A Better Alternative to Health Insurance (Really!)

From Fearless Parent, by Louise Kuo HabakusFearless-Parent_A-Better-Alternative-to-Health-Insurance_FeaturedLast year, we canceled our Blue Cross Blue Shield plan because we found a better alternative to health insurance. Yes, you read that correctly. We signed up forSamaritan Ministries International, a health care sharing ministry. It took me the better part of a year to make the switch because I was afraid to cut the cord (and my husband thought I was nuts). I wrote about our decision process in this blog: Buh-bye, Obamacare! Hello, Health Care Sharing, which provoked a lot of interesting discussion and some intrepid defectors who joined us (read the blog comments).

So, here we are, one year later. I wanted to report back to let you know how we’re feeling about our choice. And if you’re in a hreealth care ministry, I’d love to hear about your experience. For us, it has been…

The.Best.Decision.Ever.

Seriously. I wish we had done it sooner. In fact, I wish I had signed up while I still had corporate health insurance coverage over a decade ago. Want to know why?

We would’ve had the love and support of a community that really cares about its members. Think that’s corny? Just ask any Samaritan member with a medical need who switched from health insurance about her experience during a health crisis and it will blow you away. I, for one, burst out crying. More about that below.

We would’ve saved even more money… not just on the net monthly differential of the two options, but on the many tens of thousands of dollars in deductibles, co-pays, and the scads of other unreimbursed expenses that would’ve been “shared” (in Samaritan parlance).

We would’ve had a greater degree of freedom to explore the practitioners and treatments that we wanted. When you’re plowing a fortune into health insurance, it’s a kind of financial masochism to avoid nearly every kind of practitioner or treatment that’s covered… but that’s what we did. So we ended up paying into two separate systems — conventional and integrative/functional/alternative. No more!

We would’ve been supporting a program that is aligned with our values all along. Being in integrity with our beliefs feels good. It really bothered me to pay that Blue Cross premium every month. The concept behind health care sharing ministries pre-dates insurance; it harkens back to ancient times when communities came together and helped one another. It worked then and it works now. It’s an idea whose time has come… again.

Our first medical need

So… as fate would have it, our son was diagnosed with a serious eye disorder a few months ago. This came out of nowhere, during a routine eye exam for visual acuity by an eagle-eyed OD, and we were gobsmacked on every level. Members for six short months, I dialed Samaritan, feeling a combination of sheepish, overwhelmed, and incredibly anxious. Ugh… what if this doesn’t work?

I was filled with dread. Calling insurance companies usually goes something like this:

  • The recorded prompts send me to the wrong department.
  • I’m put on hold and it takes a very long time to reach a live person.
  • The reps are often apathetic or adversarial.
  • There’s almost always a deductible to satisfy or some other provision that explained why the treatment isn’t covered.

But with Samaritan, I was in for a big surprise:

  • A rep answered after two rings.
  • He emailed me forms and set everything up.
  • He invited me to contact him directly, by phone or email, if I needed anything further.
  • And then he asked if I would mind if he prayed with me.

Eye roll anyone? Not here. The floodgates opened and I allowed myself to exhale, with tears streaming down my face. A stranger in this new community reached out through the phone to hold my hand and offer up a fervent prayer for guidance and healing.

The call was warm-hearted, palliative, and hopeful. This very frightening thing was happening in our family but we now had a real ally. And the financial side of it was not going to add to our woes. I would be able to focus my attention on finding the right care for him.

What did Samaritan share?

Since Samaritan is not an insurance company, we don’t use words like claim or premium, nor do we ask “is it covered?” Instead, we say medical need and monthly share, and ask “is it a publishable expense?”

