Paying Their Share - an article from Citizen magazine (March 2014 issue)

Paying Their Share 
by Connie Marshner and Karla Dial

     When Congress was debating the health care overhaul now colloquially known as Obamacare, Nancy Pelosi famously told her colleagues in the House of Representatives that "we have to pass the bill to find out what's in it."  Since the bill became law in 2010, revelations about what's in it have emerged a little at a time.  But when a pivotal clause requiring everyone nationwide to purchase individual health insurance plans took effect last October, the American public began to feel its effects for real - and they were shocked.  The president's promise that "if you like your insurance, you can keep it" turned out to be hollow.  More than five million people have had their health insurance policies cancelled since Oct. 1 because they didn't include the top-of-the-line, soup-to-nuts coverage that Obamacare demands.

     And even worse: The time to find a new policy, or buy one for te first time, runs out on March 31.  After that, they're subject to a series of escalating annual fines.

     What about everyone else?  They've got plenty of pain too: "Our premiums were going to go up by 21 percent."  "My employer cut me to part-time hours and took away my benefits."  "I don't want to subsidize abortion, but my insurance company makes me."

     But as bad news continues to worry families and empty wallets, a growing number of people are finding a welcome respite in the form of health-care sharing ministries (HCSMs).  Instead of buying insurance, each participating family contributes a set monthly amount to help others pay their bills, and receives help from others when they have medical need.

     There are three such national Christian ministries: Christian Healthcare Ministries (CHM), established in Ohio in 1981; Medi-Shares, headquartered in Florida since 1993; and Samaritan Ministries, established in Illinois in 1994.  Since Oct. 1, their membership applications have tripled - and for good reasons.

 The Old is New Again

     "We do not have to purchase health insurance and will not be subject to fines or jail for not doing so," explains Joe Guarino,a 50-year old Virginian whose family of seven has belonged to Samaritan Ministries for the last nine years.

     There are only nine such exemptions under Obamacare, which made sure the cost-sharing model  would not proliferate as Americans staggered under the federal law's newly revealed price tags: The exemptions apply only to those groups that have been continually operating since at least Dec. 31, 1999.

     "The Amish have been taking care of themselves in this way for hundreds of years," Guarino explains.  "If their church can't take care of it, they go to their bishop and it gets shared among the other churches until its paid.  The concept of small communities pitching in to help each other pay their medical bills is not really new - it just got overtaken by what we call health insurance.  And now its coming back."


     Though HCSMs operate with a high level of trust between the ministry and members, fraud prevention is an obvious concern.  But each ministry has its own methods to control that, which have proven quite effective.

     Medi-Share members simply submit their card at the doctor's office in the same way they would an insurance card, and the doctor bills the ministry directly.  Once members reach their annual household portion (similar to an insurance deductible), all eligible bills are shared 100 percent.  At CHM and Samaritan, members submit original bills themselves.

     "I cannot send copies or a receipt - it has to be the original, fully itemized bill," says Guarino.  "And any bill over $1,000, they call the provider to verify.  They follow up.  So that makes it very difficult for fraud to occur."

It Pays to Negotiate

     Just as savvy consumers buying a big-ticket house-hold appliance know they can usually get a discount by paying in cash, some patients know they can use the same tactic at the doctor's office to get a lower price for the service.  Between 20 and 35 percent of doctor's fees are overhead used to process insurance insurance claims; when patients avoid the claim process altogether by paying for their own services, doctors will usually pass that 20 to 35 percent savings on to them.  And many prefer them.

     "The medical associations love health care sharing because they know they're going to get paid in a timely fashion.  So they don't mind giving discounts," Guarino says.

     Samaritan and CHM provide tips to members on negotiating deals, and Samaritan and Medi-Share will also help negotiate a discount when the bill arrives.  Medi-Share usually maintains its own preferred-provider network of some half a million doctors nationwide; those doctors give automatic discounts of 26 percent to members.  Patients are also free to go out of network, as they would with a regular PPO, though they may wind up paying slightly more.  Since its inception, discounts have saved Medi-Share members $235 million in medical bills.

