Thinking Outside the Box...

Are you tired of paying insurance companies (I'm talking health, here) a lot of $$$ each month for premiums, for what seems like very little coverage until you pay off your deductible? I certainly was. Erik has his insurance paid for by his work, so his premiums are at least covered. I'm not sure what his deductible is, but last summer he went to the ER with kidney stones & WITH insurance it cost us about $2400. out-of-pocket. The kids & I have been on a catastrophic plan: we receive a physical for 'free' every year, have an individual deductible of $7,000 & a family deductible of $10,000. We chose that plan because most of the things we end up sick with are things we don't actually need medical care to treat -- colds, flu, ear infections. So this was just to cover us in case something really bad came along...which we pray never does. But even on this catastrophic plan, our premiums were going up 40% last year (!!!), so we were going to be paying about $650./month for 1 Dr. visit per year (figure an annual physical costs about $100 - $150 out of pocket, times 4 of us, 1 month's premium would pretty much cover it....). I was pretty fed up (it's one thing when your employer is covering these costs, it's another when they come out of your own pocket...). So we started looking around, asking other people what they did (it's a rare thing to find an employer who pays for the whole family's premiums), & thinking a little more outside the box. We bought a Vitamix so that we could make smoothies & increase our fruit/veggie/superfood intake. We started looking at alternatives to health insurance. This is what we found:

We switched to what is called a 'health sharing plan.' It is through a faith-based organization called Samaritan Ministries ( http://samaritanministries.org ). It is based on a Bible verse in Galatians: “Bear one another’s burdens and so fulfill the law of Christ.”  This is how it works: we pay a monthly 'premium' of $370 for all FIVE of us. But we don't pay it to Samaritan. We pay it to other Samaritan members who have submitted a 'need' request, thereby reimbursing them for medical expenses they have paid out-of-pocket.

Here's how it has worked for us: In December, I woke up with a massive ear infection (on a Sunday, of course, December 23rd). I went to Urgent Care. As a cash patient they actually gave me a discount, so my office visit cost $85.  I ended up getting a bill for a bit more, as the Dr. plucked some wax out of my ear as well, so I was billed separately for that. I also picked up an antibiotic, & was referred to an Ear-Nose-Throat Dr. All of these bills relating to my ear were considered 1 incident. Each member is responsible for the first $300 of each incident, but can be reimbursed for the rest. So I saved all my receipts, called Samaritan for a need request form, filled it out, & sent it back in. Then members sent ME their 'premium' to reimburse me for my expenses. Pretty cool, huh?

Another case: When we were in California & Kaarin had her abscess (you can read about that in another post), we had to pay for all of the Dr. visits, ER, etc. But amazing things happened: the Drs. all gave us cash patient discounts. The ER knocked $1400 off of our bill. I called to pay one bill (lab work) for $197. & was told the balance was $0. AND, while each member is responsible for the first $300, if you get reductions in your bills for being a cash patient, Samaritan counts that toward your $300 -- so in this case, I will be reimbursed for the FULL amount we paid out of pocket toward her care!!!!

If Erik had had Samaritan (you can have it in addition to insurance, they will count insurance payments toward you $300 portion) when he went to the ER, we would have paid at most $300, not $2400. Ouch.

Now, there are a few drawbacks, as with anything: it does not cover dental (however, dental premiums on most insurance plans are MUCH cheaper). If you have a lot of 'single' incidents (Dr. visits not relating, or for different people), the $300 piece can add up quickly. You have to be much more meticulous about your health care statements (shouldn't we be, anyway?), as you have to provide more than just a receipt for what you paid. :) Some medications are not covered. There is a $$ amount cap. You can't be covered for things that are pre-existing when you sign up until you are free & clear for 1 yr. (which rules out all birth defects & related costs, or other chronic illnesses). So if Erik had had another bout with kidney stones, his bills would not have been covered unless it had been a year. They do offer for those things to be submitted as a 'special prayer need' & people can send you a bit extra if they feel like it, so you could still be reimbursed. I am submitting Erik's bills from his kidney stones even though he wasn't on the plan yet as a special prayer need.  But, overall, it has caused us to be much more thoughtful in what we go to the Dr. for, we have experimented with home remedies (read the posts on GOOT), & we have worked hard to improve our health so that we just get sick less often. Obviously, some things can't be avoided -- Kaarin's abscess is one example. But instead of relying on medicine & Drs. to provide us with HEALTH, we are doing everything we can to be in control of our health (I will post more on this later!).

Please feel free to ask me any questions about this. I am happy to answer!