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