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!

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?!).

Samaritan Ministries: How do you handle maternity bills?

Q. I was wondering how you handle your maternity bills with Samaritan Ministries. We just found out that we will be having our third blessing in Nov! We have been members with Samaritan since Oct 2011 & have never had to process a need. It seems like my doc & the hospital just don’t get what we’re doing & I think our bills are going to suffer for it (we have always paid our bills on time – early actually, so it saddens me that they bristle now that we are “self pay”).

We’ve been happy members of Samaritan Ministries for about 6 years, and I have received many different versions of this question, so when I answered her privately I asked if it would be ok for me to share the response here as well.  Of course she agreed.

A. I don’t use a hospital and doctor for pregnancy, but I can tell you how it works for me and how we have dealt with other doctor bills not related to labor/delivery.
My midwife has a total charge for prenatal/birth/postnatal services, with a significant discount if it is paid in full by 36 weeks.  She does charge separately for a few things, but for the sake of simplicity I asked her to put it all on one bill and she was happy to comply.
Normally, Samaritan members pay their bill if they are able or make payment arrangements as necessary.  It’s fine to explain that you are a member of a Christian medical sharing organization, but don’t expect special treatment.  As far as the provider is concerned, Samaritan members are uninsured, so they work together with us inside that framework.  Of course my midwives have been very understanding and I have been told that they usually gets their money much faster this way than when their customers have traditional health insurance!
I mentioned that normally we pay our bill up front or make arrangements to pay, but with our midwife it’s different.  Because she gives a discount for payment in advance, I contacted Samaritan Ministries and was able to share my need before the services were rendered.  This saved everyone money, which makes me happy.  It also made my midwife happy to have her payment in advance.
In any case, the first thing to do is request a Need Processing form from Samaritan.  This is just a single page where you list your bills and have your pastor/elder sign to verify that the need is genuine.  Having the form on hand allows you to list bills as they arrive.
Then I would suggest telling your providers a little about your situation.  Ask each individual provider if there is a discount for paying in advance for any portion of the bill (maybe your OB charges a set amount and will discount, for example).  Ask if there is a special cash price or self-insured price.  Talk to Samaritan about publishing a portion of your need in advance if it cuts the bill.
Otherwise, pay what you can when billed and make arrangements for the rest.  Keep track of your separate bills, and send in the Need Processing form when you think you’re done – or if you expect a lot of bills over time you can simply get the first batch in line, and submit more later.  :)
It may sound like a lot of fuss and bother, but it’s nothing like the old days when we had to submit our own claims to the insurance company.  Does anyone remember that?  I chose doctors and dentists based on whether they would do the insurance forms for me because it was such a hassle and follow-up was a nightmare!  This is nothing like dealing with an insurance company.  It really is easy, and requires just enough involvement to ensure that a member’s brain is engaged, so we don’t accidentally pay $960 for 57 bars of soap we didn’t use or get charged for an epidural that was never administered.
Once you send in your list of bills, just sit back and wait.  Here’s what happens next:
  1. You’ll receive an acknowledgment that it was received and processed, and they’ll tell you when your need(s) will be published.
  2. Then you’ll receive a checklist telling you exactly who is supposed to send you money and how much.
  3. Now you’ll start receiving checks in the mail directly from other members like yourself.  Most will arrive with cards and/or notes of prayer and encouragement.
  4. If you don’t receive everything by the date on the list, send the checklist back to Samaritan and any unreceived amounts will be assigned to other members the following month.
  5. Use the money to pay your providers, or reimburse yourself if you already paid out of your own pocket.
That’s all the followup that is required on your part.
Does that give you a better idea of how it should work for you?  As always, I strongly recommend calling the office and chatting with them.  They are always friendly, helpful and encouraging, and you can be sure you’re getting the right answers to your questions.

If you decide to join Samaritan Ministries, I would love for you to tell them that you heard about it from Kim Coghlan!

We are “uninsured,” and we like it that way

Last summer when Perry started jogging and doing an insanely rigorous exercise program at the same time, he also started having persistent chest pains.  He doesn’t like going to the doctor but after some equally persistent encouragement from me, he finally assented.  After 5 appointments, 2 months, and $1,100, we learned that his heart was fine but he has diabetes.

We are uninsured, but medical expenses are not a problem for us.

When I say we are uninsured, I’m not saying we have no way of paying for medical expenses – even major ones.  I’m saying we don’t have or want traditional health insurance, because we believe we have something far better.

We have been members of Samaritan Ministries for about 6 years, and unlike our previous 12 years of “real” health insurance, I have enjoyed writing the check every month.  That’s because now our checks go directly to real people with real names, Christian brothers and sisters for whom we pray when we write the check.  I think I have even written a couple of checks to blog readers!

When we have medical expenses of our own,  we don’t have to battle a faceless system to get the cost covered, hoping they read the rules the way we do.  We fill out a short form detailing our needs and bills, and receive checks from real Christian brothers and sisters – again, sometimes from people we know!

