Monday, February 29, 2016

Samaritan Ministries Q&A: Share the Burden

I have people ask me constantly about our healthcare with Samaritan Ministries, so here is a post to answer many of those questions! Some are based on what I hear, and some are ones you've actually sent me. Always feel free to send more my way. I do ask if you join because of us that you would write us down as your referral. Here we go...

Q: How is this different from insurance?
A: I wrote extensively on this in my first post, so this answer here will be the short version. 

There are many ways Samaritan is different. The first way is that Samaritan, unlike insurance, is not a guarantee. Honestly, I'm not sure I ever viewed insurance as a guarantee, but since our government does, I'm going to note it as a difference. Samaritan sees healthcare much the way the Acts 2 church is described - we all need to share in each others' needs! That is done by joining together with others, who have committed their lives to Christ, to share the burden of healthcare.

With insurance, you give money each month to the insurance company to "insure" your needs will someday be covered, should they occur. With Samaritan, you write a check each month to someone with an existing healthcare need. With your check, you are supposed to send a note of encouragement too. We love how personal this is and that we know exactly who are money is going to and what it is covering. 

For more on this, read that post linked to above.

Q: What is the actual cost per month? 
A: For our family, it is $405 per month. That is the cost for families with three or more people. You can look up specific rates here. The cost would vary based on your family circumstances and size.

Q: What are the variables on cost per month? 
A: I listed the rates above. Other than those, what we pay can sometimes vary. We've had many months where the cost is less that $405, simply because there are less needs shared that month than there is money in the pot. In those cases, we are only asked to contribute the amount needed. 

My husband and I have also opted to be a part of the "Save to Share" program, where we save an additional $399 per year in order to help other families, who are part of this same program and have bigger needs. I'll talk more about this in a bit. However, some months, as participants in this programs, we are asked to contribute a little more to the person in need. We have yet to contribute more than $20 extra in a given month to the person in need, and since we've joined, we have only had a handful of a months where we've even needed to give any extra money for "Save to Share." 

Q: What steps do you take to get it? Can anyone join?
A: If you are a Bible-believing Christian and are actively involved at a church, where you are a member, then you qualify to join. Be sure to read Samaritan's foundational principles. Fill out the online form or request one by mail

Q: What steps do you take to make a "claim"?
A: What insurance companies often refer to as "claims" are actually called "needs" by Samaritan members. When you spend over $300 on one particular medical need, call Samaritan and they will set up the need for you and send you a three page packet where you describe your need and list out your bills for that need. It's really that easy! 

Q: How much time does the paperwork take? 
A: it does take some time. When we have had an on-going need, I usually schedule a couple 1.5-2 hour windows, while my youngest is napping, to fill out forms, gather my bills, call billing departments if needed, and make copies. 

Q: Call billing departments? 
A: Yes. As a Samaritan member, we agree to be good stewards with money. Therefore where we can get a discount, we do. This works by calling the billing department on a bill and saying, "Hi I'm Ashleigh Lankford. I'm calling about account {xyz} where we had {such and such need} performed. I'm cash pay. Can you give me any discount?" They almost always reply with a 20-50% discount. I've had as little as 10% taken off and as much as 80% taken off. There are some doctors today that only accept cash, so in their offices, we are not offered a discount, which is totally okay! 

This may seem like a pain, but this has actually been one of the quickest parts of the paperwork for me. And it ends up being more than worth the five minute phone call, since any discount you get is taken off the $300 you put towards your need. Essentially, you can pay $0 towards your own need if you do the necessary work to get your discounts. You will never be owed money or pay a negative amount towards your own need, but $0 is possible. 

For two of our three needs, we have paid $0 towards our end total because our discounts have been substantial. For this third one, I have chosen to see a cash pay doctor, a second doctor who does not offer discounts, and a naturopath who is cash only. Therefore we will end up paying close to the $300, receiving only small discounts on prescriptions I've had filled and used the app Needy Meds on to receive a discount. 

(Please note that when I wrote this we were on our third need. Since then we have added a fourth need, my daughter's food sensitivities.)

Q: "My concern when looking into it was that we would have tons of expenses that are under the threshold. I think our kids' sick visits are usually right under that. I wasn't sure how I could budget for that. So I guess the question is, do you have lots of expenses under the need threshold? And how do you budget for that?" (Taken from a Facebook question)
A: We do have some. There are multiple ways we could go about this. First of all, the $405 we pay per month is much less than the amount we would be paying with insurance, so we could easily set aside the difference for our doctors appointments, supplements, etc. 

For us, we had money in an HSA when we first joined Samaritan, so we chose to simply use that as our money towards doctors appointments. Every few years we have put one of our extra paychecks towards health needs, and that has been sufficient for us. 

Also when people join because of us and write us down as their referral, we get $180 off our next month's share. We put that $180 towards doctor appointments, supplements, etc.

