Changing vocabulary you’ve used your entire adult life isn’t easy.
Suddenly an “insurance claim” becomes a “sharing need” and a “deductible” becomes the “initial unshareable amount” — and instead of hassling with insurance codes and red tape, I get to follow some simple steps and deal with real people on the phone (who are helpful – oh my goodness, genuine customer service is not dead!!!) who help me get paid for my medical bills.
Some change is good – and we’ve found that healthcare sharing as members of Samaritan Ministries since 2015, is very, very good.
Over the years thousands of people have utilized our comparison of the 8 major healthcare sharing plans as a valuable reference guide, and it’s one of the posts I get the most emails about.
The question top on people’s minds?
Have you submitted a need? What is it like? Was the process smooth?
Every time I have to answer this question and admit that actually we haven’t, which kind of says that I don’t know how the whole system works, I feel a little guilty. For my audience’s sake, I need to have tested the whole process. At the same time, I’m incredibly grateful that my family has been so healthy for quite a few years and hasn’t needed to submit a need for an accident or illness that cost us more than $300. Note: In September, 2020, Samaritan changed that initial unshared amount to $400.
Now, to be fair, I’ve spent more than $300 per issue tracking down my own health needs. I know because I was pursuing this process outside of conventional medicine by working with a functional coach that regular insurance would never have paid for it. I never even looked up if Samaritan would — although I think they might have, for some pieces of it like the lab testing.
It’s an entirely different process of thinking when you’re a member of a healthcare sharing ministry. I know that other real people will be sending me checks and paying for my medical bills. So anytime I have a potential need, I think about whether it’s fair or equitable that I ask for others to pay for it.
If I can afford it myself without any hardship, should I just do that and move on and use the healthcare sharing ministry only for major issues?
Being part of Samaritan Ministries even has changed the way I make decisions about pursuing healthcare. When my 7-year-old had a horrible cough last year that I was sure was croup, I hesitated to take him to the ER just because I wanted to make sure I didn’t create extraneous medical bills.
I think many people on insurance would have taken their child to our local children’s hospital, which has an excellent reputation. That would have racked up a bill over $300 in seconds.
But I cautiously went to the last open urgent care in town to make sure that I didn’t spend more was needed. The poor child didn’t need much to get him back to health, and we did not even have to pay more than $300, which meant that it wasn’t a need that could be shared for others to pay for me.
Those kinds of decisions happen regularly. I feel that if we had regular health insurance, where a lot of the expenses are more hidden and unconsidered, we would have spent a lot more money on healthcare over the last four years.
After the umpteenth time of being asked what it’s like to actually submit a need, however, I decided that literally for the sake of my readers and people depending on me at Kitchen Stewardship®, I needed to submit a need to see how it went.
We could pay for these medical conditions ourselves, but I honestly wanted to know what it would be like.
How complicated is it? How annoying? How many places along the way can you make mistakes and cause problems?
Submitting a Health Sharing Need Compared to an Insurance Claim
I still remember insurance.
I still remember hours upon hours spent on the phone with Blue Cross representatives trying to get my prenatal care paid for with our fourth child.
I used a midwife and had most of our appointments in the home. At the beginning of the pregnancy, I was told that they should be covered, at least partially (and by partially I mean more than half for the prenatal appointments). I fully understood going in that the actual birth would not be covered, because we had him at home, but I was very pleased to know that all these prenatal appointments would at least come back to me 50% or more.
I’m pretty sure I spent at least 12-20 hours tracking this down and never saw a penny. I was juggling codes and numbers and red tape and regulations and representatives who said a different thing every time I called.
My poor midwife also spent quite a few hours doing paperwork and sending off strings of digits by mail, by email, and over the phone, constantly. What a waste of time!
On the other hand, submitting a need to Samaritan Ministries has four simple steps, and the only numbers that I really needed to make sure I could track down were things like the date of service and the phone number of the provider.
I know not every insurance claim is a hot mess like my pregnancy.
I know often, a family walks into the doctor, nods their head that nothing has changed in their insurance information since their last visit, and walks out without thinking a second thought about how that medical care is being paid for.
