more Samaritan Ministries Q&A: pre-existing conditions, submitting a need

Elizabeth sent me the following questions about Samaritan Ministries.  Since I thought others might have similar questions, I asked her permission to share our correspondence.  Here it is, slightly edited for accracy and clarity.

My husband and I are really considering Samaritan Ministries. We have been looking into this option (a medical share plan) for over a year now. I had looked into other plans, but then I heard about Samaritan on your blog, and it seemed different from the rest. To make it more urgent, Obama winning a second term constricts our choices within our insurance, and our insurance premium has gone up, and is now higher than the share for Samaritan. What is most disturbing to us, and began this search a year ago is that we don’t want to continue to pay into things we feel support lifestyles which aren’t in line with God’s Word. We feel to support them financially would be wrong. We want to opt out of the World’s Solution for medical bills, and into one that is more from a Biblical perspective. We’ve looked into other options as far as medical share plans, and so far this one is looking the most probable, and the most navigable. We still have questions that aren’t addressed on the website though. Things like:

  1. How do pre-existing conditions work? (I have Rheumatoid Arthritis, but it hasn’t been treated in over 3 years. I haven’t even seen my Rheumatoligist. I’ve been managing with herbs, diet, and exercise.)
  2. How do things like dental, eye etc work?
  3. Check ups aren’t covered, right? (we have 3 children, one on the way.)
  4. I understand things under $300 aren’t covered either?
  5. When a need is submitted, do we also submit a copy, or the original bill with the form stating what need we have?
  6. And, as far as the doctors and hospitals go, we are ‘self pay’ correct?

And there are a few more, but my pregnant brain isn’t remembering our discussion from this morning! Too far away! Haha!
In any case, do you know who we would call to get these specific questions answered, and what we need to apply? (a recommendation from a Pastor, etc etc.) We are REALLY interested, and have almost decided on Samaritan Ministries, but my hubby feels we ought to be prudent and settle these questions first. It’ll be a big step for us, but frankly, we are more interested in participating in a program that honors God than anything else, and with our finances facing a bit of a precarious situation, the fact that per month it is cheaper makes it all the more compelling.

My answers to Elizabeth:

I’ll answer the best I can but they do have their complete guildelines available online, and customer service is helpful and friendly so I really suggest you call to get the best and most accurate answers.

  1. Pre-existing conditions: You are never excluded, but the treatment of pre-existing conditions may be excluded. Some have a time limit after which expenses can be shared. Most are publishable if you have gone 12 months without symptoms or treatment.
  2. Dental and vision needs are not shared. We have separate dental insurance (less than $100/month for a good policy) and Perry gets his eyeglasses from Zenni Optical for about $10/pair. :):)
  3. Routine checkups are not shared. Those who feel that routine checkups are necessary generally find that Samaritan plus the cost of checkups is still cheaper than just the premium for traditional insurance. Of course you’ll need to do the math and decide what fits your family best.
  4. Needs under $300 are not shared, but if you have multiple visits for the same illness or incident, the cumulative total is what counts. Example: Perry went to have his heart checked out a few years ago. His heart was fine, but it took about 3 office visits and 2 rounds of bloodwork. No single visit was over $300, but the total was $1100. It was entirely paid by Samaritan members!
  5. When submitting a need, you first request a form from Samaritan. Then you’ll just fill in the blanks (a few lines – it’s easy), get your elder or pastor to sign it, and attach original bills or copies of the bills.
  6. Yes, we are considered self-pay. Because they don’t have to deal with an insurance company, many doctors and hospitals will give you a discount – especially if you are able to pay up front and wait for Samaritan members to reimburse you.  This savings is part of what keeps the cost for Samaritan members so low!

To join, just visit the website and print an application (http://samaritanministries.org/wp-content/uploads/2012/10/Member-App-201210.pdf) or call and request an info packet (888-268-4377). You’ll need to fill in the form and have your pastor or elder sign it to verify that you are members in good standing at a Trinitarian church. It’s simple.
I’m happy to answer any other questions you have. I love reassuring people about how well it works, because I was nervous about making the switch from traditional insurance, and now I would *hate* to go back!
Kim

How about you? Questions? I strongly suggest contacting customer service for the most accurate answers, but I’m always happy to tell what I know and share about our own experience with Samaritan Ministries.

