Affordable Care

My family fell into the cracks. Insurance costs were very high for us – too high to manage for our budget. I had decent insurance available through work, but for the rest of my family? Out of our range.  Any subsidies offered through the ACA didn’t work for us because of the way the income scale functioned. We met with an agent – twice – and spent HOURS on the websites, trying to find away to obey the law, participate in the program, and find affordable premiums.

It didn’t happen. We were stuck.

So over a year ago, I started doing research, asking questions, and reading about alternatives. I’d heard a few good things about Samaritan Ministries, so I checked it out.

It was almost too good to be true. We signed up, with fear and trembling, wondering if 07_23_14_smsomething like this would really work.

I’m happy to report, over a year later, that it works very well. You’ll want to do the research yourself (information available here, and they’re great to talk to if you have more questions), but here’s an overview of our experience:

  • Our ‘premium’ is $495 a month for our entire family. That’s called the ‘Samaritan Classic’ plan; it covers me, my husband and the three kids that are uninsured by other means.
  • The first few months, you pay the ‘premium’ to the program for administrative costs. Thereafter, you send the entire amount directly to a person whose name, address, and need you receive in the monthly newsletter. We write the check to John and Jane Doe and it goes directly to them to cover the need that they have submitted.

That sounds weird doesn’t it? But IT WORKS. We’ve had one major event that included a trip to Patient First, followed by a trip to the ER, CT scans and meds, radiologists, doctors, etc.; all the stuff that you get charged for any time you go to the hospital. We paid nothing when we went in – we simply said, “We’re private pay”, which we legitimately are, as part of a health-sharing network. We were treated. We went home. We waited for the bills to come in.

They did. We then called the medical offices of each biller to negotiate for ‘private pay’ discounts – which are substantial – and then submitted the bills, per their administrative instructions, to SM. Within about six weeks, the checks started to arrive. People all over the country received OUR name in their newsletter, and they wrote out a check for $495 and sent it to us.

And ALL our bills were paid., Yes, they all paid. Yes, they were all on time. No, nothing bounced.

A bit more about the private pay negotiations:

  • You are expected to pay the first $300 of any ‘event’; hospitalization, injury, etc. That’s your ‘deductible’. However, if you ‘negotiate’ discounts that exceed $300, you do not have to pay the ‘deductible’. In every case, we received a discount – from every doctor and from the hospital. That’s where it’s mind-boggling; the standard private pay discount from the hospital was 82% less than what you pay if you have insurance. And the ‘negotiation’ was nothing more than, “Oh, hey – we’re private pay.”

I KNOW, RIGHT?

Mind-boggling.

Anyway, the bottom line of our experience with that ‘event’ was that it cost us, out of pocket, a whopping ABSOLUTELY NOTHING.

Nothing. No co-pays, no 20% of the final bills. We negotiated for lower rates, received them, submitted the paperwork, and – just like we do every month, somebody wrote a check and sent it to us, several times over.

There are two things to remember here: because most general doctor visits are under $300, you have to budget for any sick visits, physicals, etc. that you might need. However, it seems that EVERYBODY gives private pay discounts. You’d be surprised at how much you actually save when there’s no copay involved and you can actually afford a monthly premium that’s less that $500. FOR AN ENTIRE FAMILY.

Secondly, it is a Christian organization; and, frankly, it’s one that’s got it right, if you ask me. That whole ‘love your neighbor as yourself’? Yeah – this is a good way to put that into practice. However, you’ll see that they’re upfront and honest about Christian values, and it matters. So keep that in mind if religious stuff is a trigger for you, or if you are of another faith and that doesn’t sit well. However, they are NOT obnoxious, offensive, churchy or preachy. Nobody has ever come to my house to look in my cabinets or investigate my goodness on the Jesus scale.

Whatever that is.

Also – prescriptions? Two magic words: PRIVATE PAY. I walked into CVS a few weeks ago to pick up meds for my son after a visit to the local doc. They rang me up and said, “That’ll be $42.” I said, “Oh – we’re private pay.” She said, “Oh – give me a minute.”

Two minutes later she re rang the purchase and said, “That’ll be $4.”

I’M SERIOUS.

You’ll want to make sure it works for you; take your time, read the material (again, find it here). If you have more questions and would like to talk, I’m happy to do that – you can contact me here via the comment section or on FB.

I do think we get some sort of brownie points if you say we referred you, so that’s cool – but I’m not all about that. I just see so many people struggling under the weight of a system that’s gone wonky. Obviously we can’t count on the government to make sense of it anytime in the near future, so if this works for you – like it did for us – that would make me happy.

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One Comment

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  1. Wow, that’s amazing. I’d heard about it, but did not understand how it works. So simple, and so effective. Perfect.

    Like

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