Samaritan Ministries: How Health Care Sharing Works in the Real WorldHealthy Living
Several years ago, I wrote an article about why we ditched traditional health insurance for health care sharing. It’s been almost five years now since I called Humana, canceled our family’s longstanding health insurance policy and switched to Samaritan Ministries to cover our family’s medical needs.
If you are fed up with how broken health insurance is within the United States and how government gridlock is failing over and over again to fix it, take heart.
Health care sharing WORKS! It is a viable alternative to the expensive and/or limited options most people have going the conventional insurance route. Samaritan is the largest of the health care sharing organizations in the United States. As of February 2017, Samaritan serves over 224,000 members and 68,000 households.
How Health Care Sharing Works with a Real Life Scenario
To help you get your head around how health care sharing actually performs in the real world, my husband and I compiled the detailed diary below of our visit to the ER with one of our children and the subsequent process to get the bills paid. Bottom line: the bill was paid in full by Samaritan in a very timely manner.
Bonus: we paid NO DEDUCTIBLE due to Samaritan’s excellent advice and guidance! That’s right, nothing out of pocket for a visit to the ER!
Health Care Sharing Customer Service is ON YOUR SIDE
Here’s the biggest thing we noticed about health care sharing versus insurance when a health care crisis happened in our family. With the insurance model, the people on the phone from the insurance company are WORKING AGAINST YOU. They want to pay you as little as possible and don’t care about the grief you endure in the process.
With health care sharing, the people on the phone are WORKING FOR YOU. They are on your team. Samaritan Ministries wants you to pay as little as possible and will coach you on how to navigate dealing with the hospital and/or doctor’s offices so that your out of pockets costs are as low as possible. And yes, zero out of pocket is a possibility as you can see from our experience below.
Read on if health care sharing is a change you are considering for yourself or your family.
Paying a Hospital Bill Using Samaritan Ministries Health Care Sharing
In October 2016, one of our children sustained a serious injury on the sports field that required an immediate trip to the ER. Below is a diary of what happened. Included is how the cost of the visit was fully covered by Samaritan Ministries. The process of dealing with the hospital and doctor’s office when you have health care sharing is discussed as well.
- On October 29, 2016 (Saturday), our son was elbowed in the eye by a soccer player on the opposing team resulting in a severely split eyelid.
- I drove him to the closest hospital ER after first calling my brother (internist) and texting him a picture. He said the eye needed a plastic surgery suture. This would prevent potential future problems with the eye opening and closing. I could have gone to any hospital or doctor’s office of my choosing. We also didn’t need to call Samaritan for “permission” first. I called on the phone to find the hospital with the shortest wait time and drove there immediately.
- We checked in at the ER desk which required signing routine papers for permission to treat a minor and commitment to pay.
- While waiting to be seen by the doctor, the hospital staff pressed us very aggressively for partial payment. This was prior to treatment being administered or even seeing the doctor!
- After three hours and excellent work by the doctor including 8 perfect plastic surgery sutures, our son was all stitched up. Then, we were back at the administration desk trying to determine the extent of the bill.
- The hospital admin told us there would be two bills. One from the ER and another from the doctor.
- We told the administrator that we were self-pay. This is what you say when you have health care sharing as this gives you the best pricing. At that point, she offered us the opportunity to apply for a discount. She said we could get a reduction of as much as 85% from the ER bill once we submitted the required forms. We declined to fill out the intrusive financial aid forms, but the hospital admin said she would request a discount in the system anyway. Note, this was the first time in 18 years any of our three children required a trip to the ER. (Thank you natural remedies, traditional diet, and green living lifestyle!) A lot had changed at the ER in the interim! The process was confusing at best.
- A follow-up appointment to remove the stitches was scheduled 7 days later. The hospital staff said there would be no charge to remove the stitches IF we had it done with them at the same hospital. Mistake: we should have gotten that guarantee in writing!
- We took our son home to rest up.
- On Monday morning (two days later), we called Samaritan Ministries to let them know what happened. We were referred to a third party organization, the Karis Group. They did not pick up the phone when we called but returned the call within 24 hours. The helpful agent assigned our file told us to be patient and sit tight to see where the billing ended up. He said to expect one bill from the ER and another from the doctor’s practice.
- Before the bills arrived we took our son back to the same hospital to have the sutures removed. The administrator asked us for a $200 payment which felt strange because we did not even know what the total bill was yet. We paid the $200 she asked for on our credit card.