Q: Any other thoughts on how this has made sense financially? 
A: I cannot say enough how BLESSED we have been through Samaritan. Truly blessed. 

Here's a simple example: My oldest daughter Lilleigh has been dealing with food sensitivities. There is a variety of testing you can do for this, but I kept hearing great things about a specific naturopath who uses the Asyra machine to scan your body for sensitivities (along with anything else that may be going on). I took it upon myself to book an appointment with this naturopath. Lilleigh's appointments to see our naturopath and the supplements she's been prescribed by her are all covered. We do pay the initial $300, but that's it. Insurance would not have covered a naturopath, in my experience. Plus, our deductible was much higher than $300 when we were on insurance, so even if they had covered a naturopath, we would have had to pay $5000 before the insurance kicked in. While this need won't come close to $5000, it is definitely already over $300, and we have few more appointments to go, at least.

A more complex example: I've been very open about my health issues I've had going on. I'm currently being treated for thyroid and adrenal issues. I started by seeing a hormone specialist, who did not accept insurance. He ran many tests, and his office visits were not cheap. A couple months in, I sought a second opinion from the doctor I am currently seeing. This doctor does accept insurance. She ran many more tests and came to a different conclusion. At the same time, I decided to see a naturopath, who I knew could scan my body to confirm what we thought was going on and also to see if there was anything we were missing. Insurance generally does not cover naturopaths. In addition to office visits, this naturopath also prescribed me many supplements to get my body back on track. Every doctor I saw was at least $250 for the initial appointment and not much lower than that for follow-ups. Add in my labs, four months of my crazy amount of supplements, a couple of prescriptions, and we are currently looking at a few thousand dollars of medical bills that Samaritan is covering. Y'all, on insurance, I would have had to pay for two of these medical professionals out of pocket completely. Supplements definitely would not have been covered. My couple of prescriptions would have been discounted. And anything that insurance might have been able to cover, such as my current doctor and those labs, still falls below the threshold. So right now we would be looking at around $3,000 in medical bills to pay from savings, and I have many more appointments and supplements to go. I was unable to receive many discounts since most of these doctors are cash pay anyway, but the prescriptions were discounted by $10 here or $20 there, which means we are paying a little less than $300 for this need. We will be budgeting for supplements beyond the four month mark, and that expectation seems really reasonable to us.

More numbers to offer a big picture perspective: I've mentioned that we have had four needs in a little over two years. These have been a trip to the ER for a severe stomach bug, our miscarriage, my thyroid/adrenal issues, and food sensitivities. We are paying less than $600 for all four. 

Q: Do you worry about something BIG coming up, like one of you getting cancer or some disease that requires a hefty treatment plan?

A: Honestly, no. Part of being in the Save to Share program means any need over $250,000 will be divvied up among those in the Save to Share program. There are cancer cases, of course. That's a big question I get. There are big surgeries and life-threatening illnesses. My family's needs are a blip in what Samaritan sees. They're "easy" needs. I would STRONGLY ENCOURAGE you to sign up for Save to Share if you are considering Samaritan. The amount extra that you save is minimal, and that $399 per year is money well spent should you ever need it. 

Q: How have you been blessed by being a member of Samaritan Ministries?

A: Oops I kinda answered this above. But I'll say it again. We are so very grateful for Samaritan. I'm not sure you could ever twist our arms enough to get us to switch back to normal insurance so long as Samaritan is an option. 

Q: What are the drawbacks? 

A: If you have a pre-existing condition, this is not covered. If you have a pre-existing condition that is still requiring a lot of maintenance and treatment, you may want to weigh the cost of something like Samaritan with your current insurance plan. 

Please please send any questions my way! I am here to chat! All I ask is that if you join Samaritan because of this blog post, please do write us, Brendon and Ashleigh Lankford, as your referral. This post has taken forever, so please 

2 comments:

  1. We have been with Samaritan's over a year and unfortunately every expense we incurred last year fell under the umbrella of "symptoms existed before becoming a member". So I do want to add that caveat, it is a "pre-existing condition" restriction, of sorts. If you are like me and have been experiencing symptoms for years and are still in the process of trying to identify the issue and become a member in the midst of it all, Samaritan's will not be able to help. And since you are without insurance, you will pay for it out of pocket. You can submit it as a "Special Need" but since the individual visits, tests, and treatments all fell under the $300 minimum, that doesn't work for us either. Just wanted to give you a heads up if you are thinking of switching while currently treating an ongoing issue.

    ReplyDelete
  2. Right. Pre-existing symptoms do classify as a pre-existing condition. That's pretty standard.

    I think you are misunderstanding some of the system too. An individual test does not need to be over $300. Your entire need does. So my stuff has been a $250 appointment, $20 lab, $60 lab, $12 prescription, etc, but it all adds up to much more than $300.

    ReplyDelete