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.
• 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.
• 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.