The family might get a small bill for the deductible in the mail, pays it, and moves on with their lives.
But when I think about my experience with my prenatal care, I wondered if it would even be possible for a Samaritan need to be more complicated and more of a pain than that.
Who Is a Good Fit For Healthcare Sharing?
To digress just slightly before we get too far, I want to address what kind of family or business person should use a healthcare sharing ministry or program (since we have some new ones that aren’t faith-based). In my experience, health sharing is perfect for these groups of people.
- Entrepreneurs/small business people – health sharing is always less expensive than group insurance
- Anyone who pays over about $7-800/month through their work for insurance, including any deductibles and OOP costs – with Samaritan, our family pays just over $500/month to be members plus we pay for all our own routine checkups, which average out to just over $700/month
- Young adults without great insurance – the single young adult plan is very inexpensive!
- Families who utilize functional or alternative treatments often – some of these will even be covered under Samaritan!
- Those tired of red tape
These are the major options:
- Samaritan Ministries
- Christian Healthcare Ministries
- Christian Medi-Share
- Liberty HealthShare
- Knew Health
You can see more about all of these options, how they work and what they cost over at my comprehensive healthcare sharing review.
Steps to Submit a Samaritan Ministries Need
I admit I was a little nervous submitting my first request. I hate learning new things and always want to be efficient with my limited time.
Even with my aversion to new tasks, I was amazed at how easy it was (and Samaritan even created 1-to-2-minute videos to explain each step in case I needed a visual).
It was truly painless, and this is how quick and easy it was:
- Submit your need request to be reviewed by a Needs Advocate.
- Input all your itemized bills in the online dashboard.
- Wait for checks or PayPal.me payments to come in from other members.
- Check them off in the dashboard.
It took me a total of probably 90-120 minutes over four or five sessions working on it and two phone calls. Now that I’ve seen how the process works, I would guess a future need would take about half an hour, total.
Here’s how each step felt:
Step 1: Submit the Need Request
This is a very quick step in which I had to explain what the problem was. What was the accident or illness that caused these medical bills to happen?
Someone at Samaritan Ministries called a Needs Advocate must approve our request. Basically, this means they’re going to check the member guidelines and make sure that our request isn’t for something like dental work or a pre-existing condition that is not allowed to be shared.
It was a very quick turnaround from my submission to being approved, and then I could begin the rest of the process.
Step 2: Input Itemized Bills
I’m guessing this used to be a little bit more of a pain before the Internet was so robust. But with cell phone cameras and an online dashboard, it was so easy even I didn’t get aggravated trying to get it done (and that’s saying something – I may be Christian but patience is a virtue I am still working on!).
I had all my bills in the same folder anyway, so all I had to do was snap a quick picture with my phone, send that to my computer, and drag it over into the dashboard.
I did have one bill that was a little too simple and didn’t quite itemize exactly what had happened with each line item having a specific cost.
I had to make a call to that doctor’s office during business hours (which took about seven minutes including being on hold), watch the mail for a week, open an envelope, and snap a picture of that new bill and upload it. This was shockingly simple.
That’s the part where I will save a lot of time next time because now that I understand what an itemized bill looks like, I ask for it right up front.
I did run into one tiny roadblock in that once I had all the bills submitted, one of them was actually denied. It was one that I had submitted with a questionable attitude, a little unsure if it would go through.
We are fortunate enough to have a direct primary care office in our town, which means that we basically pay a monthly subscription for our regular family doctor visits. Everything there is incredibly discounted and most of it is included in our monthly cost. However, there are some labs that we still have to pay for.
For this issue we were digging into for my husband, he racked up a $400 charge one day measuring blood levels. This was the bill that was denied, so I did have to call Samaritan Ministries customer service, where a very helpful English-as-a-first-language speaker took a look at my account.
At first, he said there was no date on the bill, and that that was why it was denied. And then he looked more closely and said, “Oh, my goodness, it’s actually right here. I think this was just an error on our end.” He approved it while I was on the phone, and life went on.
How Discounts Work at Samaritan
The best part about that particular bill, as well as the one I had to get on the phone and have sent to our house, was that both demonstrated that we had discounted medical care.