We’re four months into the process. So far, Samaritan has published over $19,000 worth of medical expenses. These include:

  • Comprehensive evaluation at Wills Eye Hospital in Philadelphia
  • Second opinion and follow up evaluations at Weill Cornell Medical College in Manhattan
  • Individualized nutritional assessment
  • Cranial sacral therapy
  • Consultations with a nutritional optometrist, an integrative ophthalmologist, a developmental optometrist, and a holistic pediatrician
  • Surgical clearance from a family practice physician
  • All lab tests
  • All prescribed supplements (up to the 120 day limit)

We are free to choose all providers and we aren’t limited to a list of in-network physicians, therapists, labs, or hospitals.

Guidelines are member-driven. Here are a couple of things that members don’t share:

  • Travel expenses that are not pre-approved. They will share plane travel and lodging for treatment that is not available locally or that will reduce costs.
  • Specialty food items and food processing equipment that are prescribed by a physician.

We’ve received 41 checks from Samaritan members so far… almost all of them containing really lovely cards and notes, with prayers, kind messages, and sometimes even little drawings.

Helpful to know

When we first evaluated Samaritan, I did a lot of research… but there are things that I could’ve only learned by going through our first medical need. Here are a some more answers and a bit more perspective after almost one full year under our belts:

DOES THIS MAKE SENSE FOR MY FAMILY?

First things first, Samaritan is a Christian health sharing ministry and there are important eligibility criteria. If your family isn’t Christian, there are other choices… I’ll discuss another option below.

If your family is never sick, this could be perfect for you. You have no pre-existing conditions so future medical needs will be publishable. And for most people, your monthly share will be a fraction of what you pay into insurance. We pay $405/month, about 20% of what we would’ve been assessed under ACA.

If you have a pre-existing condition, don’t rule Samaritan out. The limitation applies to the specific diagnosis. For example, you will not be permitted to publish expenses for the Lyme disease that was diagnosed two years ago. You would, however, be able to submit them as a Special Prayer Need. This means that members may voluntarily send checks to help defray non-publishable expenses. And they do. Further, if you develop something else, say hypothyroidism or severe allergies, even if it’s precipitated by the Lyme disease, that’s a separate medical need and expenses for that need can be published.

If you have health insurance, this kind of plan can still make sense. Samaritan will share expenses for an approved medical need that are not covered by your insurance company. As we all eventually discover, having health insurance doesn’t mean you’re fully covered. This includes deductibles, co-pays, balance billed items, and out-of-network treatment. Depending on the type of medical condition, this can save you a lot of money.

If you have health insurance and don’t want it, your employer might give you a credit if you opt out. Ask!

If you want your employer to offer Samaritan, suggest it. It will be a lower cost option and they’ll probably love you for it. If you are a small business owner who is obligated to pay through the nose for employee coverage, this might be the answer to your prayers. Their number is 888-268-4377.

If you have a very complex medical need that threatens to blow through the $250,000 per need cap, there’s always “Save to Share.” You can read about it here. It’s simple to understand and very inexpensive to add. Most months, you don’t pay anything at all. In the past year, I paid less than $20 towards this program to support other members. In over 20 years of operation, Samaritan’s Save to Share program has been more than sufficient for needs that have exceeded $250,000.

HOW DO I KNOW WHAT THEY WILL PUBLISH?

All our publishable expenses were prescribed by a licensed practitioner. If your doctor prescribes it, Samaritan will consider publishing it.

Up to 40 therapy treatments of all kinds (chiropractic, physical, occupational, cranial, etc) per medical need will be shared if ordered by a licensed provider. There is no cost restriction on the cost of the therapy.

Samaritan was prepared to share the purchase of a prescribed medical device, up to the cost and in lieu of the remaining allocation (now about 36) of in-office therapy sessions with that same device. We’re trying to decide if this makes sense. If we decide to sell the machine, we promise to send the proceeds to Samaritan to be shared with other members.

Samaritan will publish up to four months’ worth of supplements prescribed by a licensed practitioner, if accompanied by a treatment plan specifying the formulation, dosage, and frequency. Supplements purchased outside the four-month window can be submitted as a Special Prayer Need.

HOW DO I JUGGLE THE PAPERWORK?

