Healthcare Sharing Ministries

[ctg]

"...agree to either abstain from alcohol or only drink in moderation, abstain from tobacco use except for a rare celebratory cigar or pipe, and abide by the guidelines that are constructed and maintained by our member elected board."

I guess I'm out.

 

[Insuranceman]

I know a ministers that has a health share plan and also carries high deductible plans to go along with it.

 

[smi_guy]

Hi Ann. Good questions. I am going to briefly respond to these, but I would also like to private message to a link to thread from back in 2009 when another health care sharing ministry staff answered some of these questions. (I do not have enough posts to post a link, here.) I would also encourage you to check out each of the health care sharing ministries if you are interested in this model of people helping one another pay for their medical expenses. Each ministry operates a little differently – there is not a one-size-fits-all model to health care sharing. With that…

"How do you account for pre-existing conditions, double insurance and fraud?"

SMI does not preclude membership because of a pre-existing condition but does put limitations on publishing needs that existed prior to becoming a member. When members join they are asked to list pre-existing conditions. Additionally when newer members are treated for certain conditions their physicians are required to verify that they were not pre-existing.

Each health care sharing ministry handles pre-existing needs differently. Across the board though, even if a need is not eligible to have monthly shares directed to it (be it pre-existing, dental, optometry, etc.) each ministry has a program that will let their membership know of the need and members can give over and above their monthly shares to help out.

As far as double insurance and fraud goes, there are member service staffers that review member's medical bills and make sure that they are eligible for sharing according to the guidelines that are written by a member elected board. When a member submits a need, they are required to send original, itemized bills. This allows SMI to verify that bills match the need that is being submitted and also would show any payment by insurance. Third party negotiators validate/verify most bills with providers when they are helping members secure discounts.

"Do you have a waiting period for pre-existing conditions, or an underwriting process that excludes certain expensive conditions that are already pre-existing or already in process (like current hospitalization)?"
I would recommend researching how each ministry handles these matters. None of the ministries underwrite and the quick answer to pre-existing conditions according to the Samaritan guidelines written by the member-elected board is that monthly shares will not be allocated to pre-existing heart conditions, Type II diabetes, & cancer (7 year remission exception)…for all other kinds of pre-existing needs, they cannot be shared unless there is a 12 month period of no symptoms or treatment.

"Do you coordinate benefits with other insurance, or can a person be double insured? For instance, if a person has a $50,000 hospital bill, submits it to his own insurance, which pays most of the bill (let's say $45,000 of it), how to you keep the person from submitting the same $50,000 bill to you, gaming the system and making a whole lot of money off double coverage?"
My ministry will not share a need that an insurer has paid, or is obligated to pay. As described above, our bill and negotiating process would almost always catch any such effort. There is no "coordination" of benefits since health care sharing is about sharing needs and a member with insurance to pay a bill does not have a need.

We leave health care planning and decisions to the individual member and they coordinate the care that they need and how they intend on paying for it. If a bill has already been paid by a medical insurance plan that is liable for paying all or a portion of it (which in our experience is rare), our third party negotiators will notate the insurance payment and we can have members share whatever is remaining.

"Same issue, if the person is double covered, how do you account for fraud committed against the actual insurance company that paid $45,000 of the bill when the person was actually "double covered" and should have coordinated benefits between the coverages?"
"How do you handle outright fraud where the person bills (or "publishes") a fraudulent bill for thousands of dollars? Doctors and pharmacists are in the news right now for fraudulent charges to Medicare."
Besides the detection built into our bill and negotiating processing, we are relying on the good faith of our members. Our sharing ministry is only for committed Christians willing to step out in faith. The world may think that is naïve, but over 18 years of handling tens of millions of medical bills, we can count on one hand those incidents where it appeared that a member cheated in some way. If you think that means we are just missing a lot of fraud, then it's hard to explain how our members are meeting each other's needs on monthly shares of $355 for a family of any size. And for those few who may slip a fraud through, we trust God to handle the situation. Acts 5.

"How do you account for guaranteed assurance? If a person joins your group, has a large claim, then the group folds or has a drastic drop in membership, what about the assurance you have made to the person to help fund their medical bills? For instance, with Obamacare, many of your members may find that their premium is subsidized for traditional insurance to the extent that they pay far less premium than the membership fee they are paying to you. If/when you have a drastic drop in that income, what assurances do you have to your members for ongoing claims? Insurance companies have reserves and reinsurance. What do you have?"
There are no guarantees. Members know this when they join. Our members prefer this model though because they know that their brothers and sisters in Christ share the common belief to "bear one another's burdens." By God's blessing, as mentioned above, to date every eligible bill that has been submitted to the members through our ministry has been paid.

While one of our guiding principles is only God is sufficient to meet all our needs, not man made institutions – that does not mean that we don't act prudently in operating our ministry, watching for trends that could undermine the integrity. All of our full-time employees are required to participate in the health care sharing, and few, including all of the leadership, have health insurance to fall back on, so we have an extra incentive for the ministry to succeed.

As for the Obamacare subsidy you refer to, while it may lure some of our members to a system that pays for abortions, at the same time it will so increase the cost of individual premiums that many people who previously felt secure in their health insurance will no longer be able to afford that security and will look to health care sharing.

Finally, I would also humbly submit that the "guarantees" that insurance companies often tout have been known to disappoint their policy-holders on more than one occasion as noted below. These ministries are not insurance. They do not assume risk, and they are not liable for paying member's medical bills. Each ministry is founded on the biblical mandate of believers to share each other's needs. Our goal is to apply Galatians 6:2, "Bear one another's burdens, and thus fulfill the law of Christ" to the ever-rising medical costs which can be quite burdensome for anyone, single or married, young or old. It is a principle that has been around since the birth and growth of the early Church. The Book of Acts reports, "All the believers were together and had everything in common. Selling their possessions and goods, they gave to anyone as he had need," (Acts 2:44-45). These Christians are making a decision to be there for their neighbor in need and bring glory to God in the process of sharing. So, again: we facilitate members sharing medical burdens.

