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Below is an article (Paying Their Share) from Citizen magazine
The article below is from Citizen magazine (paying Their Share), 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
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6/17/14
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 the 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 it’s 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 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 .........
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