alternative health "insurance" with samaritan ministries

We are often asked about what we do for health insurance, since Shawn and I are both self-employed. For many small businesses, freelancers and self-employed people, traditional health insurance is very expensive and typically very complicated in terms of what is covered. We have continued to check rates on private insurance over the years, and it is much more expensive than Samaritan, especially now that we have a family of 5.

The reason I put "insurance” in quotes above is because Samaritan is not technically health insurance. It is perfectly legal, though!

Samaritan Ministries is essentially a very organized response to Galatians 6:2: “Bear one another’s burdens, and so fulfill the laws of Christ”.

Samaritan is a large group of like-minded believers who share their medical bills and essentially pool their money so that they can alleviate other’s medical bills, and then in turn, have their own covered when it is time. It’s truly a beautiful, Biblical way to handle a major burden, and our family has been blessed by this ministry over and over.

I’ve written about this subject several times on my blog before, but it is time for an update. We have been members of Samaritan Ministries since 2012, and have had a baby and several larger medical procedures since.

A few things you need to know about Samaritan:

• It is not technically insurance, but it is perfectly legal

• You do have to sign a yearly commitment to attending church and living a moderate lifestyle.

• It is NEED-based, meaning it is intended for use with individual medical needs, not chronic conditions.

• Rates for families of 3 or more do not increase with additional children (yay!)

• You’ll likely be paying out of pocket for any needs under 300.00 (well checks, etc.), so you will need a small savings account for those purposes.

• Some medications are not covered (birth control being one), and some medications will not be covered after 120 days

• Dental/Vision is not included

• You can do everything online- it is so easy!

You can view current rates here: https://samaritanministries.org/membership-levels

Our family currently does Samaritan Classic, and we do opt-in to the Save to Share program, which allows us to submit needs over 250,000.00.

Samaritan is FOR YOU if:

• You aren’t finished having babies. Samaritan has GREAT coverage for pregnancy and childbirth- everything was covered for us when Liv was born. One caveat, though, is that they will consider pregnancy a pre-existing condition if you sign up while pregnant. So, if you’re thinking about having children, go ahead and sign up before you get pregnant. :)

• You have more than 2 kids. We love that the rates stay the same for families of 5+.

• You aren’t generally sick, or only go to the doctor a few times a year. Being with Samaritan has changed my approach to healthcare, and I have started incorporating some more homeopathic remedies into our lifestyle before rushing to the doctor. I have learned how to treat a fever or ear infection at home without needing to go to the doctor (of course, I take my kids if/when it gets bad enough!), and I feel more in control of our options, and our health. It’s been empowering, honestly- to know I can take care of my kids. That being said, it’s been wonderful to know we can go to the doctor if we need to, and it’s covered. We don’t worry about the cost any longer.

• You are self-employed, work at a church, or looking for an alternative to the crazy that is healthcare in our world right not

• You can handle paperwork (it’s not that difficult, it’s just different). Being “self-pay” puts you in a whole other category as far as health care providers go. We have been shocked to find that the self-pay rate at many providers is 40-90% less than the insured rate. YES! We have actually received a 90% discount on a surgical procedure before, just because we are “self-pay”. Guys, if that doesn’t reveal that they system is broken, I don’t know what does. This does mean, however, that in many ways you will need to be in charge of the paperwork. Samaritan will ask you to submit your bills for every need, which means you have to obtain and keep up with the paperwork (this is clearly a struggle for me, haha- but I have learned and thankfully Shawn handles this most of the time!).

Major Benefits:

• No limits on network. You can go to ANY doctor you choose. I think this is so freeing and I love that I have the ability to research and take my kids to the best doctor for their needs and not worry about being in-network.

• Low cost. Compared to all of the other options out there, Samaritan’s monthly costs are low. Much of this is because of:

• The Karis Group. This is an advocacy group that Samaritan utilizes to lower medical bills for their members. Yes, that is right! More than once we have benefitted from the Karis group. Recently, Shawn had an emergency appendectomy and the bill totaled over 17,000.00. We sent our bills in to Samaritan, who then sent them to the Karis group, who researched and negotiated that amount FOR US down to just over 5,000.00- all of which will be covered for us by Samaritan members. Friends, I don’t know how much better it can get than that.

• Prayer and notes of encouragement. Samaritan encourages their members to pray over the needs they receive each month. This means that we receive an actual person’s name and medical need each month, and pay our share directly to that person. It is really a cool process to be a part of- both on the giving and receiving side. We have been prayed for and had the honor of praying for others in their time of need. I will never forget the time a Samaritan member sent me an incredibly kind note and Christmas ornament after we submitted some bills from a miscarriage. It was such a powerful picture of the body of Christ holding each other up.

• Other perks- like getting to vote on the board of directors and share increases (when was the last time your insurance company asked you for your input on its leadership?), and the Special Needs Adoption Fund (of course we love this!).

