How We Do Health Care

Oct 10, 2013 | In the Name of Love

Hey guys and gals — I’m interrupting the regularly scheduled 31Days posts (but not skipping a day — I will post again tomorrow!) just to share a bit about how we do health care. I started a post about this topic in February of this year… yes… but finally decided, with a nudge from the legislation of el gobierno, Okay, I’m getting too many questions NOT to write this post. (Otherwise I’ll be answering the same questions over and over, right?)

So with no more than eight months’ ado, here’s the skinny on how we do Health Care:

We are a part of a Christian Health Care sharing ministry called Samaritan’s Ministries International. {Not affiliated with Samaritan’s Purse or Samaritan’s Feet…} Their system is pretty simple and we love it, because it feels like we are a part of the body of believers in a great, tangible way.

{Image from a card I received from a fellow SMI member when my Dad died. Source.}

HOW IT WORKS

Each month, SMI sends a newsletter with the name of a person who has had a health care issue, explains the issue (not in great detail – that might be weird) and sends their address. Your mission, should you choose to accept it, is to pray for that person, and send your ministry “share” (your check) directly to that member who has a need. Our share is $370 per month — and (bonus for us) this amount does not change regardless of the number of children you have.

You send your share to a fellow member 11 months a year, and directly to the SMI offices to cover administrative costs 1 month a year.

So, for example, the month I started writing this post we were sending our check to a couple in Asheville — the husband recently had surgery for prostrate cancer. And when I submitted the doctor’s bills for the Belle’s pregnancy and delivery, we began receiving checks from other members with notes of encouragement and so on, to cover our bills.

WHEN YOU GET SICK

When you have some sort of health-related issue, you simply pay the bill yourself (or wait, if needs be), submit the need to SMI, and then “reimburse yourself.” Or, if you’d rather, you can wait until the funds come in from your SMI submission, and then pay the bills. {Just keep in mind sometimes you get a nice discount for prompt payment, which is kind of better for everybody, if you can swing it. But sometimes it’s good to wait longer — it seems like discounts are sometimes easier to negotiate when you’ve taken your time about paying a bill. Hard to decide what to do sometimes! SMI folks can help if you’re in a conundrum.}

MAKING A CLAIM

In SMI speak, Making a Claim is called Submitting (and Publishing) a Need. (An eligible need is “published” when it is sent to other members of SMI so that they send their gifts to cover your need.) Needs are only publishable if they are:

1) Over $300 (up to $250,000)

2) Not needs that you had before you became a member of SMI.

Because SMI is less expensive than most traditional health care options, you do have to budget for the fact that a routine doctor’s visit will not be covered, unless it’s more than $300. (But what doctor are you visiting whose routine visits are more than $300??)

But because SMI is not Health Insurance, you are considered self-pay and usually receive a very significant discount because of that. (i.e., the Belle’s $128 baby check-ups are often reduced to $58. Which to me indicates something is wrong with the health care system in general but never you mind.)

DISCOUNTS

In many cases, you are able to negotiate discounts on health care costs. For example, by offering to go ahead and pay three different bills related to my pregnancy with the Belle, the company I needed to pay for the lab tests (or whatever) was willing to knock something to the tune of $600 off the total amount owed. When I submitted those bills to SMI, and indicated that I received that discount I negotiated, the $300 deductible was reduced to nothing. Better explained:

If you are able to negotiate a discount off your bill, that amount will come off the standard initial $300 deductible, and you’ll just pay the remaining amount you owe. If you negotiate a $50 discount, you’ll just pay $250 out of pocket and the remaining amount will be published by SMI.

I ended up paying about $0 for my pregnancy and delivery with the Belle.

IF THERE ARE MORE NEEDS THAN SHARES

On months where the total amount of needs being submitted is higher than the number of shares scheduled to be sent, the needs are prorated to cover as much as possible across the board. For example, SMI might only be able to publish 90% of the amount of your need. Members are then encouraged to send an additional amount if they are able to. You might be able to negotiate additional discounts if you haven’t paid your bill yet. One way or another (Keep Calm and Trust God) it generally works out. And if/when people do make additional gifts to cover pro-rated needs, SMI will touch base to see what happened and if you need additional funds.

