The Need Process
Samaritan Ministries is not health insurance. It’s healthcare sharing for Christians. As a result the processes are a bit different than you’re probably used to. We found that Samaritan’s methods make more sense and put us more in control of our healthcare AND help us keep more of our money in our pockets instead of being stuck with huge bills.
With traditional health insurance you pay a monthly premium, you have a fixed deductible, and you have co-insurance (the portion of each medical bill you are always responsible for until you meet the max).
It’s different with Samaritan. Every month we send a monthly share, similar to a premium. Instead of sending our premium to an insurance company, we send our monthly share amount directly to a fellow member who has a medical need. None of that money runs through the main office, which gives us total transparency about who is getting our monthly share. In our case, our monthly share is $607.27 cheaper than the least expensive premium offered to us by Blue Cross for 2016 and $993.35 cheaper than the only plan they are offering us for 2017.
$993.35 x 12 = $11920.20 per year we are saving just in monthly “premiums”!! Many families save even more since the monthly share for a family is $495 no matter how many children you have. Initially I was hearing of families who saved well over $1000 a month by joining Samaritan Ministries, but with the rising premiums that figure has grown to over $2000/month that some families are saving.
Samaritan’s office organizes and matches up the shares with those having a need. They have a sophisticated database which does all the matching, so each member gets a customized newsletter telling them where to send their money. One month we may send to someone in South Dakota with prostate cancer, the next month it could be a family in Florida who just had a new baby. Along with our monthly share we also send a note of encouragement. We pray for that person. We are sharing far more than money. Members not only get their medical bills paid they also receive the spiritual benefit of knowing that so many people are praying for them.
What if you have a need yourself?
- You see your doctor. There’s no network to worry about. You see the doctor you want to see. You work out a treatment plan that fits your needs, there’s no need for your doctor to ask permission from your insurance company to treat you. The relationship is you and your doctor, there’s no longer an insurance bureaucrat standing between you and your healthcare.
- Call Samaritan and tell them about your need. Or you can also submit needs online through your online account and a rep will contact you within 2 days to continue the process (you can choose email or phone). They will pray with you. After verifying that your need meets the qualifications for sharing they will send you a simple form that you fill out to help you easily organize the bills you will be getting OR you can do the entire process online including bill submission.
- The doctor/hospital sends you a bill. You tell them you’re self-pay and request any self-pay discounts they offer (many doctors and hospitals offer generous discounts for self-pay because they don’t have to deal with the insurance company and also get paid faster). Look over the bill, check it for double billing, error billing, etc.
- You submit an itemized bill (showing the discounts you got) along with the simple form to Samaritan (either by mail or online).
- Samaritan will also review your bills for errors (80% of medical bills have at least one error, per http://consumerist.com/2009/05/14/80-of-medical-bills-have-errors/) and also have the Karis Group contact your medical provider if they feel additional discounts could be obtained (SMI contracts with Karis to do this for us). All of this is done for you at no additional cost.
- Samaritan will then publish your need to as many members as necessary so that your bills are paid.
Is there anything not shared by Samaritan?
Yes. Samaritan is very strong in the Christian faith and does not share needs resulting from unhealthy, non-Christian living. So abortions, birth control, injuries resulting from drunk driving, alcoholism, drug abuse, or promiscuity are not covered. These things are clearly outlined in their guidelines (found here). Additionally, preventative care is not shared. Samaritan follows Galatians 6:2 and 6:5, where we take care of the small burdens ourselves and we share in the larger burdens with others. To that end, regular checkups and physicals are not shareable under the guidelines. Additionally, pre-existing conditions are not shareable, although for most conditions if you have been considered cured with no treatments, symptoms or medications for a year then it’s no longer considered pre-existing (some have a 5 year term like cancer and heart conditions). Everything is detailed in the Guidelines. For those pre-existing conditions and anything burdensome which doesn’t meet the guidelines for standard sharing, Samaritan offers an additional resource through Special Prayer Needs to help members obtain financial help with those needs. (When was the last time an insurance company gave you an avenue for additional resources?)
What portion will I have to pay as the patient? — similar to a “deductible”
As the patient, we have a $300 personal responsibility for each need, similar to a deductible. It can actually become $0 with discounts being applied to that portion first. Think about how great that is. Let’s say you get billed $1200 for services and they discount the bill by $400. The bill is now $800, but because your discount was at least $300, you will have no personal responsibility left to pay! Samaritan actually reduces your responsibility to zero because your discounts count toward it! Think about that. Has your insurance company ever reduced your deductible?!? Wow…
A need is defined by a single event. So if you see 4 doctors over the course of 6 weeks to treat a single incident and each bill was less than $300, but all 4 together added up to more than $900, that is published as a total need of $900+ even though each bill was less than $300. If we get $50 in discounts, our responsibility is $250 and Samaritan would share the remaining $650 with other members.
