CrowdHealth, a health care startup that seeks to replace health insurance with a crowd-funding model that the company says lowers costs and diverts money from insurance conglomerates to real people. Perlman likes the company because he says it sidesteps insurers’ incentive to deny claims and seek profit, while erasing patients’ ignorance about what health care actually costs.

“You have a feeling you’re part of a community and you’re looking out for them,” says Perlman. “It feels like the money I am paying is helping other people.”

CrowdHealth, which was founded in 2021, offers a new take on an old idea. For decades, religious health-sharing ministries with names like Medi-Share and Samaritan Ministries have asked communities to pitch in for the medical bills of strangers. CrowdHealth has no spiritual affiliation; it’s a peer-to-peer financial-technology company that allows its roughly 10,000 paying members to make payments toward fellow members’ medical expenses.

To join, members pay an administrative fee of about $55 a month. Each month, they get a message from CrowdHealth informing them that another member needs financial assistance for a specific medical issue. Members can agree to pay their share of the bill, which doesn’t exceed $140 per month for a single person under 55, or $420 for a family of four. Or they can decline—at the cost of eroding their rating on CrowdHealth’s site, making it less likely that fellow members will contribute to their own needs.

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When a member has a health care expense, they’re instructed to pay in cash, or tell a hospital that they are a self-pay customer, save the receipts, and submit them to CrowdHealth for compensation. (CrowdHealth sometimes negotiates the price of planned labs or procedures ahead of time.) The company says it covers 99.8% of claims, though it does not specify what exactly is counted in that statistic.

What draws people to CrowdHealth is deep discontent with the U.S. health insurance system. The share of Americans who said that the quality of health care in the U.S. is excellent or good—44%—is the lowest since at least 2001, according to a December Gallup poll. Even many of those with good insurance coverage are frustrated at the system’s perverse incentives, byzantine regulations, and opaque processes. It’s this frustration, in part, that led to a groundswell of public support for Luigi Mangione, who was charged with first-degree murder in December for allegedly gunning down UnitedHealthcare CEO Brian Thompson in Manhattan. (Mangione has pleaded not guilty.)