Our share is the same every month, and it’s far less than the cost of traditional health insurance (currently $315 for our family of 12).  We have had 4 babies and a few other smaller medical expenses, and every penny has been paid by the members of Samaritan Ministries.  We personally know people who have had much, much larger needs that were paid as well, with never a problem. Regular members may submit needs of up to $250,000, but if you are a member of the modestly priced add-on Save To Share program (we are!) there is no dollar limit on needs that you may submit.

If you’re skeptical, take a look at the new series on the Samaritan Ministries blog, Health Care Sharing Myths.  It answers many concerns that others might have about this way of paying for healthcare, and promises to answer even more.  Subjects so far:

If you decide to join, tell them I sent you (Kim Coghlan).  We get a credit toward our own membership, because the more members Samaritan Ministries has, the better the system works!

Questions? I’m happy to share my own experience, but the people at Samaritan are friendly and knowledgeable, so I encourage you to give them a call (888-268-4377) or email if you want to talk about whether it’s a good fit for you and/or your family.

Are you already a member of Samaritan Ministries, or do you know others who are?

On Obamacare

I can’t take credit for the quote below, but I love it anyway.  When hubby spotted it on his mom’s Facebook status (credited there to an anonymous friend), he predicted that it would go viral.  I love it when he’s right!

Let me get this straight—we’ve got a health care plan passed by a Congress that hasn’t read it but exempts themselves from it, signed by a president that hasn’t read it and smokes, with funding administered by a treasury chief who didn’t pay his taxes… and financed by a country that’s broke. What could possibly go wrong?

Yes, as Christians we should be exercising charity, caring for the sick and the poor.  But institutionalized theft is not the way to do it.  Our healthcare system is a mess, but government intervention and so-called funding (straight from our own pockets) are not the solution; they are largely the problem.  Medicare created much of this mess in the ’60′s, and now the problem is going to get far worse.

On the other hand, as liberal civil rights leader Al Sharpton pointed out in an interview with Bill O’Reilly:

I think that [the passing of the healthcare bill] began to transform the country the way the president had promised.  This is what he ran on….the American public overwhelmingly voted for socialism when they elected President Obama…

watch the youtube video here

As a nation we got what we asked for, whether or not we want it now in its present form.  May God have mercy on us.

I’m thankful to be a member of a Christian medical sharing group that is, under the bill’s current wording, exempt from the requirements.  However, exempt or not we will all suffer from the far-reaching consequences of this new law.

Be sure to watch The Common Room for helpful summaries and link roundups on this topic, for those of us who are incompetent to digest all the garbage being tossed about by the media.  Start here and here.

Another reason I love Samaritan Ministries

I just called my not-health-insurance provider to request a form for submitting my midwife expenses.  I’m not due for another 17 weeks, and I haven’t even made an official choice of midwives yet, but I want to have the form in hand so I can get it ready asap.

Samaritan MinistriesI love Samaritan Ministries, and it’s not only because they have such a great referral program.  [hint, hint...tell them KimC sent you.]

I love them also because they encourage me to care how much my medical care costs, even when it doesn’t come out of my pocket. When I had traditional health insurance my only concern was how much it would cost out of my own pocket.  Now my perspective is different.

Many midwives gives a hefty discount if you pay by 36 weeks.   I don’t want my Christian brothers and sisters to pay more than is necessary for our baby’s birth.  I want to save them money just as much as I want to save money myself, and so I’ll be submitting my need  just as soon as we make a choice – with the blessing and permission of Samaritan Ministries – to save us all $400.

curious?  here are my past posts about Samaritan Ministries

Samaritan Ministries: an alternative to health insurance

I’ve posted about Samaritan Ministries in the past, and I can’t say enough good things about them.  I think they have a fantastic system worked out, and if you’re looking for an alternative to traditional health insurance, this might be perfect for you.

I’m still receiving some questions about Samaritan, so thought I’d share the answers here in case anyone else is interested.

How does Samaritan work?

I think I read on your blog that you use Samaritan for your insurance program.  We are facing a substantial rise in our insurance costs and hoped you would give me some info. on it?  We are a family of 8 and are really only interested in major type medical coverage.  One of our boys tends to be accident prone so we definitely need insurance that actually will cover expenses if/when he hurts himself! Thanks for your help.

Samaritan members pay only the first $300 of any eligible medical expense, so it could be just what you’re looking for.  The cost is currently $285/month for a family of any size.  It’s very easy to submit a need, and I have a whole pile of lovely cards with personal messages from members’ payments when Bethany was born.  We even received cards from people who weren’t assigned to send payments.  That’s what you get when you are joined with Christian brethren.  :)

Does Samaritan really work?

My husband is a little hesitant about not having traditional insurance.  Do people actually pay what you what they are supposed to?