It’s not too bad but you do want to be organized. While you’re face to face with the practitioner, ask for what you’ll need… namely, an itemized bill and a prescription for any supplements, medication, therapies, or other treatment. Have the forms with you so they can be signed on the spot. The member sends all documentation by mail to Samaritan.

As a self-pay patient, some providers will apply a meaningful discount if you offer to pay in full. If you have difficulty obtaining an itemized bill from a provider, The Karis Group will intercede on your behalf.

It takes over two months to start receiving checks. Most providers are patient and will wait if you explain there will be a delay. Samaritan processes all need submissions received by month-end. Most recently, I sent in documentation for expenses incurred in October (and one from September; it took awhile to get the superbill) by October 28, to make sure it was received by October 31. It takes them a month to process and approve (or decline) the expenses. Most members send their monthly shares by the third week, so I can expect to receive October’s expenses by mid- to end-December. If The Karis Group gets involved, it can take an extra month.

HOW EASY IS IT TO COMMUNICATE WITH SAMARITAN?

Samaritan communicates and shares information by phone, e-mail, mobile app, and web portal. A rep calls me by phone every month to let me know what was published. I can send an email to inquire about administrative issues, including follow up for missing checks or requests that checks be re-issued (i.e., payable to me and my husband and not to my son). As for record keeping, all checks can be logged online. Samaritan just wants to know three things: 1) who’s it from? 2) what’s the check #? 3) did they send a note?

Easy-peasy.

WHAT IF WE’RE NOT CHRISTIAN?

Look into Liberty HealthShare, which is another eligible health care sharing ministry under the Affordable Care Act. These are the biggest differences:

  • Liberty has three different options that offer 70% or 100% cost sharing, up to $125,000 or $1 million per incident, with a $5 million lifetime limit. Samaritan has one program for all members, with 100% cost sharing up to $250,000 per incident and no lifetime limits.
  • Liberty charges an annual membership fee — $125 the first year, then $75. Samaritan assesses a one-time $200 fee.
  • Doctors send bills to Liberty. Members send bills to Samaritan.
  • Liberty shares annual physical exams. Samaritan does not.
  • Liberty has special rules for pre-existing conditions and provisional membership status for those with chronic health conditions.
  • Liberty allows members to worship in their own way as long as they believe that personal rights and liberties originate from God. Samaritan requires members to attend church.
  • Liberty allows for same-sex marriage. Samaritan does not.
  • Liberty does not have a program that invites members to share expenses outside guidelines.
  • Liberty reimburses providers at the Medicare allowable rate plus 50-70%. Samaritan

This is the thing you wish existed

For increasing numbers of people, health insurance is broken. It’s overpriced, wasteful, adversarial, and in many cases it is explicitly harmful because it incentivizes the wrong behaviors and treatments. We know about the unholy alliances with drug companies, academic institutions, and government bureaucrats. We are tired of the scale of corruption and back channel dealmaking… not to mention the multi-gazillion dollar pay packages of the corporate CEOs running these behemoths.

I love this idea of health care sharing. Simple though it may be, it’s powerful. It’s a bit of ancestral wisdom that has the potential to be a kind of disruptive “technology.” Imagine what could happen if millions of people opted into a better system?

If you choose this option, we’d love to know. And if you tell Samaritan that Fearless Parent™ (Louise #64821) sent you (ditto for Liberty, just mention Kelly Brogan), they’ll send us a small referral fee that will help support our work.

Louise circle 8-7-14Louise Kuo Habakus is the founding director of Fearless Parent™, lead host and producer of Fearless Parent Radio™, and mom of two. She is a published author, runs the non-profit Center for Personal Rights, lectures widely, and has appeared in numerous media outlets, including ABC World News Tonight,Fox & Friends, and The New York Times. Louise was a Bain consultant and a C-level executive in the financial services industry. She holds two degrees from Stanford University. She is an advisory board member of GreenMedInfo and The Documenting Hope Project.

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Source: A Better Alternative to Health Insurance (Really!) – Fearless Parent



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