Samaritan Ministries health plan?

[imhim]

Hi,

Has anyone tried this plan? I am looking for people that have experience with this.

Thank you.

[mhg]

We've been members for many years now since 2002 ish.

Love it!

 

FWIW, my sister-in-law's family and my MIL are also members.

Edited November 10, 2010 by mhg

[Chris in VA]

Wanted to try it, but son has addiction issues and they won't cover recovery.

Sounded great, tho.

[imhim]

Thank you for your answers.

I do not understand how it helps. They do not cover well visits - we have 3 children, almost 4, age 7 and under. They do not cover sick visits either. What do they cover? The bill has to be over $300 to be covered, but not even that. I do not get it....

[mhg]

I'm not an authority per se, but I do know that Samaritan costs a 2parent family $320 per month. And you're right that it doesn't cover well office visits/related charges. You have to do the math on what other coverage would cost you. I went on ehealthinsurance.com to get an idea what health insurance for your family of 2 parents and 4 kids under 7 years of age with a $5000 deductible would cost -- it said about $500/month (and I'm not sure the deductible isn't $5000/person or not). But, you have to do the math on what health care costs your family per year and compare. The advantage of Samaritan is that, for illnessess/injuries/births, etc. --- you are only going to pay $250 per incident and Samaritan covers the rest in full. So, for example, with my birth, we were out only $250!!! I went to the Emergency room by ambulance once and the bill was $6800; for this, again, I was ultimately out only $250. You have to consider your families' predicted needs and then do the math to decide. Hope that doesn't muddy the waters.

 

Disclaimer: this post in NO way summarizes Samaritan ---- you'd need to read their website and publications to do this :).

 

You have to compare the two and decide.

[creekland]

Thank you for your answers.

I do not understand how it helps. They do not cover well visits - we have 3 children, almost 4, age 7 and under. They do not cover sick visits either. What do they cover? The bill has to be over $300 to be covered, but not even that. I do not get it....

 

We're on it, have been on it for years now, and love it. Here's how it saves us $$.

 

Before we were with Samaritans (10 years ago) our insurance cost us $600/month for the family, then had a $1000 deductible and only paid 80% until we had paid $5000 out of pocket. We could, however, get one well visit per year for free.

 

With Samaritans we pay $323 per month, have a $300 deductible (it might be $400 now, I'm not certain), and it pays 100% afterward. We have to pay for well visits. We also pay $170/year for belonging and $400/year to have amounts over 250K covered.

 

With no claims, the first cost us $7200/year. The second costs us $4446. This leaves plenty of room for well visits since they don't cost us $2754. Our doctor gives us a discount for paying cash.

 

When we have a claim (we've had two) we only pay $300 - $400 and the rest is covered at 100%. Before, the deductible would have been $1000 each (different years) and then we would have had to pay 20% of the rest.

 

I have NO desire to go back and am glad these programs are allowed with the new health care regulation. They aren't right for everyone, but they are right for us.

[NoPlaceLikeHome]

Samaritan Health Plan is not health insurance and it clearly says their is no guarantee of payment should you have a health care bill.

 

 

IMHO I would not do this since it is a big risk IMHO since there is no guarantee of payment which means you could end up broke or without medical care should you have a medical disaster. I worked many years in critical care and acute care and saw way too many bad things happen to people:(

[G5052]

If you're basically healthy but might have a few expensive events, it might be a good choice.

 

I haven't read their materials in several years, so note how they view pre-existing conditions and repeat procedures for things like cancer. We ended up keeping our insurance, and that was the right choice. We had a food of small claims that would not have qualified and then a very large claim (around $100,000) that would have been for a preexisting/ongoing condition.

[Tiffani]

We've been with SM for 10 years and love it!!!! It is such a blessing. They will cover anything over $300 per incident. So we don't go to the dr. for just anything. But here's how it has totally blessed us.

 

When you go to the dr./hospital (whatever) you are considered "self-pay". My youngest ds had to go to the hospital this past summer for pneumonia. B/c we're "self-pay" the hospital knocked 60% off our bill. Then SM's policy is if you get a discount of more than $300 they waive the $300 deductible and pay the bill in full. We had over $2000 worth of medical bills this past summer :scared: and ended up not paying anything! What other "insurance" company would do that. We've had 4 babies, 2 tonsilectimies, hospital visits, dr. visits etc.... and have not paid much for any of it.