PRACTICAL OUTWORKINGS

In March of this year, my Dad, who had not been an SMI member for very long, suddenly had a heart attack, spent a week in the hospital in the Cardiac ICU, and then I saw him for the last time I’d see him this side of heaven and he was gone.

About $140,000 worth of medical bills were left behind.

Nearly $17,000 was knocked off his main hospital bill because he was an organ donor, which was awesome. (And guys, please consider being an organ donor. It blesses me to know that a woman with three grandchildren received a kidney transplant when my Dad died — something positive out of something so hard.)

But, for you non-mathematicians out there, we still owed… 100,000 + 3700 + 4,000… um, a LOT.

When the bills came in, I gathered them up, filled out the necessary paperwork (which by the way is impressively little) and submitted the need to SMI.

Needs are usually published around 30 – 60 days after their submission, and it took me a while to get everything together (the hospital actually took a long time to send the main bill???). So, in September of this year, my Dad’s need was published and hundreds of checks began to arrive in our mailbox in the days that followed. Many of them complete with beautiful cards, prayers and notes of encouragement and Scriptures — and WOW did it mean a lot to me.

The knowledge that so many people had prayed for my family was very powerful, very meaningful. The checks have been deposited to the Estate’s bank account, and I will be paying the bills in the days ahead.

Because the need was such a large amount, even though September was a month where they needed to prorate needs, SMI decided to divide my Dad’s need up and publish it over two months to make sure we got the full amount. Which was HUGE. And just blessed my soul.

To me, it is absolutely evidence of the body of Christ in action.

Every time I called SMI to get their help in the process of submitting needs after my Dad’s death, someone ended the conversation by asking if they could pray for me. EVERY time. It was such a gift, and though it often brought me to tears, it often overwhelmed me with the knowledge that the Lord was with me through that very challenging time.

FIND OUT MORE:

This is by no means a comprehensive explanation of SMI. You’re welcome to ask questions in the comments but I would love it if you would first visit their website and especially check out their detailed FAQ page.

Here’s my little Pros & Cons breakdown:

The Pros:

• It is not as expensive as health insurance, and we love the “vision” of Christians sharing with one another as they have need.
• They cover almost any medical needs, except for ones that existed before a person became a member with SMI. If there are large needs that existed before the person became a member, they will often still send out “Special Prayer Needs” and ask members to give something if they would like to and are able to help.
• As previously explained, the first $300 of any need is to be covered by the member, so if you have a $75 doctor visit, you’ll be paying that out of pocket. But, if you submit a need over $300 and you’re able to negotiate a discount, the discount you negotiate will reduce the deductible. (And when you explain to a health care provider that you are self-pay, they often have a discount — even $75 bills have been reduced for me just because I’ve asked about this.) Since we negotiated multiple deductions for my pregnancy and delivery, we haven’t had to pay anything.
• They give you a monthly prayer guide, so you are praying for other SMI members with medical issues around the world each day. It is a beautiful connection in the body.

The Cons:

• It can sometimes take time for the need to be submitted and for you to begin receiving shares. So this could either affect your cashflow or you could have a special savings account just for medical expenses… or you could use a credit card if you willing. Or you can just wait to pay the bills… we have had some of our bills reduced just because we took our time about paying them!
• Not having coverage for smaller doctor’s visits can be a bummer if finances are tight — but budgeting for this when possible should make that okay.
• It is probably easier to pull out an insurance card than to have to keep track of shares and submit medical bills. (But remember — convenience often comes at a price and I think our country is feeling that price right now. )
• If there are more needs than shares in a particular month, your need might be “pro-rated” and only be covered 80-90%. In this case, they often encourage people to give a little extra to help cover things.

MY PERSONAL OPINION

Overall, we have been EXTREMELY happy with SMI. It is perhaps a little less “convenient” than health insurance, but since it seems like the health insurance system is a mess that’s only getting worse, and we are very happy to be doing it this way – probably saving a lot of money, and participating in a church-minded way of bearing one another’s burdens as we are encouraged in Scripture.

You can check out their website at www.samaritanministries.org to find out more about how they work. And if you do sign up, please let them know Caroline Collie referred you — one of our monthly shares will be discounted as a result, and since I spent a gabillion hours trying to write all this in a blog post, that would be awesome!

xCC