It may be that with a new year, many people are updating/changing their healthcare plans, or that our government just instated a rickety healthcare plan of its own (cough, cough), but I have had a ton of questions about Samaritan Ministries lately. So, I figured it was time to write a little update. I'm going to do my best to include some of the specific things people have been asking me along with my personal experience (the only thing I am really the expert on). With this season of life, we are expecting a new baby in March (yay!), and so this review will focus heavily on the maternity need we have submitted. Hopefully I will answer many of your questions as to what that looks like.
For those just hearing about Samaritan, you may want to check out my previous blog posts first:
When we'd just signed up + when we'd been with them about a year.
Samaritan Ministries is a "biblical, non-insurance approach to healthcare needs". Basically, it is a large group (over 38,000 households) of like-minded (Christian) people who have committed to sharing and meeting their healthcare needs by pooling their funds monthly, instead of sending a premium to a traditional insurance company. We've been with Samaritan almost 3 years now and though we would not consider ourselves "sick people", we have shared 9 needs- one emergency room visit for our son, several miscarriages, bronchitis, and now a maternity need.
There are several things you need to know before you jump ship with your traditional insurance company and sign up with Samaritan.
It is a different mindset. You can't treat Samaritan like your traditional insurance company, because it isn't your traditional insurance company. There are very specific things they don't cover (which are clearly stated in their Guidelines- you can read them all here). They do not cover medical treatment that is not need-based. For example, my family was required to get routine physicals when we were applying for adoption. Because none of us were sick, and the physicals were not a result of any sickness, Samaritan did not cover those. The good news was that we still got a self-pay discount for them- we were just not able to submit them to the group.
Samaritan members as a whole have a proactive view of how they handle medical costs. Essentially, we are self-insuring, which has shifted our perspective on how we consider medical needs. I do feel more like a steward of our funds- sending our monthly share to a real person, considering costs and different types of treatment- whereas when we had traditional insurance, I always felt the victim- heading to the clinic in panic mode and then after all was said and done making phone calls to our insurance company to see how much they were going to cover.
You must be able to keep a savings account (I would suggest around 300.00) to help with the cashflow of your medical costs. Samaritan does not accept needs less than 300.00- which means if I need to take Knox to the pediatrician, I know I will be paying a 50.00 co-pay plus whatever medicine he is prescribed. These visits would not qualify for submission, and so having that small savings account makes a huge difference and lends this momma some security knowing I can take care of my son should he get sick.
I love lists, so to keep it as short and sweet as possible I'm going to do some more pros and cons like I did in my last post.
CONS:
• As I mentioned before, certain things are un-shareable. When we submitted our maternity need for this baby (more on that in a second), we had about 1200.00 in bills for genetic testing (i.e. bloodwork that looks for down's syndrome and other genetic defects). Because this was optional for us, and not testing that was specifically prescribed by my doctor because of a concern she had, they weren't able to include those bills. Samaritan did say that if I had a letter from my doctor stating a concern and a need for getting those tests done, they would then be considered need-based and submittable. The silver lining is that we were still able to get a lower self-pay rate from the lab that did the testing and Samaritan is going to include those bills as a Special Prayer Need when our other bills are submitted for those members who want to give above and beyond their monthly share- so we could end up having a portion of those paid for.
They also do not cover conditions that exist before you become a member. This can be a major let-down for people with diabetes or other conditions that require regular medication/maintenance. Again, they will submit those pre-existing conditions as Special Prayer Needs.
• The need submission process can be straight-up frustrating. Perhaps it's pregnancy brain, but I had one hell of a time getting our maternity need submitted- not necessarily because of Samaritan, but because our medical providers aren't used to working with groups like Samaritan. Because we are self-pay, my doctor and hospital both require full payment before delivery. Thankfully, Samaritan allows us to submit needs before the baby is born (this is actually a pro, not a con), but holy moly- it was rough. As I said before, we have two hospitals in town- one that is very self-pay friendly, and one that is not. Of course, my OB-GYN, whom I love, only delivers (and offices) at the latter. So, when it came time to collect receipts and bills for routine OB visits, it was a pain. Samaritan requires that all bills have 1) my name, 2) an itemized listing of what I paid for (lab tests, ultrasound, etc.), 3) any self-pay discounts received, 4) the total before the discounts. The receipts I was given by my OB's office were essentially credit card receipts that only had one payment amount and the date. After attempting to get the type of receipt I needed from my OB office, I called Samaritan in frustration. They were very helpful, and I ended up making a special trip to my OB's office where I had to have an office worker write out the missing information by hand on every bill. Yeah- not for the faint of heart...because every medical office worker wants to be interrupted by that "self-pay lady" who needs you to hand-write every discount on her receipts. :/ But we got it done, and Samaritan accepted those bills.