The way Samaritan Ministries works is that for each need submitted for sharing, the family needs to pay the first $300. However, there’s this wonderful clause that if any discounts are obtained in the amount of $300 or more, that first $300 is no longer the family’s responsibility.
Because I could show on my direct primary care bill that we had discounts as members to the tune of about $200, that was $200 less that we would have to pay out of pocket.
The bill above was from a specialist. I called to see if our hospital had cash-only discounts and got that $69 taken off.
That doesn’t seem like much, but that’s someone’s food bill for the week, perhaps. Worth a quick phone call!
The last bill was for an MRI. Our primary physician helped us find an office about two hours away, where instead of paying around $3,000 in our hometown, we only paid $570.
Update: As of September, 2020, the reduction for discounts has been changed to a $250 credit for getting the best “fair price” using Samaritan’s tool. Why? So many medical providers charge more than necessary, and sometimes even a 50% discount doesn’t get a procedure down to the price one could get across town or a few hour drive away. Samaritan wants to encourage members to get the BEST price, not just a discount.
Because that discount was not exactly shown on the bill — the bill was just lower than it would have been in our hometown — I expected to have to make some calls and explain that fully. But whatever I typed in online just worked!
You can see in this image that the blue bar shows our discounts, which are significant and well above the sharing threshold line, which is $300.
Without any trouble at all, our entire expense is covered by our fellow member families at Samaritan.
In the insurance world, this would be like having no “out of pocket” expense, which is incredibly rare in this day and age, is it not?
Step 2b: Rate the Provider
This little step was a big surprise to me — I was asked to rate each provider!
I’m not actually sure what Samaritan does with the information, but I imagine they could create a very good database of helpful vs. unhelpful providers over time!
Health Sharing Referral Discounts
If you find it helpful and end up signing up for Samaritan Ministries, please mention us as your referral: Kristopher & Kathryn Kimball, Michigan. We’ll get a credit on our share (and you can do the same by passing on the news to others).
Step 3: Wait for checks
The first part of the process was far easier and took far less time than I expected, and then I completely put it out of my mind.
When I got an envelope in the mail with a personal return address I didn’t recognize, my curiosity was piqued. Who is sending us real snail mail that’s not a bill or an advertisement?
When I opened it, I quickly realized that it was our first check to cover this need. Quite a pleasant surprise!
In all, we will get two checks in the mail and one PayPal.me payment from what I can understand. We are still waiting for the final check, but I just finished this process about four to six weeks ago.
Step 4: Record the Checks in the Samaritan Dashboard
All I had to do at this point was log in, open the needs section of my dashboard, and literally check a box for a check received.
There’s one more checkbox about whether a note of encouragement was with the check.
This was part of the Samaritan process that I hesitated about before we signed on back in January of 2015. As a community of faith, members are requested to send a note of encouragement and pray for the person to whom they’re sending their share. I always felt like that would be one more thing on the list.
But in general since then I’ve embraced it, because who doesn’t need a little more prayer?
I was surprised to find that this personally addressed envelope actually just contained a check, no card, and no note. So I wonder how many people skip that step!
Honestly, it’s okay, it’s not a big deal. It makes me feel a little better for the months where I’m lazy and don’t write much.
I try to pay through PayPal as much as possible now because even though it’s less personal, it’s also less of a drain on my resources of time. But I always write a little note!
The person who paid me through PayPal also did, and it does feel very encouraging and heartwarming, I must say.
Health Sharing Need Submission vs. Insurance Claim
Just for fun, let’s compare this to my recent experience of trying to get a few chiropractor bills paid for through our vehicle insurance after getting into a small car accident back on New Year’s Eve, almost a year ago.
I have a pile of paper a half-inch thick; countless phone calls to try to figure out what process I needed to go through to get a few hundred dollars paid for; and a grumpy chiropractor who didn’t really want to submit all the special codes, because he has had too many experiences where he does some work and his patient does not get any money from the insurance company anyway.
I was on the phone a couple times with Felicia, my very pleasant and helpful account manager. The forms to fill out took a good 10+ minutes each (there were four of us who received treatment).