When you submit a need, you receive a checklist of who is supposed to send payment and how much.  After a certain amount of time, you send it back to Samaritan.  We have found that most members pay very promptly but if anyone didn’t pay, that share is assigned to a new member and Samaritan deals with the non-paying member.  It’s very easy on your end.
For example, when Bethany was born we were supposed to receive payments from 21 members.  By the end of the month, 19 had paid and I sent my checklist back to Samaritan.  The next month we received a new checklist, and the other 2 payments came from different members.

How much does Samaritan cost?

When I read the paperwork, it said that the monthly amounts don’t change unless the board initiates it.  Has that ever happened?

Yes, it’s happened once or twice since we joined several years ago.  Of course we don’t like to see prices go up, but the increases were moderate, based upon the total amount of needs received, and it’s still far cheaper than if we were to buy traditional health insurance.  Our monthly share has also occasionally been less than what we expected, just because there were fewer needs submitted for that month.

The current price for a family is $285/month, and much less for singles or single parents.  We especially like Samaritan Ministries because they don’t charge per person; in a big family, the “family rate” becomes a really great deal.  I also love that they waive the $300 deductible for homebirths.  While traditional health insurance often penalizes people for choosing to birth at home, Samaritan Ministries seems to recognize that it is both safer and less expensive.

Um…we also like their generous referral program, so if you decide to join up please tell them Kim Coghlan sent you.  Because the only thing nicer than the current price tag of Samaritan coverage is getting it for half price.  If you’re interested, Samaritan will send you an info packet.

More questions?  Look here.  If you don’t find your answer, try me.

Why homebirth?

A reader asked why we have our babies at home. The short, easy answer is because my parents had most of their children at home. It was the most comfortable place for me to give birth.

Of course, that’s not the entire basis for our decision! We did some research and learned that even according to the CDC (where one might expect to find negatively slanted statistics), for low risk pregnancies, home births attended by a trained midwife have a statistically better outcome for both mother and child than do comparable low risk hospital births.

So having established that birthing at home was a safe and reasonable choice, we moved on to weighing the reasons to do so:

  • I’ve never enjoyed hospitals. Quite frankly, they give me the heebie jeebies. There’s just too many needles there.
  • Labor is uncomfortable. I had no desire to hop in the car for a long bumpy ride during labor.
  • I wanted to avoid unnecessary interventions and procedures that would likely slow my recovery, such as an episiotomy. Especially since an espisiotomy would require the application of needles to certain areas of which I am highly protective.
  • Hospitals are generally for sick people. I don’t want to think about all the germs floating around there, and I don’t want to bring a healthy baby into an environment full of sick people and pathogens.

We really only saw one reason for us to consider a hospital birth, and it simply wasn’t enough to outweigh all of the reasons above: for most of our children, our health insurance did not cover the midwife’s charges at all, or only provided minimal coverage. Nearly every birth at home cost us more than a hospital birth would have cost. Until we became members of Samaritan Ministries, that is. Now we don’t pay a dime. :)

And so…we birth our children at home. Each labor has been uncomplicated, but our midwives over the years have had a strong medical background, up-to-date training, and the equipment and knowledge to handle most emergencies. They also have a very low rate of transport to hospitals, a very low rate of c-section outcomes, and they know their stuff. And we don’t forget this part: God is in control. Man proposes, but God disposes. We do our best to make a wise decision, and rest in the sovereignty of our Lord.

A man’s heart deviseth his way: but the Lord directeth his steps.

Proverbs 16:9

“There are many devices in a man’s heart; nevertheless the counsel of the Lord, that shall stand.”

Proverbs 19:21

Samaritan Ministries

With the birth of another child looming near, I’ve been meaning to post about Samaritan Ministries, an alternative to traditional health insurance. We have been on both the giving and receiving end of Samaritan Ministries, and were blessed both ways.

Every month, we receive a newsletter and instructions telling us where to send our monthly share and what the family’s need is. We send our monthly payment directly to another Christian family, along with a card or note. We enjoy knowing who receives our monthly contribution and being able to pray for and personally encourage them.

When our son was born, Samaritan members covered every penny of the expense, unlike traditional health insurance policies which always penalized us for having our children at home with a midwife. The outpouring of letters, cards, and Biblical advice from Christian brethren was an added bonus!

The cost of coverage is far less than traditional health insurance; our family pays less than $300/month for 10 members. One payment/year goes to the central office for administrative costs. All other payments go directly to other members.

New members are carefully screened when they apply, but not in the traditional way. There is no physical exam necessary, but your pastor must sign a statement confirming that you meet all of the membership requirements. Just take a look at the membership requirements and you’ll begin to understand why this is not traditional health insurance. You’ll also see part of the reason that it costs so much less: God’s standards for His people rule out many risky behaviors that increase the cost of healthcare for non-Christians.

Questions? Please let us know if you would like more information or if you decide to join – Samaritan Ministries has an affiliate program of sorts, and we would love to offset some of the cost of our monthly contributions! Or if you just can’t wait, tell them you heard about Samaritan Ministries from Life in a Shoe.