- Happily, when the bill from the ER arrived in the mail, it already included a nearly 80% discount (this is why saying you are self-pay is important when you have health care sharing). So, there was no need to submit the personally intrusive financial aid application. The ER portion alone was $1,135.53 less the discount of $925.50 netting out to $210.03. We were close to having that paid off with the $200 we had already put down on the second visit.
- When the bill from the doctor came in the mail, we were disappointed to see that they had indeed charged us $191.00 for removal of the sutures making the total bill $1,428.00. Remember, we were told by the hospital that there was no charge for suture removal.
- The total bill combining ER and doctor’s fees was $2,563.50 ($1,135.50 + $1,428.00). That came to a little over $300 per stitch!
- The ER bill was discounted immediately from $1,135.50 to $210.03 which was a nearly 80% reduction.
- Karis Group advisor informed us that, since the discount was more than the normal $300 deductible, then our deductible was covered so there was hope we would end up paying nothing out of pocket! This bears repeating. When you get a discount from the hospital or doctor’s office, it applies toward your health care sharing deductible! This is a nice bonus that we did not know when we originally switched to health care sharing.
- Karis Group took a look at our bills and recommended calling the doctor’s practice to ask them for an uninsured patient discount. Health care sharing is not health insurance, so this is absolutely truthful. They committed to 30% off the initial procedure on the day of the injury. This amounted to $865.90 down from $1,237. The same discount was offered for the subsequent visit to remove the stitches. At this point, my husband informed them that we were expecting no charge for the second visit based on what we were told at the ER. They denied any obligation to wave the second fee. Instead, they offered to reduce the total for the second visit by 50%. At that point, we were willing to live with that to save our nerves dealing with them. This reduced the follow-up visit from $191.00 to $95.50.
- All this back and forth with the doctor’s office and hospital took more than two months. It likely took longer than normal as it occurred over the Thanksgiving, Christmas and the New Year holidays. The Karis Group advisor recommended paying $200 against the full, non-discounted doctor’s bill when it arrived. This made sure we stayed in their system as a paying patient. This also prevented the bill from going to Collections. We knew we would get those funds back from health care sharing members within a short period of time.
- The final bills were settled early in January 2017. It took a couple of iterations since the doctor’s office sent one version of the bill without the fee for the second visit then followed with it included! My husband then submitted everything online to Samaritan Ministries for review. Samaritan’s job at that point was to determine what portion would be “publishable”. This means what portion of the bill would be paid by other Samaritan members.
- Samaritan did a good job dealing with a couple of the iterations and deciphering the correct final amount. As expected, by the end of January, the final amount of the two bills was 100% publishable, i.e., covered.
- Great! The only question left was this. How long will it take for the other Samaritan members to send the funds?
- We soon got the paperwork from Samaritan that explained that the members would pay by early March 2017.
- In the intervening 4 weeks, the Karis Group advisor recommended we keep making small payments to the doctor’s office. Again, this kept us in the system so they knew the obligation was being met. We made another small payment over the next month. Then the shares started coming in from the other members in March 2017. Some members sent their share (approximately $300 per member) as soon as it was published. We used those funds to pay the rest of the bill to the doctor’s office. The funds from the last few members which came at the end of March replenished the funds we had already paid.
- All in all it was a very pleasant experience with the Samaritan/Kamaris staff. All were incredibly supportive and available. They were always happy to help and responded quickly when we needed them to get back to us.
- In the end, the entire discounted bill was covered by the shares sent to us by Samaritan members. We paid nothing out of pocket!
- This was our very first experience getting a health care need covered by Samaritan Ministries. We will be a little more savvy if we are ever in a hospital again on how to best deal with the crazy bureaucracy. For one thing, we will be sure to ask in writing when they “guarantee” that a service will be performed without charge! An oral guarantee from the hospital clearly means next to nothing. We will also be sure we know who the billing parties actually are and how to contact them. We learned that one the hard way. One of the bills was sent to us with out of date contact information!
- The best news of all is that our son’s eyelid healed perfectly without even any visible scar!
Having gone through this experience of taking my child to the ER and having the billing 100% resolved by Samaritan Ministries, I am more excited than ever that we switched away from traditional insurance. My experience mirrors that of my friends who told me for years that the customer service is exemplary and the coverage is excellent when a need arises.
If you have any questions about how health care sharing with Samaritan Ministries works or our experience described above, please ask in the comments section! I hope this testimonial encourages any of you who may be on the fence about health care sharing to take the plunge!
Sarah, The Healthy Home Economist
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