Samaritan Ministries Q&A

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.

QUESTION:

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

ANSWER:

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.

QUESTION:

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

ANSWER:
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?!).

Comments

  1. I think I would have the same concerns as Janice. For those of you that are members of Samaritan, what do you do for checkups. Is it just out of pocket?
    Kim, you mentioned that this was an option presented to you by your husband’s employer, it seems like it would definitely benefit his company for you guys to do this since they would no longer have to pay for your families insurance. Do employers that offer/suggest Samaritan as an option tend to offer a bonus or perk for choosing Samaritan over traditional insurance? It seems like that would be fair :)
    Also (one more question, I promise!) do those of you with Samaritan generally pay out of pocket and hen get reimbursed for your medical bills later? Right now we have Aflac through my husband’s employer (which basically works like that, you pay, call your rep who then submits your claim, and they give you the money if it’s approved [i.e., they don’t work with the hospital/doctor’s office at all], but you don’t just give a card to the receptionist and go on your way like you do with insurance, you actually have a bill that you have to pay, and as far as the office sees it, you’re uninsured) we haven’t used it at all, because 1. we generally don’t have enough extra cash hanging around to pay any doctor’s bills, and 2. even if we did I’m still scared that Aflac won’t cover it…which so far has been OK since we’re healthy and have no children yet, but there have been a few little things, like my husband spraining his wrist really badly and refusing to go to the hospital because we didn’t have the money, or me forgoing my asthma medication and medication for depression/anxiety due to cost. Could you explain to me if and/how Samaritan would be different?

  2. I would love to do this, but the big downfall to it for us is that my husband has had SEVERE asthma since I was 8…a pre-existing condition. When I emailed Samaritan several times to ask questions, never once did I receive a reply.

  3. We’ve been Samaritan members since 2010 and have nothing but GREAT things to say about them. My c-section with baby #8 was completely covered w/o a problem – not covered, I guess, but “shared” by other believers who also send encouraging notes and pray. Spread the word!

  4. We’ve been Samaritan members for a little over a year and are expecting a baby in October. (I’m due exactly one week after you, KimC!) We have been able to get discounts on a lot of our bills. The funds to pay for a hospital birth are already residing in our credit union account due to Samaritan encouraging us to get, and submit, an estimate from the hospital. And that alone is over $10,000! This will also allow us to pay cash at the time and get a further discount.

    One of the things I know some people worry about is “What if a member doesn’t send their share?” We had that happen with one of the rounds of bills we submitted and Samaritan “reminded” that person and the check came with in two weeks. Also, if a member fails to send their share a certain amount of times, I think it’s three, they are removed from the program. SO, while Samaritan is legally required to say that payment is not guarenteed, they do a pretty good job of making sure you aren’t left high and dry. And since you receive checks from several members for bigger needs, the chances are pretty slim that you wouldn’t get the majority quickly.

    I’m super excited about Samaritan, since we won’t have to spend years making payments on this birth. When we had our first child, we had “the best” plan our insurance offered, lowest deductible, lowest maximum out of pocket, etc, and we were still stuck making payments on over $6000 of bills. I think dealing with a little more paperwork and ending up with only $300 out of pocket in the end is TOTALLY worth it!

    Ok, I’ll just stop, I think I could go on for days….. :)

  5. I wanted to speak to Samaritan covering BIG needs. My parents have been members of Samaritan for more than 14 years.

    After joining Samaritan, my mother had a massive heart attack (congestive heart failure, emergency surgery, ICU for nearly a week, etc.). A month later, as a result of the effects of the heart attack she had a stroke. Their medical bills were well into the 6 digits and Samaritan covered everything promptly.

  6. We’ve been members of Samaritan for around 12 years. Our 17 year old daughter was diagnosed with brain cancer in February of this year and in March went to meet the Lord. Her medical expenses were over $200,000, and every bill has been publishable. The Karis Group works on behalf of Samaritan members to get discounts on bills, but some of our bills were automatically discounted because we don’t have insurance. We’ve also had needs met for pregnancy/births and a broken wrist.

    • Susan, I’m so sorry to hear about your family’s recent ordeal, but I’m sure Samaritan Ministries was a blessing. Isn’t it wonderful to know that so many Christian brothers and sisters were praying for all of you, and to receive their cards and words of encouragement in dark times?

      • Samaritan has always been wonderful. Every person I’ve talked to has been warm and caring, offering to pray for me/us, and then doing so right then and there. More than once, I’ve been on the phone with someone from Samaritan and ended up in tears, and they have been very understanding. We’re still receiving money to pay for our daughter’s medical expenses, and yes! the cards and words of encouragement are such a blessing. Losing a child is HARD.

  7. Janice Nelson says:

    I am very interested by Samaritan Ministries and have read a lot about it. Do you know why they don’t offer coverage for checkups? Especially for new babies and older people. I love the idea of this but it’s a scary leap to take!

  8. Thanks for posting these questions! We just recently joined Samaritan and though I’m excited to be a part of this ministry I’m still a little anxious about being outside the umbrella of big insurance. We haven’t had to submit any needs yet, but it is really encouraging to hear about others who have done so successfully. When we were in the process of deciding what to use for healthcare support we were very impressed with the staff of Samaritan that we spoke to. They were super pleasant and helpful. I look forward to working with them!

  9. Teresa Carstens says:

    With Obamacare passing does this affect how Samaritan Ministries works? Just curious. Thanks!

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