Technically we have to remember that entire bill is the responsibility of the patient and the money we get from other members is to be used to pay those bills. Samaritan is not insurance there is no contract guaranteeing payment. However, they are a Christian organization with wonderful checks and balances and their history offers assurance that other members will help us cover these bills. As far as I’m concerned this assurance from fellow Christians is more comforting than an insurance contract with a dozen lawyers behind it try to get out of paying and looking for every little loophole. Samaritan basically says, hey: we can’t offer you a legal contract, but we offer you comfort that we won’t let you down. It’s an assurance backed by 20 years of sharing the medical bills of their members and currently over 60,000 (as of Oct 2016) Christian families standing with you in your time of need… Beats those insurance company lawyers any day! Assurance, not Insurance.
How long does it take to receive shares so that I can pay my bills?
Let’s say you break your leg and get treated in May. In June you’ll hopefully have all your medical bills from that event. You send those bills to Samaritan in June. Samaritan will publish your need to other members in August. You will have most, if not all, of your payments by August 20th. A few members may pay toward the end of August, but mostly you’ll have the checks by the 20th of the month. Samaritan will spend time in June and July to check your bills for errors and ask for additional discounts (unless you got a big enough discount on your own that they don’t need to get more). Really large needs may get spread over a couple of months, especially if more and more bills are still coming in for that event… and we have to be sure we are submitting fully itemized bills (don’t let the hospital get away with one line and one total dollar amount). If they think it’s warranted, Samaritan uses the Karis Group to negotiate additional discounts on our behalf. They are polite, respectful, firmly gentle, and very successful. They save an average of 44% off our medical bills which is beneficial for all members. Karis understands we want to maintain good relationships with our medical providers and they work for discounts from that perspective. I appreciate that very much.
Do I pay the bill myself and get reimbursed?
You can. Depending on the size of the bills some members will pay the entire thing and pay themselves back when their Samaritan shares come in. However, many times it’s best to pay just the minimum amount for those two months and allow Karis to negotiate further discounts for us. If we pay the bill in full then there are no more discounts to get. This is obviously a bigger deal if the bills are very large. Sometimes we can get a large discount right away by paying in full quickly. This is ok if you have the cash around to pay it. If you don’t have the cash to pay it (or credit card), just pay the smallest amount they will allow, and assure your provider you will be paying the rest within a couple of months. You can explain the process to them. Healthcare sharing ministries have been around for over 30 years, many providers are becoming quite familiar with it and love how easy it works for them.
What if someone doesn’t send me their share?
It’s possible, but it doesn’t happen often. Generally members are very happy to quickly send their share and their notes. It’s part of the draw of membership to be participating and actively helping with the needs of others. However, members may forget and be a bit late, or the post office lost it or have some other reason to cause a delay. Samaritan will give us a checklist of names and amounts we should be expecting for that need. It’s a simple list, allowing us to know in advance what to expect and who it’s coming from. We keep it for the month and send it back to Samaritan (or update our online members area) noting anyone who forgot to send their share. Samaritan will remind them to send it, and usually that’s enough, it comes shortly after. Members are to send their shares by the 15th of the month, but some may pay their bills toward the end of the month. This personally doesn’t bother me, as long as it comes that month. Sometimes its necessary for Samaritan to reassign that need to someone else, which they do the next month. We are never left hanging. Jesus Christ is the ultimate provider for all life’s needs. Standing on that foundation Samaritan works to help make sure that our needs our met during the need process. The sharing process is very organized and closely monitored. It’s not a haphazard mess. It’s very well managed. Our family has a small medical savings fund that we use for non-publishable things like dental appointments, eyeglasses, etc and while we wait for shares to come in from a published need we can draw from that account in order to make small payments to the hospital/clinic. Then when the shares arrive in our mailbox we finish paying all the bills and pay ourselves back the rest.
Don’t they have administrative costs?
Sure. Here’s where they get administrative funding.
- Joining has a $200 application fee
- As new members your first two or three monthly shares go the main office
- Every year on your membership anniversary that one share (so 1 in 12) goes to the main office instead of a member.
- And Save to Share has a $15 annual admin fee.
That’s it. They don’t pay CEOs millions per year. In fact I read the President has a salary of less than $190,000. Compare that to the salaries of top insurance CEOs… they run in the 10s of millions. Ridiculous! This is very non-profit and the goal is to get as much money to member needs as possible. They do have a good sized paid staff. They also have a few volunteers. There’s such a personal touch with Samaritan. Myself and the friend I referred were just shocked that when we called the office with questions before joining, a real person answered the phone! And they are so friendly, so helpful. I hang up from their calls walking on Cloud 9, feeling so loved, so protected and cared for. Insurance companies never gave me that feeling, ever.