Revisiting Samaritan Ministries...

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Back at the end of 2013, on the eve of Obamacare coming into effect for most Americans, we wrote some posts about Samaritan Ministries and other Christian health care cost sharing programs. (Here are the links to the series: part one, part two, part three, part four, part five, part six, part seven.) Some of us who joined now have more in-depth experience with Samaritan Ministries, and we thought it was time to give an update. 

Three different families and their experiences inform this update. My wife had a hospital delivery that ended with a C-section. The sticker price was around $30,000, but the total actually paid after negotiations was closer to $10,000. All of it was covered by other Samaritan members. The Weeks family had a normal hospital delivery whose costs, at around $17,000, were all shared through Samaritan. Their daughter, Mary, has had many medical complications since her birth, and those costs have been covered by the state of Indiana's medicaid program. In the Ummel family, Jonathan had a medical emergency that almost took his life. After a life flight from Bloomington Hospital to Riley Children's Hospital in Indianapolis, he eventually stabilized by God's grace. Shortly thereafter he had major surgery in Chicago to correct the underlying problem. The financial burden shared by the Samaritan members totaled over six figures.

As you can see, Samaritan Ministries has played a major role in our extended family over the course of the last year. Each of us is very thankful to Samaritan and the many members who have helped bear our financial burdens. So given our experience, do we recommend Samaritan Ministries? Absolutely, but we must do so with some warnings. As you will see, there is a real non-monetary cost to joining Samaritan, but there are also some compelling reasons to do so...

The first thing that must be said is that the Samaritan Ministries model works—and not just for us. According to Samaritan, there are currently over 50,000 households (165,000 people) in membership, sharing over $15 million dollars of medical expenses each month. Both of those numbers have increased dramatically in the last year, but share amounts have remained unchanged since July, 2014—$405 per month for a family of 3 or more. How is that possible, given the rapidly-rising cost of medical care? A large part of it can be attributed to the hard work the members put into keeping their own medical costs down. Yes, the prohibition of sharing unbiblical treatments and procedures saves money. So do the reasonable policies, such as "no tobacco." Undoubtedly limiting membership to Christians who are members in good standing in a local church, and requiring accountability to your church leaders, also keeps costs down. But there's a more basic method of keeping costs low. 

Lots of work

It is the expectation of Samaritan that you will do your best to keep your own medical costs down for the sake of the other members, and the procedure for filing your requests is the main way they make sure you actually do it. The procedures and paperwork can be a substantial burden.

  1. You must include an itemized bill with your request for help that shows non-discounted charges. 
  2. You are then expected to negotiate a reduced price with the medical provider. 
  3. You must also include a bill that confirms those reduced charges. 

To be clear, these are perfectly reasonable and necessary requirements, but sometimes the first task is herculean, not to mention the second two. Samaritan Ministries is often making the point that it is not "insurance." This is partly because they need to not be insurance or viewed as insurance for legal protection. But handling bills and negotiating prices with healthcare providers is a major part of the work that insurance companies do, and Samaritan does none of it. Instead, as a Samaritan member, you are required to shoulder that burden.

About a week after her birth, Mary Louise Weeks contracted RSV and had to spend the next three weeks up at the Peyton Manning Children's Hospital in Indianapolis. Life was crazy, and the work of collecting itemized bills for the birth and getting them sent off to Samaritan simply fell through the cracks. It was not until the end of February that Lucas finally had bills in hand and worked through getting them all paid. Despite the difficulty of the time, the experience with Samaritan Ministries was very positive for the Weeks:

  • They were able to negotiate lower rates with the smaller, local doctor's office on their own.
  • Samaritan partners with The Karis Group so that Samaritan members can have the Karis Group negotiate bills with medical providers on their behalf at no extra cost. The Weeks took advantage of this, and the Karis group was able to negotiate lower costs with the hospital where Mary was born.
  • The Weeks had intended to have a home-birth, and had already paid for a mid-wife. The baby came too early to deliver at home, however, and the midwife attended the birth at the hospital. All expenses, both for the midwife and all hospital-related bills, were covered under Samaritan's non-insurance.