• Occasionally our monthly rate is lowered because there were overall a lower amount of needs. Isn’t that awesome?! We never pay more than we need to.

• GREAT customer service. I will never forget being brought to tears when I was trying to deal with our insurance company after having our son, Knox. I was pushed around to several different people, didn’t understand the terminology, and felt helpless. I don’t ever hesitate to call Samaritan, because I am always able to speak with a helpful person, who usually ends up praying with me before we get off the phone (not kidding- it’s awesome!).

• Discounts of prescriptions. Samaritan has a prescription discount card we have found very helpful. I have also learned to ask for generic prescriptions from our doctors or remind them that we are self-pay, so they usually give us a less expensive option (sometimes even free samples so we avoid having to get the prescription at all!)

Unfortunately, part of the reason Samaritan works so well for its members is because it has some restrictions in place to keep costs down and the community of one heart and mind.

Samaritan is NOT FOR you if:

• Do not attend church, uncomfortable with asking a pastor to sign your need form (required to submit your bills)

• Smoke

• Have pre-existing conditions (yes, this includes pregnancies that begin before you are a member). Sidenote: we did learn that some pre-existing conditions can be considered “healed” or no longer an issue with a doctor’s note saying that the symptoms no longer exist or you haven’t had issues for a long period of time.

• Need monthly medication covered. This partially falls under pre-existing conditions, and the fact that they typically only cover medications up to 120 days after prescribed.

I hope this has been helpful! Feel free to comment with any questions you may have, or give Samaritan a call.

We will get a referral discount on our monthly share with Samaritan if you put my name (Lissa Anglin) in the referral space when you sign up. We are big fans of Samaritan and I’d be sharing regardless, but I so appreciate it if you include my name.

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having a baby with samaritan ministries • updated real-person review

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!

samaritan ministries review • a year later

UPDATE! I've written a more recent review here, though this post will touch on a few things not mentioned there: 

http://lissa-anglin.squarespace.com/blog/2014/12/3/having-a-baby-with-samaritan-ministries-updated-real-person-review

Over the past week I have had 4 different people contact me to ask about Samaritan Ministries- so I guess it's time for an update!

You can check out my first post about Samaritan, written almost exactly a year ago, HERE. At that time, Shawn and I were just 3 months into our "non-insurance" plan with Samaritan Ministries.  Basically, Samaritan is what you would call a bill-sharing service. At its core, it is a collective of Christians who have committed to help meet each others' medical needs. If you want to get a good general overview of it all, there's a great video at the end of this post. 

Each month, we receive the name and address of another member who has shared a medical need with the group. We get a short description of the need (i.e. Tom fell and broke his arm), which helps us pray more specifically for that person. We send our set amount (ours is currently 355.00) directly to the person, along with a note of encouragement. 

So, how do we feel about it a year later?​

Great. Really great. I've never actually heard someone say they felt affection toward their medical insurance provider, so I count it as a real blessing to talk about mine in a positive manner. :)

As I did before, I'll go through a few pros and cons we've experienced over the past year.​

CONS:​

• The rates went up a bit. One of the biggest things that interested us in Samaritan was the fact that the monthly rate for a family of 3+ was simple and straightforward- 320.00. About mid-year, Samaritan sent out a letter stating that the current rates were not completely meeting the increasing number of shares, and we ​needed to vote on a rate increase. After the vote, our rate changed to 355.00- still well under what we'd be paying with traditional insurance as 2 self-employed people with a child. I could consider this a pro in a sense, though, because I actually got some input on whether or not the rate should increase. That definitely does not happen with traditional insurance.

• Change of mindset/attitude when visiting a doctor.​ Before we were with Samaritan, I'd typically wait as long as I could before taking myself to the doctor- which usually meant I was completely beside myself when I finally made it into the exam room. This isn't true for when I need to take Knox- but regardless, I would just hand over my insurance card and not think much more about it. Since joining, I've had to change my mindset a bit. I have had to do a little research on what "self-pay" rates are at various clinics/doctors. I can't just stumble into the clinic without remembering that I need to ask for some samples if there are any (I've found that most doctors are pretty generous with this)- and also remind them that we are "self-pay" when they are writing prescriptions. I know what pharmacies give free amoxicillin and have focused more on preventative care than ever before. It is a bit humbling to state that we do not have insurance, but after experiencing the completely different pricing schedule most providers have for self-pay patients, it is totally worth it to me.

​• The need process takes a while. When you have a need to submit (and boy did we have some major needs last year- 2 miscarriages which included one visit to the ER, bronchitis for Shawn and I, multiple ear infections for Knox), Samaritan asks that you wait until you receive your bills in the mail, and they send you a Need Packet. You'll list your bills out, including any self-pay discounts given (this is a wonderful thing, because they will count it against your deductible of 300.00. If the total discounts are over 300.00, you will get a full refund of your bills. We have never paid the deductible with any need we've submitted.) The next month, they distribute your name and address to other members, and you wait for checks to arrive. You then send them a checklist to update them on the checks you received and from whom. One of the questions I have been asked most is "What if someone doesn't pay?". This has happened to us once, and it is really a non-issue. You call Samaritan and they take care of it. Most of the time they just re-distribute the amount to another member. All in all, it is around a 3 month process for one need. Which brings me to my next point...