     In 2012, participants in the three ministries shared over $151 million in health care costs.  Last October alone, they shared $17.1 million in medical bills.

     Medi-Share President Tony Meggs tells Citizen that "since 1993, every medical bill that was eligible that we've published has been shared 100 percent" - including a liver transplant in 2013, which cost nearly $1 million.

     Sharing costs, says CHM President Howard Russell, "is infinitely more reliable than any insurance regulation."  Discounts for CHM members typically average about 59 percent after the ministry negotiates bills.

HCSMs in Action

     When Michele Gano, a former biology teacher in Columbia, S.C. discovered in 2007 she had contracted Lyme disease, she decided the best doctor for her was in New York City.  Through her Samaritan Ministries membership, she was able to go to New York, and her bills totaling $4,000 were completely paid.  She considers herself fortunate, especially compared to friends who have to worry about "in-network" and "out-of-network" providers and "pre-approvals."  With HCSMs, if you like your doctor, you really do get to keep him.

     Susan and John Willings, who serve as missionaries in South Korea, have been Medi-Share members since 2001.  That became a life-saver in 2007, when Susan was diagnosed with breast cancer: The Medi-Share community helped pay more than $140,000 for her surgery and chemotherapy while the couple continued with Korean children. 

     "It was a relief knowing I didn't have to worry about my medical bills," Susan says.  "I was also comforted knowing the community was praying for my recovery.  The wonderful news is that today I am cancer-free and the ministry my family worked to establish in Korea is thriving."

     When Larry Huff, a marketing executive from Greer, S.C., became self-employed a few years ago, his family lost the great benefits he had when he worked for a large company.  With three children, he and his wife LeAnn didn't dare go without insurance.  The plan they purchased had premiums of about $1,000 per month with a $5,000 deductible.  As it happened, that year the family's out-of-pocket medical expenses came to only $4,800.

     "We spent just shy of $17,000 out of pocket for zero benefit," Larry tells Citizen, "and we were making half of what we had made before.  This was absurd!"

     So they investigated HCSMs and eventually joined Samaritan Ministries, where their monthly share level is about one-third what their insurance premium once was.

     "I can tell you it's a lot less painful writing  a $370 check every month than a $1,000 check.  And you're writing a check to a real family so it feels so different," Larry says.

     "My daughter saw a check come, and it really impressed her that Christians would take care of each other like this," says LeAnn.  "And every month we pray for the family (receiving) our check."

    What's the cost of a life?  Fifteen years ago, doctors told a CHM member with a cardiac problem to abort her baby or she would die.  Instead, she got a heart transplant.  So far, CHM participants have shared $800,000 for her care, after discounts, fully paying all bills.  Because she helped negotiate discounts, her initial out-of-pocket cost was $0 - and today, her son is a teen.

     Such enormous costs are rare.  Samaritan Ministries Executive Vice President James Lansberry tells Citizen less than one-half of 1 percent of medical needs exceed $200,000 at self-pay rates - and in Samaritan's history, "only three or four dozen needs have exceeded $250,000."

     Nonetheless, HCSMs make provisions for hyper-catastrophic medical needs.  For example, Samaritan has an optional "Save to Share" program.  Should it become necessary, Save to Share members may be asked to share bills above $250,000.  Lansberry says Samaritan Ministries participants collectively have more than $8 million in their accounts ready to share with Save to Share families, in the unlikely event they have hyper-catastrophic needs.  Med-Share doesn't have a lifetime limit on sharing needs.

What's the Catch?

     If all this sounds too good to be true, you may be wondering how many caveats you'll have to look out for.  The answer is: Very few.  There are of course, some conditions and necessary limits., which vary from ministry to ministry, detailed on each Web site and in their respective application forms.  Each ministry has an application fee and different ways of handling administrative costs.

     But what they all have in common is an element of trust, present from the very beginning of the relationship: Applicants describe their medical status and history on brief forms.  No physical exams or corroborating health records are required.

