Insurance Agent Forum

[somarco]

We do negotiate discounts, and average about 20% on providers who we negotiate with, over 30% on our successes. We don't want to be a part of a PPO or any type of network, though, because our members having the ability to choose their own providers is important to us.

That's a lot of work for nothing. You could access a network on a captitated basis for a lot less than the manpower you are using to negotiate after the fact.

Those in a PPO contract can use anyone they wish too. If they use a par provider the claim is lower, less OOP. If they go out of network, your folks can still negotiate if they want but even that is not necessary if you hooked up with a tertiary network.

Bottom line. You are paying too much all around. Doing a disservice to your flock.

Overall it appears you have a well run plan but you are a bit naive about how risk management really works. I spent close to 15 years in the stop loss business and had clients with more covered participants than you have who were wise enough to purchase cat cover.

[ins.dave]

Originally Posted by JamesLansberry

The news story about our ministry was less than friendly, and these non-profits operate in a way that is difficult, if not impossible, to characterize fairly in a 2 minute news segment.

I have offered some thoughts of response on my blog at healthcaresharing.org

Our members share in millions of dollars in needs every month, over $35M this year alone. I'm not a pastor, but I'll have to assume the comment about "the pastor" above was referring to me--we are a faith based ministry. There was no attempt to be evasive, and it is obvious if you go back and look at the segment that it was cut mid-thought. There are no guarantees, but our members have seen their needs met over and over and over again, and they are happy with our ministries. We are providing a charitable, affordable option to health insurance for those who choose it. It's not for everyone, but the 100,000+ people in the U.S. who are using this model would like to keep it.

James Lansberry
Vice President
Samaritan Ministries International

And I'd like to continue to drink alcohol, but because it is a bad idea, I don't do it anymore.
My advice, leave God in God's world and take care of business in this one?
You sir are a joke.
But as long as you don't have to work for a living I suppose ...?

Call what you and your's do whatever you want. If and when the poop hits the fan financially, you'll be the first one at the emergency room shifting the cost to the rest of us.
Then again, at that time, you can always just say it is God's will. Or is it "Gottes Wille?"
I wonder if coverage is mandated whether or not yours will qualify? Irresponsible. Plain and simple. Hypocrite.

[JamesLansberry]

Originally Posted by somarco

Bottom line. You are paying too much all around. Doing a disservice to your flock.

Overall it appears you have a well run plan but you are a bit naive about how risk management really works. I spent close to 15 years in the stop loss business and had clients with more covered participants than you have who were wise enough to purchase cat cover.

I certainly see your logic here, but still disagree because it'd be contrary to what we are. We're not trying to be what you are, and we're not trying to accomplish risk management. As it is, we're sharing needs above $300 for less than $300/month for a family, and the resources and contracts and legal difficulties to get to something different simply have more risk than reward for us.

No problem at all with your logic and your perspective, but I'll let my elected board determine whether there's a disservice to our members being done. I do appreciate the input though, and I'll pass the thoughts along to those who make the final decisions on that, but as we've discussed pros and cons before I don't expect this is an area where we'll change.

James Lansberry
Vice President
Samaritan Ministries International
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Originally Posted by ins.dave

And I'd like to continue to drink alcohol, but because it is a bad idea, I don't do it anymore.
My advice, leave God in God's world and take care of business in this one?
You sir are a joke.
But as long as you don't have to work for a living I suppose ...?

Call what you and your's do whatever you want. If and when the poop hits the fan financially, you'll be the first one at the emergency room shifting the cost to the rest of us.
Then again, at that time, you can always just say it is God's will. Or is it "Gottes Wille?"
I wonder if coverage is mandated whether or not yours will qualify? Irresponsible. Plain and simple. Hypocrite.

First of all, thank you to all the other posters here for the hospitality you've shown me on your forum. This is your forum, and I am a guest here, and will attempt to conduct myself accordingly.

Secondly, "dave", I'm more than a little perplexed by both your post and your vitriol. I am pretty sure that I do work for a living, and I don't believe that you've gotten enough information from this thread or even what you can find on line to really substantiate the accusatiion that I'm a hypocrite. This kind of anonymous ad hominem attack really doesn't contribute to understanding one another.

I can certainly understand how someone who is steeped in the study and application of risk management would consider what we do to be irresponsible. But that's the outside impression of anything that is faith based. Our members share in millions of dollars of medical needs each month, and they pay their bills. They are not leaving unpaid bills at the emergency room, but are pursuing medical care just like anyone else in our nation, choosing their own providers, and finding help from a community of others when those bills get too big to handle on their own. Many of our members would qualify for Medicaid or SCHIP, and yet are choosing a private, charitable option instead, and most of our members (who are self-employed) couldn't afford a major medical insurance policy at three times our monthly share.