"Please understand that I am not bashing your organization nor your will to help. As an insurance agent for over 30 years (and a Christian), I have seen many people hurt by programs that do not have good standards. It is our job to protect consumers from those plans, and to steer them toward plans that offer valid protection at an affordable price."

I appreciate your thoughtful questions and my response is not intended to bash health insurance companies, but rather to simply recognize that their economic model (even those that are "not for profit") is to minimize their payout of claims. That is why they: Penalize their insureds for choosing their own doctors "outside of network," won't pay for certain procedures that were not preapproved, and deny other treatment as "experimental." Their bottom line success is usually evidenced by shiny new office buildings and overly generous executives' salaries.

Our model is ministerial – how can we apply our Guidelines to help members meet their medical expenses (as well as ministry to emotional and spiritual needs).

Our ministry gains nothing by denying assistance to a member [and a panel of members can overturn any decision that a member appeals.) There is a reason why there are Departments of Insurance in every state that field tens of thousands of complaints against insurers while our ministry has operated for 18 years and now have over 23,000 households participating, and to our knowledge no member has ever filed a complaint with any government agency.

Countless numbers of our members (including our General Counsel) recount frustrating experiences dealing with insurance companies refusals to pay, delays, and expensive co-pays which impelled them to leave the "guarantees" of insurance to sharing among a community of believers. Not everyone is ready for what is a step of faith, but we welcome these who are, and are ready to provide answers to those who are skeptical.

Regards,

J

 

[Ann H]

Thank-you, Smi-Guy for your response. I appreciate the tone of your writing, which is respectful and informative. I wish you the best in your endeavors.

 

[somarco]

These ministries are not insurance. They do not assume risk, and they are not liable for paying member's medical bills.

From a provider perspective, this is exactly why some might be reluctant to accept these plans for expensive, elective procedures.

Countless numbers of our members (including our General Counsel) recount frustrating experiences dealing with insurance companies refusals to pay, delays, and expensive co-pays which impelled them to leave the "guarantees" of insurance to sharing among a community of believers.

You, your general counsel and members fail to grasp the legalities of a risk assumption contract. The term guarantee is precise and follows the letter, if not the spirit of the contract.

 

[AllenChicago]

This concept will undoubtedly gain traction in the coming months/years I would think. I never even really heard of this until lately.

Any comments on this? How widespread is this? Are people who opt to do this truly exempt from the regulations, penalties, etc. under the new health bill?

February 23, 2016

Your prediction was right on target, PCBInsurance.

Since Obamacare's passage, health sharing membership has more than doubled, from about 200,000 to about 530,000, according to the Alliance of Health Care Sharing Ministries. The law exempts health sharing members from having to abide by its "individual mandate," which obligates people to buy health insurance or pay a penalty.

Ref: Membership for Health Sharing Ministries Soars Under Obamacare - US News

 

[fostever]

February 23, 2016

Your prediction was right on target, PCBInsurance.

Since Obamacare's passage, health sharing membership has more than doubled, from about 200,000 to about 530,000, according to the Alliance of Health Care Sharing Ministries. The law exempts health sharing members from having to abide by its "individual mandate," which obligates people to buy health insurance or pay a penalty.

Ref: Membership for Health Sharing Ministries Soars Under Obamacare - US News[/QUOTE It sure as "H" is! With the doubling and tripling of premiums in the last year and all the mandates from the ACA it is a very real and proven alternative that avoids a tax penalty. The main ones have been around 20 and 30+ years with very little if any complaints from members and no lawsuits except for failed challenges from certain state OCI.(Kentucky being one example) They are upset because it is keeping potential relatively healthy individuals out of the ACA plans while formerly uninsurable people are flocking to ACA driving up premiums. Foiled again Obama!

----------

From a provider perspective, this is exactly why some might be reluctant to accept these plans for expensive, elective procedures.



You, your general counsel and members fail to grasp the legalities of a risk assumption contract. The term guarantee is precise and follows the letter, if not the spirit of the contract.

These are successful ministries with proven track records of covering members medical needs. It really follows the principle of the law of large numbers. By attracting people who live according to actual biblical principles they are able to share each others needs and do it effectively without a legally binding contract. Statistics prove that people who are spiritually convicted to live better lives have fewer health problems. Yes members rely on faith since this is the original model of sharing the burdens of other believers financially and spiritually.

 

[somarco]

Fostever, I know this is above your pay grade but I will pose it anyway.

How many of the sharing ministries have contracts with providers that include a contractual guarantee to pay the claim?

----------

How many have reserves that are backed by state guaranty funds?

How many have DOI oversight?

 

[scagnt83]

How many have reserves that are backed by state guaranty funds?

How many actually publish any info at all about their reserves?? Ive searched a couple websites of sharing ministries and have never found any detailed financial info about reserves.

 

[kgmom219]

These are successful ministries with proven track records of covering members medical needs. It really follows the principle of the law of large numbers. By attracting people who live according to actual biblical principles they are able to share each others needs and do it effectively without a legally binding contract. Statistics prove that people who are spiritually convicted to live better lives have fewer health problems. Yes members rely on faith since this is the original model of sharing the burdens of other believers financially and spiritually.

I'll be sure to share this idiocy with the 12 people in our church bulletin on Sunday requesting prayer for their cancer battle.

Or since I know at least 4 of them are receiving treatment at MD Anderson, should I let them know that if they were using a Christian ministry plan, they would have been turned away at the door?