If you decide to become a member of Samaritan Ministries, please tell them you heard about it from Kim Coghlan!

Comments

  1. Hi there!

    Kim, your posts on SMI have been EXTREMELY helpful! Thank you for sharing from your personal experience and all the practical implications of the sharing costs. Do you know of anyone who uses Medishare? It’s very similar, and my husand and I are about to join.

    Thanks again, God bless you!

    • Chris,
      I don’t know anyone that has been a member of Medi-Share, but a quick search on Google didn’t impress me. While it’s almost impossible to find dissatisfied members of Samaritan (past or present), there are some unhappy Medi-Share users. Not a lot, but enough to make you stop and think. Here’s one that goes into a good bit of detail: http://www.moneyhelpforchristians.com/medishare-review-experience/
      It sounds like its harder to submit your medical bills, the “deductible” is higher (unless you opt to pay a much higher monthly share), customer service is less helpful, and you are limited in your choice of providers. Of course I’m biased because we’ve had nothing but positive experiences with Samaritan, but that’s what I base my opinions on. :)

      • Kim, thank you SO much for your prompt response!!! It was very helpful. I agree, I haven’t seen hardly any negative comments/experiences from Samaritan users, but I HAVE seen a decent amount from Medishare users.

        My husband and I are now looking more into Samaritan Ministries, and are praying for God’s direction. I did just request an info packet from SM and said I heard of them through you!

        • I’m glad I could help. Let me know if you have other questions about Samaritan Ministries. I’m always happy to share our experience
          It can be scary to make the jump to non-traditional solutions for any problem, and health insurance is no exception.

  2. Thank you for replying! I’ve had the same frames for several years (I believe I have replaced the lenses once). The prices do make it tempting to try something new.

  3. I’ve never ordered glasses online, but did get my doctor to give me my pupillary distance at my last check up (evidently necessary for ordering online). I’ve read pros and cons regarding Zenni and other eye glass makers. I take it you all have had positive experiences? (I do have a stigmatism, don’t know if that makes it more complicated for online ordering.)

    • Perry has astigmatism too, and has no trouble getting his prescription glasses online. The only 2 downsides we have found:
      1. You can’t try on the frames before you buy. It helps if know what style you want before you order.
      2. The frames do seem a little less durable, but for 90-95 percent savings, we’re happy to buy an extra pair per year!

  4. Janet Kiessling says:

    Hi there, Our family thought about Samartian Ministires. We emailed them with questions – they promptly answered us back with our answers!..:) But due to nasty mirgraines & medication for them – I can not use this wonderful insurance. Yes, you have to be medication free for a year!
    I sounds amazing!

  5. Charlene Prigge says:

    Could you share your source for dental coverage. Our family of ten has never had that and we have been avoiding all dental visits.

  6. Kim

    I have a question. So in 2014 when Omaha care goes into effect, I will be exempt and won’t pay fines for not taking the government plan?

    We are considering this but know once 2014 comes health care will change.

    Thank you, Heidi

  7. Kim, do you mind sharing what insurance you do use for dental coverage? Are there limits for every family member per year? Do they help cover braces or crowns or surgery? Sorry for so many questions. It’s interesting that hubby and I were discussing Samaritan Ministries as an option just this afternoon and dental coverage had come to mind! Thanks for all the info. :o)

    • Charlene and T.J.,
      We have a group policy with United Healthcare, but I looked them up online and even without group rates they are still very reasonable. We get free cleanings every 6 months, xrays as needed (I think it’s every 2 years?), free sealants for the kids on permanent teeth. Fillings are 80% covered, and most major services are 50% covered. There are limitations as with any policy, but we save big bucks just on regular cleanings!

  8. What happens with the Obama care mandate? Will you have to pay the fine through the IRS?

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