That story does happen to have a happy ending when a few checks finally showed up in the mail, but the process took nine months in total, including at least two months between finally finishing all of the red tape requirements and getting those checks.
So far, this process has been much more smooth with Samaritan Ministries.
What Can Go Wrong with a Healthcare Sharing Ministry?
Now to be fair, I’m still waiting on just over $500 to fulfill this need. If that member has a glitch, and I end up not getting paid and have to chase down $500, of course, I won’t be happy. Updated to add that the last payment came in right on time, as promised, via PayPal.me.
I have heard from many other Samaritan members in the comments of my healthcare sharing ministry comparison post.
Lots of them have wonderful experiences. But every so often someone will share with me either in the comments or by email a negative experience that they’ve had.
For example, I recently heard from someone who had about $50,000 of medical bills from a car accident. They actually had to open a credit card just to cover them, because they didn’t have that kind of money in the bank. By the way, you are a better fit for a health sharing ministry if you can cover $50-$100,000 without having to take out a credit card. Nonetheless, this is a workable situation.
Unfortunately for this family, it took quite a long time for all the shares to come in, and they had to pay interest on that credit card debt, which was certainly not ideal.
This commenter claims that about $3,000 of the need was never covered, and once a full year has passed, apparently, Samaritan won’t help anymore. This was absolutely shocking to me because it’s the first time I’ve heard of something that was an approved need not being fully paid for, but I guess it happens, and there’s no litigious resource for you to get that money back.
So there is certainly some risk, and we’re depending upon the honesty of other members.
According to Samaritan guidelines, if a member did not send their check to you, that amount will be reassigned in the following month to a current active member. So not getting paid shouldn’t really happen, and I’m not sure what went wrong with this particular member, but I definitely feel sorry for him. Somewhere some human error took place is my guess!
Some have also commented that getting discounts is more difficult than Samaritan Ministries makes it sound at first. This may be true, but it’s only a $300 risk, even if you can’t get a discount. So that’s definitely something you need to be ready for if you sign on with a healthcare sharing ministry.
As you can see above, I had no problem mitigating the $300, but my large discounts were unconventional expenses. The “regular” specialist only discounted $69, although that could add up over just a few appointments! Note: If this need had taken place after the new policies in September, 2020, I’m guessing we got the best fair price.
The final issue that many people write to me about is unshareable needs. You definitely need to read every word in the member guidelines before you sign on to something like Samaritan Ministries.
For example, if you ride a motorcycle, motorcycle accidents will not be covered. Psychiatric and psychological help is also not covered. (That’s one that irks me because I do believe mental health is just as important as physical health, but nonetheless, it’s in the guidelines.)
Pre-existing conditions, vision, dental work, and a few other categories sometimes pop up and surprise people. But if you’ve read the guidelines, you should know what you’re getting into.
Basically, because Samaritan Ministries knows that other people will be paying for your care, they reduce the risk of your having large, sharable medical bills by excluding both pre-existing conditions and what they see as overly risky situations.
In other words, if you as a person are taking a risk like a motorcycle or making a bad decision like drinking too much or having sex outside of marriage (which goes against Christian morality), medical problems that result from those decisions are your responsibility, not your faith community’s. For everything other than the mental health issue, that makes sense to me.
I love what one reader shared in the comments of my other post as people discussed their fears about what might go wrong if they chose health sharing over insurance:
“At the end of the day, was I trusting Aetna, BlueCross, United Health, Samaritan, MediShare, CHM, etc, or was I going to trust the Lord to provide and care for me via any means He chose? That ‘what if’ fear loves to creep up and strangle me. It’s in God we rest; not insurance and not healthcare sharing.”
Common Vocabulary for Samaritan Ministries Health Sharing:
Have I used any words in this description that you weren’t quite sure how to interpret?
As I mentioned in the intro, there’s definitely a new vocabulary to learn, but it’s not too complicated.
Here are a few words and definitions that may help you understand what I’m talking about when it comes to healthcare sharing:
- Need – The money a family has spent on a valid medical bill (like a “claim” in insurance-speak). One need is every medical bill related to the same incident or illness, which may include many doctor’s appointments, procedures, labs, etc.