 

That's been our experience with them. Would highly recommend it praying about it.

[cbollin]

Wanted to try it, but son has addiction issues and they won't cover recovery.

Sounded great, tho.

 

:grouphug:

 

I remember a few years ago comparing this one to something similar (medi share?) and was very sad to learn that neither of them would cover my autistic child or any special needs child. I don't know why she was considered outside of biblical lifestyle? whatever. Thankfully, the world insurance takes care of her.

 

And I've had friends who are big names in homeschooling conventions (and use these "programs) still have to appeal to family and friends to help cover hospital costs and surgery and recovery from car crashes.

no guarantees of coverage.

 

let the buyer beware. read the fine print. It might be just the right thing in your family. read the fine print. ;)

 

oh well, back to reading my dh's open enrollment info from the hospital where he works. :)

 

-crystal

[imhim]

I appreciate everyone's input, thank you. I will havemy husband read them all.

[creekland]

With respect to car crashes (since someone else had mentioned them), I'll note that it is an optional $3/month for motor vehicle coverage. We pay it as I trust them to pay far more than I trust either my or whoever we crashed with's "for profit" car insurance (IF they were even carrying insurance). I don't understand those who wouldn't pay it, but it is optional.

 

And yes, if you have pre-existing conditions, this plan is quite probably not right for you. It "works" based on the fact that people are healthy when they join - not that they wait until they have "issues," then want to join. Granted, many don't find out about it until long after the issues have occurred, but nonetheless, they can't have everyone joining knowing those folks will be needing more than the "average" family needs.

 

I think it's well worth the $400/year for coverage above 250K too as major things can happen.

 

Just in the month of Nov:

 

One person had surgery and chemo for lung cancer that spread to her cerebellum.

 

A one year old child born with Pierre Robin Sequence (facial bone malformations) had several treatments.

 

A lady had a mastectomy.

 

A man had a brain tumor removed and radiation.

 

All of these were paid due to having coverage in excess of 250K. To me it's essential "just in case."

 

Then there were several "basic" (less than 250K) coverages as well, but we don't get notification of all of them. Our money went to support a person who received surgery after hitting a tree while on his motorcycle. Each month it's something different - and money I gladly send out along with a card and prayers.

 

From October's stats there were 15,457 member households and $3,767,062 in needs were met.

[NoPlaceLikeHome]

If you're basically healthy but might have a few expensive events, it might be a good choice.

 

I haven't read their materials in several years, so note how they view pre-existing conditions and repeat procedures for things like cancer. We ended up keeping our insurance, and that was the right choice. We had a food of small claims that would not have qualified and then a very large claim (around $100,000) that would have been for a preexisting/ongoing condition.

 

Yes but in life there is no guarantee of health:( I saw this every day in the hospital. There were many, many people with good health one day which was gone the next:(.

Edited November 10, 2010 by priscilla
grammar

[NoPlaceLikeHome]

 

From October's stats there were 15,457 member households and $3,767,062 in needs were met.

 

When I worked in critical care and acute care, I took care of many people who racked up over a million dollars in hospital bills:( Will this group be able to pay that amount? I find it hard to believe and again this group clearly states that there is no guarantee of coverage. Plus, you will not have the benefit of contracted rates that insurance companies provide which are usually significantly less than the full charges.

[creekland]

When I worked in critical care and acute care, I took care of many people who racked up over a million dollars in hospital bills:( Will this group be able to pay that amount? I find it hard to believe and again this group clearly states that there is no guarantee of coverage. Plus, you will not have the benefit of contracted rates that insurance companies provide which are usually significantly less than the full charges.

 

This group by LAW can't say they guarantee coverage since it isn't technically insurance. However, by history, things covered in their rules/handbook, whatever have been paid. Once in a while payments are prorated at 95%, 90%, or even 80%, but remember, with insurance payment was only at 80% to begin with (for us). When this happens 2 to 3 months in a row, a member vote is taken and our payments generally increase. They also offer people the option of paying more than they are "supposed" to in order to meet the difference due to pro-rating. One of our claims was on a pro-rating month, yet we still got close to the full amount from voluntary "overpayments", so it was still cheaper than if we'd had "real" insurance.