I'm not exactly sure what I've done that seems to have offended you so. If you want to discuss the merits of what we do by pointing out accurate, factual information about health care sharing I'd love to discuss it. If the best you have to offer is calling me names and making baseless accusations I don't know what we can discuss. You certainly are entitled to your opinions, and I'm taking part in this thread because I wanted to dispell misinformation that may be out there. It's impossible in a 2 minute TV news segment to even scratch the surface of what we do, any more than one could accomplish it with a standard insurance policy. I have home insurance and car insurance and I couldn't summarize my policies in a 2 minute video segment, let alone give anyone complete understanding of what that is. So why would anyone expect that to be sufficient for something that is a completely different paradigm than most Americans have seen?

If you'd like to continue the conversation, "dave", I'm glad to do so. Follow up with some questions and I'll be back to answer them.

James Lansberry
Vice President
Samaritan Ministries International

[URDRWHO]

One time I looked into one of the faith based plans. They had a $50 nonrefundable app. fee. I went through the tele app. process. Then they declined be for something I had in 1971. Hm? Ok. Now doesn't that give cannon fodder to the national health plan people. But they aren't insurance plans and don't have the pre-x look back of a certain time period.

In 1971 me and my friends went south of the border for a while, eating, drinking and having a good time. One of the eating establishments had an outbreak of hepatitis and we all got it. Some gama globulin (sp) and we got over it.

Originally Posted by somarco

I had the Good Sam group several years ago. They paid their bills on time and were an outstanding risk for my carrier. We reinsured claims xs of $50k.

Can't say if they still do that or not.

Medi-Share is a similar organization.

The concept makes sense. It is tough to qualify for coverage and the plans don't cover a lot of things insured plans cover.

Since it is not insurance, they don't have to comply with state mandates, and don't have to meet reserve requirements.

The biggest challenge for their members is getting a doc & hospital to accept assignment if you need something major. Since there is no guarantee of payment, it is all on faith, you may have trouble getting someone to agree to schedule that kidney transplant on faith.

I like the concept, but I feel anyone who goes into this kind of arrangement needs to have a high deductible plan to back it up. Time still offers (I think) a $25k deductible. Problem is it is priced about the same as $10k deductibles here in GA.

[ins.dave]

Originally Posted by URDRWHO

One time I looked into one of the faith based plans. They had a $50 nonrefundable app. fee. I went through the tele app. process. Then they declined be for something I had in 1971. Hm? Ok. Now doesn't that give cannon fodder to the national health plan people. But they aren't insurance plans and don't have the pre-x look back of a certain time period.

In 1971 me and my friends went south of the border for a while, eating, drinking and having a good time. One of the eating establishments had an outbreak of hepatitis and we all got it. Some gama globulin (sp) and we got over it.

One of your flock needs open heart surgery.
The tab is $100,000+.
How does that go down for him / her?
Who ends up paying for it?

[somarco]

The Christian ministry plans like this conduct moral underwriting as well. It's not for everyone, has flaws just like, but different from traditional health insurance. Some of the plans are very well managed while others have had problems.

If I had one I would certainly have a high deductible plan, $10k at least, as a back up.

JMO.

[JamesLansberry]

Originally Posted by ins.dave

One of your flock needs open heart surgery.
The tab is $100,000+.
How does that go down for him / her?
Who ends up paying for it?

One of our members has a need over $100,000 almost every month. We've seen needs in excess of $500,000 that our members have met.

First, let's consider something that's actually likely to hit that $100,000 mark. Most of our heart related needs come in under $75,000. But let's say that it's $110,000.

First the member, who is treated as a self-pay patient by his providers, gets the itemized bills and sends them to our office. We check for fraud controls and that the bills are actually for our member. Let's say we received these in our offices on August 15th.

Late in September we allocate for our October newsletter. At that point we'll (for this need and another $2M+) assign each member to share in a need for October. So somewhere between 350 and 400 members will be asked to send their shares that month to the member with the huge need. We'll assign about $100,000 to the need and send them a list of the members assigned to them and the member checks them off as they arrive.

In the meantime we'll contact the providers and ask for discounts. With a need of $110k, we'll expect discounts in excess of $20k, but it could be as little as $10k, depending upon what the hospital and doctors will do for cash patients. Anesthesiologists, for example, rarely discount their fees for our members.

The member then will receive gifts totaling enough to pay the bills and pay his bills, after discounts, and send any excess gifts on to another member the following month.

That may be more or less than you were looking for--so feel free to ask follow-up questions. I know this doesn't sound like the most efficient way to do things, but it works for us, and engages the patients in the center and keeps everyone's costs as low as possible for us, and through this mechanism we're sharing over $3M in medical needs each month among over 13,800 families.

James Lansberry
Vice President
Samaritan Ministries International
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Originally Posted by somarco

The Christian ministry plans like this conduct moral underwriting as well. It's not for everyone, has flaws just like, but different from traditional health insurance. Some of the plans are very well managed while others have had problems.

If I had one I would certainly have a high deductible plan, $10k at least, as a back up.

JMO.

We do have a few members with HDHPs, but very few. Certainly this isn't disallowed, but we ask that the insurance plan pay any bills first before our members share in them.

James Lansberry
Vice President
Samaritan Ministries International

[somarco]

Does Samaritan use an independent TPA to adjudicate claims?

[Questions]

Originally Posted by ins.dave

The tab is $100,000+.

that's your example of a big claim?