• Cashflow.​ ​Because Samaritan will not accept needs 300.00 or less, cashflow can be an issue. Knox has had an ear infection at least 6 of the 12 past months, and let me tell you- that wears on a bank account. His pediatrician visits are 50.00 at the self-pay rate, and unless he can get the free antibiotics, we are stuck paying for 75.00 antibiotics. So, 125.00 in addition to our normal Samaritan rate was tough at times. Thankfully, we have a separate Health Savings Account that allows us to cashflow small doctor's visits like this more easily. And the truth is, God has provided each and every time- with a healthy child, and with the means to care for him.

​• What they don't cover. One big downside to Samaritan (or any other provider, for that matter) is that they don't cover pre-existing conditions. Thankfully, Shawn and I are generally healthy people, and before last year, never really got sick or had big medical needs. One caveat is when we had to get physicals and several tests done for our adoption paperwork. Ethiopia requires several tests to be run and the physical exam cost us each 275.00. When I called Samaritan about it, they said that because the need was not related to a sickness, it was not eligible to be published. They did say, however, that we could submit it as a Special Prayer Need. I haven't done this yet, but I'm sure I will, as we have given an extra 5 or 10 dollars to the Special Prayer Needs listed on our letters before. For more info on what they do and do not cover, check out the straightforward guidelines HERE.

PROS:​

• We understand it.​ This may sound silly, but after spending hours going back and forth on the phone with our old insurance and the doctor's office, I really appreciate the clear-cut and simply stated literature and customer service reps. In reference to investing, Dave Ramsey always says something to the effect of, "Don't do anything you don't understand". It is such a relief (and gives me such a sense of ownership) to really understand what's going on.

​• Compassion. Twice last year, when I had to call Samaritan to let them know we'd experienced a miscarriage and would need a Need Packet sent, I was responded to with compassion. This was a really big deal for me. They didn't have to care.

​• The Karis Group. With the 30+ bills we've submitted, there have only been 2 providers that did not give us a self-pay discount. In one instance, Samaritan contacted me to say they felt that it was a bill that could be reduced. They asked if I would be ok working with The Karis Group to reduce the bill (free of charge to us). A few days later I spoke with a very nice representative from Karis, who just asked me a few questions about the bill, and a week later- he called me back to say he'd negotiated a reduction! He gave me the amount, address, and protocol to pay it off. It was a great experience to have such an advocate.

​• Baby Makin'. You heard me- they are totally OK with the baby makin'! Shawn and I want a full house. It is a huge relief knowing that we already pay the max amount (rates go from singles, to college students, to couples, and families of 3+), and that we could have 27 more children (haha, ok- that's totally unrealistic), and we'd be more likely to get a high five from Samaritan than a higher rate. And yes, if you're wondering- our adopted child will be covered, too.

• Wise advice. Each month, along with the information we need to send our check, Samaritan publishes a newsletter with lots of articles on everything from the changing healthcare laws, to natural treatments and remedies, to interesting stories of members and their work (missionaries, doctors, etc.). Much to my surprise, I have really enjoyed reading it. It's here I learned about oil pulling and it's nice to hear from a Christian-based perspective about ​things like Obamacare and how it will affect me.

​• Encouragement. It doesn't seem like it would be a big deal, but getting those notes of encouragement along with people's checks is huge. It's a reminder that they've prayed for you, and that you are in this together. When I had my first miscarriage, a lady who'd seen our names in the monthly newsletter (there is a special section for loss) wrote me a long note and sent a special ornament that she herself had received when she'd experienced a miscarriage. I'm glad I'll get to see it every year, even though it will be bittersweet. It's a reminder that God knows how I feel, and He knows the children we didn't get to meet in this life. He also provided others to help us through a tough time. I feel that this is such an authentic picture of what this scripture talks about:

"This is how we know what love is: Jesus Christ laid down his life for us. And we ought to lay down our lives for our brothers. If anyone has material possessions and sees his brother in need but has no pity on him, how can the love of God be in him? Dear children, let us not love with words or tongue but with actions and in truth.​" 1 John 3:16-18

I hope this review has helped shed a bit of light on our experience with Samaritan Ministries! I know there are probably about a million questions I've spurred, and if you do have some- I'd just call them at (888) 268-4377. Or, I'll be happy to go into more detail if you'd like to email me (not that I have all the answers).

​Samaritan does offer credits to its members for referring others, so we would love it if you mentioned us in the referral section of your application should you apply. However, I'd be saying all of this regardless!