 

I suspect some of those things listed above have come to 1 million dollars (or more when all is said and done) and I agree with you that I think people should pay for that assurance (esp since it's $400/year for the whole family for the extra coverage, not just an individual).

 

While they don't have contracted rates, they do use Karis group to negotiate the higher bills (as they did with one of ours - THEY did, not we did). Many people have found hospitals and doctors freely offer discounts when they know they are going to be paid in cash. Ours waited the three months until our cash came in with no issues whatsoever - after they had lowered the bill due to negotiating with the Karis group. We can choose any hospital and any doctor we like - worldwide (not experimental though). My mom has traditional insurance (HMO) and had to wait 2 months to see a bladder/urinary specialist who was on her list. She's now waiting for biopsy results and getting rid of a seriously entrenched infection. Both of us wish she could have gotten in 2 months ago, but she couldn't pick her doctor. The one on the list had a long wait.

 

Our doctor gives us a 20% cash discount whenever we go there.

 

This group keeps track of bills and incoming money. When needed they adjust the cost (by member vote). Health care bills have gone up everywhere, so our costs have gone up some too. They still have yet to reach the costs we paid 10 YEARS ago for family coverage that was nowhere near as good as what we have now. Non-profit is a wonderful thing IMO. They try to work it the best for the people involved (low as possible cost with coverage). No, it's not perfect for everyone and no, they can't do monetary miracles, but it sure beats other options for us.

[cbollin]

With respect to car crashes

 

well, I do hope that Jessica Hulcy (author of Konos) had that coverage. I know her bills were huge and many things were denied. The group she used (and it may have been the other one and not SM) denied many claims, but they sent out emails asking members to contribute directly to her. She was found to be at fault in the wreck instead of the fire fighter driving the other vehicle. I'm just thankful the fire fighter was able to immediately care for her and get a helicopter lift to her. sigh.... I stopped following her story a while back, so it might be all resolved.

 

And yes, if you have pre-existing conditions, this plan is quite probably not right for you. It "works" based on the fact that people are healthy when they join - not that they wait until they have "issues," then want to join.

 

pre existing.. good point.

I know that wasn't my case. My autistic child is healthy physically. She needs language therapy. I wasn't waiting until she had issues to look into their program. It was after a job change. Thankfully, the laws with group insurance do allow for coverage with pre existing if there isn't a lapse in coverage beyond certain number of days.

 

Granted, many don't find out about it until long after the issues have occurred, but nonetheless, they can't have everyone joining knowing those folks will be needing more than the "average" family needs.

 

wow. made me look up acts 2:45

 

From October's stats there were 15,457 member households and $3,767,062 in needs were met.

 

that averages to $243 per member household for the month. interesting tidbit of info.

 

oh well.... I still pay mostly cash options and discounts at the chiropractor. I was thankful that our chiro in old state didn't do any insurance. He was able to keep costs very low that way.

 

fun discussion. of course, I'm blessed right now that my dh works at a children's cancer research hospital and we have options that don't support unhealthy or "controversial" procedures. ;) I like that. best of all worlds for us. but not everyone shares that option.

 

I pray more options are available to meet many needs for all people. and am thankful that SM and other similar programs work for some people and meet their needs. :)

 

-crystal

[creekland]

wow. made me look up acts 2:45

 

 

 

That's all well and good, but in reality, money does have to play an issue unless you know of someone with unlimited resources that is willing to contribute.

 

that averages to $243 per member household for the month. interesting tidbit of info.

 

-crystal

 

Note also that singles ($135), single parent families ($200), and couples ($270) pay less than the $323 per month my family pays. I'm not certain what the breakdown is in numbers of each type. Add $3 to each if they want motor vehicle coverage (which I recommend). I think that $3 can go up to $30/month if it's needed, but it hasn't been needed in my memory. Seniors also get a $30 monthly discount for their category.