So despite the significant difficulty of managing your own medical bills, Samaritan does work to make it doable for its members. Of course, if you've ever had to deal with major medical issues and insurance, you know that there's often still a great deal of work involved there, too. On the balance, though, there is no denying that you will do more of it with Samaritan. Sometimes much more.

It can be "more expensive"

Many families with a middle-class income and lots of children will pay little to nothing out of pocket for medical coverage under Obamacare once you take all of the credits and subsidies into account. For those of us within that demographic, Samaritan will cost more than an Obamacare plan. The place where this really comes home is with children's doctor visits. If you've been on government programs or had very good insurance, it's possible that you never think twice about taking your children in to see the doctor. On Samaritan, you will. Routine visits, which can easily cost between $100 and $250, are not shareable, and so you simply have to pay for them out of pocket. And, of course, children get sick all the time: ear aches, colds and coughs, etc. With Samaritan, you'll think twice about whether or not you really need to take your son or daughter in, or whether you'll wait another week to see if the cough goes away.

It's not "normal"

Doctors, office managers, hospitals, and billing departments have often never heard of Samaritan or any similar program, or are confused about how such programs work. And even simply telling them that you're "self-pay" causes consternation for billing departments. This can contribute to the difficulty in various ways, including making it harder to get the appropriate documentation mentioned above. It also means that you aren't likely to understand how it works yourself without studying and learning quite a bit first. This all adds up to a substantial increase in stress, especially as you face your first major medical need using the program. Fear of how and whether it will work, confusion about how to approach it—these things can make an already stressful situation feel worse. On the other hand, Samaritan employees are very helpful in answering questions and helping you understand the process, and respond promptly to email. Once you've done the first time, it won't be nearly as stressful.

Increased financial pressure

The reality of how bill negotiations, hospitals and doctors work is that by far the best way to get the service you need at a decent price is to pay up front or immediately after service. Depending on your financial position and the magnitude of the bills you are negotiating, this could be impossible. For example, the hospital told me that if we paid in full before we left, they would discount the entire stay to $3000. If we waited until they sent us a bill, it would be for the full price—in this case, over $14,000. Nothing necessitated us doing that, but when faced with the prospects of losing that discount, the pressure is certainly there.

A much harder situation was the one faced by the Ummels. Until you have a bill for a completed medical service of some sort, Samaritan members can't help you pay it. In other words, you can't get the money beforehand. Jonathan needed surgery. The hospital wanted proof that they would be paid. The only proof they would accept was insurance, which the Ummels obviously didn't have. A promise to pay, on the part of thousands of Christians, meant nothing to them. Only the legal obligation to pay that binds an insurance company was good enough. Without insurance, they wanted full payment up front—to the tune of $196,000. After about 50 hours of phone calls, hard negotiating, assurances, explanations, etc. they finally agreed to perform the surgery with "only" $30,000 paid up-front. By God's grace, the money was borrowed, and it was soon repaid by the faithful Samaritan members. But the financial pressure was unbelievable, and it was compounded by the fact that the money was needed immediately if Jonathan was to get the surgery in a timely manner. Delay in getting the money might actually have cost Jonathan his life. Hospitals like to be paid up front or deal with insurance, and Samaritan makes that all but impossible for major medical needs, unless you've got 10's or 100's of thousands of dollars at your fingertips.

Admittedly, there are similar sorts of conundrums with normal insurance. Attempting to get an insurance company to pay for a necessary procedure might end up being just as difficult, with the same refusal on the part of the hospital to move forward without approval from the insurance company. This is especially the case with rare medical procedures. The Ummels have heard many horror stories about insurance companies simply refusing to pay for an expensive procedure.