Someone throws "god" into a paragraph and your panties bunch up. Ever heard of a captive insurance company? This is still insurance...it's just a matter of how well structured it is.

[somarco]

Actually, this is not insurance (but some states choose to view plans like this as insurance).

This is more like a co-op.

[Questions]

Originally Posted by somarco

Actually, this is not insurance (but some states choose to view plans like this as insurance).

This is more like a co-op.

by the very definition of insurance, it is insurance. It's just structured differently than what is viewed as today's "traditional" insurance or risk transfer.

[somarco]

If you want to argue the finer points of what is, and isn't insurance then answer this. Given the fact there is no promise to pay anything at all, how is this insurance? This is not an aleatory contract.

[Cenla Agent]

James, thanks for your informative responses.

[ins.dave]

Originally Posted by Questions

that's your example of a big claim?

Someone throws "god" into a paragraph and your panties bunch up. Ever heard of a captive insurance company? This is still insurance...it's just a matter of how well structured it is.

Whatever mouth.
You pick the amount.
Organ transplant? $250,000 - $400,000
Real carriers offer $5,000,000 lifetime max.
Whenever people start trying to combine "god" and money, problems begin. Always.

Point is, there done with their little church plan.
Not financially solvent.
Then with a pre ex, good luck picking up another carrier.
That's the point church lady.
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Originally Posted by JamesLansberry

One of our members has a need over $100,000 almost every month. We've seen needs in excess of $500,000 that our members have met.

First, let's consider something that's actually likely to hit that $100,000 mark. Most of our heart related needs come in under $75,000. But let's say that it's $110,000.

First the member, who is treated as a self-pay patient by his providers, gets the itemized bills and sends them to our office. We check for fraud controls and that the bills are actually for our member. Let's say we received these in our offices on August 15th.

Late in September we allocate for our October newsletter. At that point we'll (for this need and another $2M+) assign each member to share in a need for October. So somewhere between 350 and 400 members will be asked to send their shares that month to the member with the huge need. We'll assign about $100,000 to the need and send them a list of the members assigned to them and the member checks them off as they arrive.

In the meantime we'll contact the providers and ask for discounts. With a need of $110k, we'll expect discounts in excess of $20k, but it could be as little as $10k, depending upon what the hospital and doctors will do for cash patients. Anesthesiologists, for example, rarely discount their fees for our members.

The member then will receive gifts totaling enough to pay the bills and pay his bills, after discounts, and send any excess gifts on to another member the following month.

That may be more or less than you were looking for--so feel free to ask follow-up questions. I know this doesn't sound like the most efficient way to do things, but it works for us, and engages the patients in the center and keeps everyone's costs as low as possible for us, and through this mechanism we're sharing over $3M in medical needs each month among over 13,800 families.

James Lansberry
Vice President
Samaritan Ministries International
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We do have a few members with HDHPs, but very few. Certainly this isn't disallowed, but we ask that the insurance plan pay any bills first before our members share in them.

James Lansberry
Vice President
Samaritan Ministries International

Well, with over 13,000 families you may be a little more solvent than some of the others we have come across.
Maybe I'll join your church to get the coverage.
What's the total charge per month to be a member?
By the way, I'm diabetic with a heart condition is it still o.k. for me to join? Any waiting periods?

[somarco]

James -

When Samaritan sends out their newsletter, are the names of those needing help listed in the letter? What other details are provided?

[Rivers1]

Originally Posted by pipedream

I do think that if all Americans paid OOP for routine medical expenses (checkups, flu shots, routine office visits & blood work, etc.) and all had HSAs that would assure coverage for the big stuff, many of the ills that the administration and congress are trying to address could be cured.

I totally agree. This is the way insurance is suppose to be. People think health insurance is meant to pay for everything. Health insurance is the only type of insurance that is thought of this way, "needs to pay every dollar or the coverage is awful".
Why???

[Questions]

Originally Posted by somarco

If you want to argue the finer points of what is, and isn't insurance then answer this. Given the fact there is no promise to pay anything at all, how is this insurance? This is not an aleatory contract.

Didn't read the fine print...if there's no promise to pay, then you are correct. It's not insurance. My apologies.

[Ron Van D]

Originally Posted by JamesLansberry

First of all, thank you to all the other posters here for the hospitality you've shown me on your forum. This is your forum, and I am a guest here, and will attempt to conduct myself accordingly.

Secondly, "dave", I'm more than a little perplexed by both your post and your vitriol.

Don't mind Dave. His continual bickering with Al3 has made him a little cantankerous.

[al3]

Originally Posted by Ron Van D

Don't mind Dave. His continual bickering with Al3 has made him a little cantankerous.

A little?

He is not "cantankerous." The guy has major anger-management issues.

Al

[JamesLansberry]

Originally Posted by Cenla Agent

James, thanks for your informative responses.

Thanks!

And I'm not ignoring the other questions that are out there. I just got back from a long weekend spending some much needed time with my wife and woke up yesterday with bronchitis. I'll get back to this before the end of the week, Lord willing.

James