You know how much we love Samaritan Ministries because I’ve blogged about Samaritan’s medical bill sharing many times in the past. I’ve answered a few new questions recently that I thought I would share here since others may have similar questions on their minds.
Our insurance has gone up yet again, and it’s lousy insurance to begin with. I am very interested in this. I love the idea of helping others, cutting free from big business insurance companies, the personal connection, and the midwife clause! Haha. I didn’t know about the car accident policy . . .
My husband is deeply skeptical and asked me to look for some negative/neutral reviews. His concerns are 1. not actually having our medical expenses met in a true medical situation where the bills are more than we can handle or 2. having something happen to make us ineligible for insurance (or in the current situation–eligible for insurance we could affordable) like a chronic condition or disability and then have Samaritan Ministries fail. Is this group going to be around for the rest of our lives?
We are committed Christians and I know some of this will have to be taken on a matter of faith, whatever decision we make, but my husband takes his provider roles seriously. Just wanted to know if you had any comment on any of this. ~Andrea
Switching from a traditional mega-insurance company to Samaritan Ministries *is* a big jump. It’s something that we had talked about for years, but probably wouldn’t have done if Perry’s employer hadn’t presented the option in the place of traditional insurance. But I’m so glad we were nudged into it, and I hate the idea of ever going back!
To answer your husband’s concerns, there is no guarantee that this company will be around forever, but there’s also no guarantee that the big insurance companies will be around – or that they won’t change dramatically if and when the government gets more heavily involved in healthcare. As they stand, they’re already far from ideal, stable, or affordable, and it seems likely that they’ll only get worse. Samaritan is big and growing, so unless government regulations crush it the future seems bright.
About having needs met, we have had every penny of our own needs met each time we submitted a need, and never had a need over $300 that wasn’t eligible. The rules clearly state what is eligible, and unlike traditional insurance the company is on *your* side. They want to help you, so if something seems ambiguous in the rules they are going to interpret it in the best possible light rather than just trying to get out of paying the bill.
Our needs have all been under $5,000 so far, but we have personal friends whose needs were much closer to 6 digits (some may be over; I haven’t asked) and their bills were paid in full by Samaritan members as well.
I think it’s very telling that it is almost impossible to find negative reviews by people who actually participated in Samaritan Ministries. The few negatives you find are either those who never joined and just doubt that it could work, or those who belonged to other medical sharing organizations that were poorly run and they assume that Samaritan must be similar.
How is it determined whether or not the care is “preventative”? For example, if my husband is concerned about some moles and wants to have them looked at, at what point does SMI begin to cover? None if they turn out to be benign? Or would it cover the testing to see if they are okay? And, do we send in all of the bills for one medical “event”? What about a chronic condition that is diagnosed after joining (making it not preexisting”?
Lastly, I guess this is a silly question, but I’m already pregnant…I suppose I couldn’t get an out-of-hospital birth covered this time around? ~Debbie
In my own words, preventative is when you go in just for a checkup or a physical, not when you have a specific concern. When my husband had his heart checked out because it was racing, it turned out his heart was fine – but the cost of all his visits was published and paid for by Samaritan members. Even though each visit was less than $300, the *chain* of visits and follow-ups was considered a single incident because they all stemmed from a single cause, so the total need was publishable.
So in your example, all visits relating to the moles should be publishable as a single need, even if it turns out to be benign – unless the total cost is less than $300, of course.
You can send in bills one at a time if you want, but it’s easier to submit them all at once if you can cover or make arrangements for the cost in the interim. That’s what we did when Perry was having his heart checked out.
A chronic condition discovered or diagnosed after joining would be publishable since, as you mentioned, it’s not preexisting. Even if you suspected it at the time you join, it seems to be more of an ethical issue than anything else. If you believe you had it before joining but it was never confirmed, I think it would up to you to decide whether you could submit needs for publication in good conscience.
Preexisting needs are not normally publishable, but pregnancy gets special treatment. With a preexisting pregnancy, your need will be published up to the amount that you have contributed so far, i.e. if your monthly contributions as a member totaled $1,250 before the baby was born, you would be eligible to receive $1,250 toward the birth of your baby. If you get pregnant after joining, the entire cost of prenatal care and delivery can be published, even though it can much more than you have contributed.
Do you have questions? My first suggestion is always to ask Samaritan directly, to get the most accurate answer. But if you want to talk to a happy member, I’d love to help.
Just a reminder – I don’t work for Samaritan and I can’t speak for them, so please check my answers against the member guidelines or call them directly. I’m just a very satisfied member who loves to encourage others to join. If you do decide to join, please be sure to give credit to the member who referred you (me? was it me?!).