Flexibility is a mixed bag

Many doctors offices have no interest in dealing with self-pay patients. The flexibility that Samaritan offered to the Ummels is what allowed Jonathan to have the surgery he needed performed in Chicago by the world's leading expert and the man who developed the surgery in the first place. The importance of being able to get the right surgeon cannot be emphasized enough. On the other hand, when we moved to Cincinnati earlier this year and were looking for a new family doctor, we had difficulty finding one that accepted any form of payment besides insurance. They didn't want our money, just our insurance card.

The big picture

The fact that medical care providers are willing to turn away those who want to pay cold hard cash in exchange for their services is an indication that there is a major problem in the industry. This is important. It may seem like a big hassle to seek itemized bills, carefully examine them for accuracy, negotiate better rates, etc. Yet according to the documentary "Wait Till It's Free," one big reason that healthcare costs are so high is because the costs are hidden from the consumer.

But this leads us to some of the big picture questions about how medical care "should be" in this country. For those of us who have been on Samaritan for over a year now, it seems obvious that if you must handle your medical coverage yourself, you will have a strong incentive to know the costs and keep those costs down. The alternative, it seems, is for government bureaucrats or insurance companies to decide how to keep medical costs down. Of course, we have no confidence that our government or the insurance companies will make their decisions with any fear of God. And should they be the ones making those decisions anyway?

But what does that mean for individual families? It's one thing to have a philosophical commitment to limited government and the doctrine of subsidiarity. It's another thing to claim that Christians have a moral obligation to avoid Obamacare plans. For some, Samaritan, or a similar program, will be cheaper than a government controlled insurance plan. For those of you in this category, we encourage you to give Samaritan careful consideration. For others, an Obamacare plan will be cheaper than Samaritan. Then what? Should you sign up for Samaritan "on the principle of the thing"? If so, what is the principle?

Principle #1: Joining Samaritan as a way to cause change?

As far as cultural and political momentum is concerned, we see it as inevitable, barring a miracle, that we will end up with a single-payer medical system in this country. Americans simply assume that healthcare is a right, and that those who provide it should be forced to give it to them. So does joining Samaritan do anything whatsoever to stem the tide of public and political opinion in this matter? It is our judgment that it does not.

Principle #2: Joining Samaritan provides higher quality of care?

Does Samaritan give you access to superior health coverage? With the flexibility available to you, and provided you're willing to pay for it, the answer is likely that Samaritan does provide either equivalent or superior coverage. Whether or not that superior coverage is worth the cost is an open question. For the Ummel family, the answer was an unequivocal "yes." For others, the answer may not be so clear. And, of course, you must remember that some medical care providers may not be willing to do business with you if you are self-pay as indeed was almost the case with the Ummels.

Principle #3: Joining Samaritan as a moral obligation for God-fearing Christians?

But is it right for Christians to take part in Obamacare? In our judgment, it is indeed foolish (not to mention unconstitutional) for our federal government to require every citizen to buy healthcare. Additionally, the wealth redistribution schemes of our government, both federal and state, should be stopped. That said, we do not believe that it's wrong for individual Christians to take part in government healthcare. As a matter of fact, two of the families contributing to this post relied heavily on government subsidized healthcare. Another approximately $100,000 of Jonathan Ummel's care was covered by Indiana medicaid, although Samaritan would have covered it. Mary Louise Weeks' ongoing medical needs since birth have been paid by the same, and many of them would not be covered by Samaritan. So instead of considering it a moral imperative to remove yourself from government healthcare at all costs, we'd rather suggest that if you can be free from it, you should strongly consider it. Joining Samaritan will give you more freedom to get the care you need without compromising your Christian convictions. This will only become more important as the culture grows more anti-Christian.

At the end of the day, I think it's principles #2 and #3 that should have the most sway with Christians. We're planning to write more on the topic of medical care, its intersection with faith, the government, rights, and mercy in an upcoming post. In the meantime, let us know what you think in the comments.

Joseph and his wife, Heidi, have five children, Tate, Eliza Jane, Moses, Fiona and Annabel. He graduated from Vanderbilt University and Clearnote Pastors College. He is currently planting Christ Church in Cincinnati with several other families.