The hospital has been another thing. When I inquired about the process of having a baby there and being self-pay, they said they'd mail me the "maternity discount packet". I literally laughed out loud when I received it in the mail- it was a stack of papers, typed out entirely in ALL CAPS, that read "MATERNITY DISCOUNT PACKET", with no hospital logo or even an organized cost schedule. It simply listed the amount I'd pay were I to have a c-section, and the amount for a vaginal delivery, along with some other procedural information. I was skeptical that Samaritan would accept it- but they did! Praise the Lord.
PROS:
• New Online Member System. Recently, Samaritan got a new online member system that will allow me to log in and view our needs, shares, and lots of other helpful info. Here's a screenshot of our last need, when I had surgery for the gynecological condition that had caused several miscarriages.
Just an interesting side-note- with this need we actually had about 900.00 in overages that were paid to us after additional self-pay discounts we received, so we got to send that money to other members. It was such a neat experience to send the money we'd saved to other people we knew needed it.
I really like the system so far and have found it very handy for updating when we receive checks and send our shares monthly.
• Submitting a Maternity Need. One of the biggest reasons we had for considering Samaritan was experiencing the birth of our son, Knox, with traditional insurance, and also seeing some close friends also have a baby weeks later without maternity insurance (they were self-pay, and not Samaritan members). I so appreciate our friends' transparency in this aspect- we had the same OB and delivered at the same hospital just weeks apart. I was shocked to realize that in the end, we paid over 3,000.00 more for our birth than they did- and we were the ones with "great insurance"! Seeing that difference really made us question why we were doing what we were doing and really prompted us to start looking into other options.
I stated before that because we are self-pay, both my doctor and hospital require pre-payment. Thankfully, Samaritan allows you to submit a maternity need before the baby is born. We were able to submit all of our bills for regular OB visits, bloodwork, and an estimate from both doctor and hospital for the actual delivery in September. Our need will be published in January, which is when we will receive checks from other members. It's at that time that we will work to pay any currently un-paid bills along with the pre-payment for the doctor and hospital. There will be additional bills after the delivery, and we will just add those on to our current need at that time.
• No increase in "premium" with a new baby. It's incredibly relieving to know that our monthly share (or the equivalent to a monthly insurance premium) will not be going up after we have this baby. Because Samaritan members get to vote on share increases, and we are already at the highest share bracket (currently 405.00 per month for families with 3 or more people- you can check out current rates here), we know exactly what our share amount will be. We do participate in the Save to Share program, which takes care of needs greater than 250,000.00- and have only had to add an extra amount of 10.00 or 20.00 per month a few times for those needs.
• Reduced Shares. Likely because of all the new members signing up, we have experienced a reduced share amount for the past couple months. Essentially this means that the amount of member shares coming in has been greater than the needs submitted, and so as a result, Samaritan reduces all shares that month by a percentage. This month, our share was reduced by 8%, which was a 32.40 savings for us. That is a reflection of being a part of a not-for-profit organization- when was the last time you heard about a traditional insurance company lowering premiums because they could?!?
• Again, the Karis group. Samaritan employs the help of the Karis group (at no cost to members) to help seek additional reductions on bills from medical providers. Basically, when we submitted our recent maternity need, Samaritan identified the bills where we did not receive a self-pay discount and contacted the Karis Group to advocate with those providers on our behalf (with our permission). They take care of the scary negotiating and work out a plan for you. It is amazing. This does not mean that I don't still have to ask for a self-pay rate and/or different payment plans. But in the case I receive a bill from a provider who has not offered a discount, it is really great.
• It really is a blessing to give. I really can't overstate the difference it makes mentally and emotionally to send your monthly share to a real family and a real need. We know every month to whom our money is being sent and what need it is meeting for them. I'm not sure it gets much more biblical or practical than that. Our need this month will be going to cover the costs of a one-year-old's ear tube surgery (something we were very close to needing for Knox a couple of years ago)....and, the check I'll be writing is to a mother named Liv (the name of the babe currently growing in my belly). Coincidence? I think not. :)
Considering signing up? Here's what I would do:
Call your regular doctors/hospitals. One of the most popular questions I get about Samaritan is how the self-pay system works. It is different for every provider. For the ones you frequent (like your pediatrician), I would just call and ask "what if"? We have two hospitals in our city, and while both provide excellent care, one is significantly more self-pay friendly than the other. What I mean by that is- they are more willing and more used to dealing with people that do not have insurance, and already have billing systems and self-pay discounts set up so that payment is clear and easy.
Download the Application Packet. You will need to fill out the application packet that asks some interesting lifestyle/personal questions such as how often you attend church and how much you consume alcohol (remember- different mindset! One huge benefit to this group is that they can say "no" to an applicant, which keeps the group healthier as a whole and costs down- unlike the new Affordable Care Act). A pastor/staff member at your church will also have to sign your application (like they will with every need you submit).
I'd love to answer any questions this post may have spurred in the comments section- so don't be a stranger! If this review has helped you at all, we would love to be listed as your referral when you join. Thanks for reading!