     All the sharing ministries require from participants a signed document saying they believe Jesus Christ is the Son of God, regularly attend worship and are committed to a healthy life-style.  All members pledge to engage in sexual activity only within marriage and to abstain from illegal drugs.  If they use alcohol, they promise to do so in a Biblical manner.  And to increase accountability, CHM and Samaritan also have participants' pastors sign the documents.

     With all HCSMs, families are responsible for their own maintenance care (annual physicals, semi-annual dental cleanings, etc.).  All the families interviewed for this story indicated that they are health conscious in terms of diet and exercise.

     Samaritan Ministries is the only HCSM that has members send money to each other directly.  Administrators randomly pair a sender with a receiver each month at predetermined share levels, and both parties report back afterward.  However, all three ministries keep records: When senders don't comply administrators contact them; if they go three or four months without sharing, the ministry no longer accepts medical needs from those individuals' families.

The Way Out of Coercion

     Joe and Dawn Coletti of Cary, N.C. had been clinging to a grandfathered individual-purchase insurance plan for their family for the last few years.  But when they received a letter last fall saying Obamacare was going to force their premiums up another 13 percent, they made the switch to an HCSM.  Joe admits they might not have had the faith to do it a few years ago, but is glad that "we can finally live through our values now" - including the relational component.

     "There's no personal connection with the people who benefit from your paying taxes," he notes wryly.  "The way out of coercion is if you're able to cooperate.  Being a Christian makes that easy."

     But there is a deeper reason why HCSMs are growing.  "If we do a  good job," says Meggs, "we really can affect the culture, and reflect the love of Christ for the world to see."

Connie Marshner is a freelance writer based in Washington, D.C.

FOR MORE INFORMATION
Focus on the Family does not endorse any particular approach to health care; each family should carefully investigate all options, as this story is intended solely for informational purposes.  To learn more about Christian Healthcare Ministries visit www.chministries.org.  For more information on Medi-Share, visit www.medi-share.org.  Details about Samaritan Ministries can be found at SamaritanMinistries.org.  For more information about negotiating costs with health care providers, visit selfpaypatient.com.  Valuable information about this approach can also be found on the website of the Alliance of Health Care Sharing Ministries, healthcaresharing.org.


 - - - - - - - - - - - - - - - - -MINISTRY COMPARISON - - - - - - - - - - - - - - - - - - - -
MINISTRY       FOUNDED       NUMBER OF        SHARING         LEVELS        PERSONAL
                                                     MEMBERS        COMES FROM    OF SHARE     RESPON-
                                                     AT END                                            AMOUNT       SIBILTY
                                                     OF 2013                                                                     AMOUNT

Christian                1981                60,000              indirect; from         Gold: $150/unit/    $500 per unit,
Healthcare                                    individuals         other families               month                 per year
Ministries                                                                  via escrow           Silver: $85/unit/
800-791-6225                                                                             account                      month                
                                                                                                                                     Bronze: $45/unit/
                                                                                                                     month
                                                                                                                                          * "unit" gener-
                                                                                                                                           ally equates to one
                                                                                                                                            person

_________________________________________________________________________________________________

Medi-Share                1993                67,213                 Personal               Depends on          Annual House-
                                                        individuals           account at            several                   hold Portion
800-772-5623                                                                                ministry                 variables           [AHP] options           
                                                                                                                                        there are 1,900     vary from $500
                                                                                                                                     different share            to $10,000
                                                                                                                                       amounts,
                                                                                                                                        with the
                                                                                                                                        average being
                                                                                                                                        $300/month
_________________________________________________________________________________________________

Samaritan               1994                   93,690              Direct from       $165/month/       Member pays
Ministries                                         individuals       other families        single          first $300 for
888-268-4377                                                                                          $315/month/  first incident 
                                                                                                             couple
                                                                                                             $230/month/sin-
                                                                                                             gle-parent family 
                                                                                                                                   $370/month two
                                                                                                                                    parent family
_________________________________________________________________________________________________

The above article is from Citizen magazine, March 2014 Vol. 28, No. 2 issue.  For more info. contact: 800-A-FAMILY or 8605 Explorer Drive, Colorado Springs, CO 80920.  Email: Citizeneditor@family.org, or find them online at CitizenMagazine.com
    
end of article .........