- Share – What you pay each month (or the verb in “share a need” which is like “submitting a claim” in insurance-speak)
- Initial Unshareable Amount – With Samaritan, the family needs to pay the first $400 of any need. As I explained above, this amount is reduced with any discounts obtained, and often many people get it reduced to zero, as I did.
- Note of Encouragement – Members are requested but not required to send a nice card or note of encouragement with their payment for the share that month.
- Member – Any family who is consistently paying their monthly membership in Samaritan, which means that their money is covering someone else’s medical need.
- Maximum Amount – Samaritan does have a ceiling for how high your bills can get for one shareable need. For our membership, which is called Samaritan classic, that threshold is $250,000. If we have a catastrophic event that costs more than that in medical bills, needs shared will be capped at a quarter-million dollars.
- Save to Share Program – Because of that maximum shareable amount, our family has chosen to be part of the save to share program. We pay a little extra each month. The Save to Share program basically eliminates the limit on medical bills. If something catastrophic happens, like an incredibly serious accident that causes someone to be in the hospital for many months or cancer, which is what I most often see on the Save to Share needs, the first $250,000 will be paid through the regular Samaritan sharing system. And the rest, without a real cap, will be covered by the Save to Share program participation. There’s no real limit, but if there are too many needs, it is true that you may not get paid for all your medical bills. From memory, I generally see about two or three Save to Share needs each month. They are generally the same from month to month, because these people with cancer continue to incur more medical bills.
- Pre-existing Condition – A condition that existed prior to membership – BUT these are still shareable needs IF “the condition appears to be cured, and 12 months have passed without any symptoms (whether or not benign), treatment, or medication (even if the cause of the symptoms is unknown or misdiagnosed).” I think this is wonderful news for some with potential “pre-existing conditions” that are not a real issue anymore. My husband, for example, had Crohn’s Disease (a chronic autoimmune disorder) when we started with Samaritan, but because he wasn’t on medication, it didn’t count as pre-existing. He’s now completely healed, praise be to God! If a condition is active, it’s true that
- Prorating – If the needs for a month are greater than the shares, Samaritan may “prorate” the need, meaning that a member might only get 80-90% of their needs met. The prorated amount that is unpaid will be brought forward to the next month, and usually, most needs are met fully. Members are also given an opportunity to give extra during prorated months. (If prorating happens more than 3 months in a row, a vote will be taken about raising monthly shares. This has happened twice in 5 years and passed both times, but it hasn’t been a massive increase in monthly cost for us.)
Final Thoughts: Was it Easy to Submit a Medical Need with Samaritan?
I think I’ve made it pretty clear in this post that I am over-the-moon impressed with how simple this process is. If I can do it, anyone can do it!
I’m sure that if my medical needs were in the many thousands of dollars, it would be a bit more orchestration to make sure all the checks were checked off in the dashboard. But still, this should be nothing that any normal person of average intelligence cannot handle. It’s far easier than insurance, it’s far easier than codes, and I really love the feeling of being taken care of by someone else out there in my faith community.
Since I started this process for my husband’s issue (which, by the way, is not a big deal…even though we are still figuring it out, it’s not life-threatening by any means so please don’t be concerned), you’ve seen in recent posts that two of my boys have very severe dust allergies, and you’ll read next month that we are starting allergy drops for these boys.
Allergy drops cost $70 per month per kid, and the process of being officially tested at the allergist was about $600. Ouch.
I called Samaritan to ask what might be covered, and it sounds like at least all that initial appointment and testing time can be shared along with 90 days of the drops (that applies to any prescription).
So right now I’m considering whether I submit that need or just determine to cover it ourselves.
Obviously, we will still be paying $70 a month for quite a long time, three to five years, so submitting this need would be a small assistance on the path that we have chosen to take.
At least I knew to ask for an itemized bill so I could be ready, and if we discern that I’m going to put “submit Samaritan need for boys’ dust allergies” on my to-do list, I won’t look at it with so much dread, since I know it’s a very easy process.
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