Insurance Agent Forum

[JamesLansberry]

Originally Posted by somarco

Does Samaritan use an independent TPA to adjudicate claims?

No. We're not adjuticating anything--we don't have claims because we're not insurance. Our members count on us to provide a charitable coordination of ministry, and a TPA would only raise our administrative costs and depersonalize what we do. It certainly something that may be great for health insurance, but it's not something we see the need for here.

James
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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.

I think you've already gotten an answer from your colleague on why we're not insurance--we make no promises of payment, as he said.

As for large--I was using Dave's number not mine. We've had needs over $500k and expect that we'll have even larger ones at some point, and by God's grace we've seen them get met.

Please remember that over half of our members would qualify for Medicaid in most states. They're using this private, charitable option instead, and we're glad to be able to provide that service and ministry to them.

James
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Originally Posted by Cenla Agent

James, thanks for your informative responses.

You're very welcome. I'll probably hang out for another week or so to see if anything new pops up, but with the health reform going on in DC my life is incredibly busy here so someone will have to contact our ministry directly for questions if any come up much after that.
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Originally Posted by ins.dave

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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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?

Dave, I'm pretty sure you wouldn't be happy here, because you don't believe something like this can work. God and money can be combined often without any problem--and just because there are occasional scandals by sinful men doesn't mean that it doesn't work in most places at most times. Nobody says after Enron that "money and power companies don't mix" do they? No. We punish the guilty and move forward.

Samaritan has an accountability system built in--an elected disinterested board that oversees the budget and sets officer/executive salaries.

Whether or not anyone is interested our monthly share for a family of 3 or more is $285 plus a membership dues of $170/family each year. That's an annual cost of only $3,590 for a family of any size. It's not for everyone, but we like it. That monthly share has not gone up since late 2007.
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Originally Posted by somarco

James -

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

Every month each member gets three things (and these are our terms, and I'll try to summarize what each is): a newsletter, a prayer guide, and a share slip.

In the newsletter there are informative faith related articles, news about the ministry, and the birth and death announcements for our members to pray about in praise and weeping. We include the addresses and vital stats for the babies so that members can send cards if they want. After one of my children was born a member randomly sent us a brand new outfit for our little girl. Having been relatively poor over our marriage to that point we'd never had non-thrift-store clothes before. It was pretty cool.

In the prayer guide we give a month's worth of prayer requests to the members--one prayer request a day. We print up several versions to include all the prayer requests and randomly put those in with each newsletter. Some of our members ask for all of the versions so they can pray for more members. This includes the member's name and how the member has asked for prayer.

The share slip is the monthly assignment for which need you'd share financially, spiritually and emotionally in. It includes a longer version of the prayer request and the member's address. The member then is expected to pray for the sick member, and send a note or card along with their monthly share to the member in need.

James Lansberry
Vice President
Samaritan Ministries
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Sorry to put so much in all at once. As I mentioned, I'll hang out for a week or so to see if there are any follow-up questions. Sorry to take so long on this but I've been sick and couldn't string thoughts together very well.

Thanks again for letting me take part in your forum and explain our ministry!

James Lansberry
Vice President
Samaritan Ministries

[somarco]

You say you don't adjudicate claims (or requests) but you also said you negotiate with the providers for a 20% or so discount. This implies there is some sort of adjudication process.

As for your monthly prayer list, it seems to me there are some HIPAA violations there. Even though your plan is not insurance, there is PHI that is being disseminated to the public. I am a bit surprised someone hasn't called you on that issue.

[pipedream]

Somarco - As a ten year participant in a similar plan, I think what you are missing is that the individuals and families know their information is going to go out on the newsletter to the other members of the group. Participants write about their own situation and requests and this narrative is submitted along with their medical bills. This is voluntary and can reveal as much or as little as the person(s) submitting the request desires. I can't see how that would be a violation of HIPAA.

It's really no different than attending a church meeting and asking for prayer for a specific need, burden or concern in person.

[healthagent]

If you're in church and want to offer a prayer you cannot be specific without consent. If there's no consent there's nothing wrong with "I'd like everyone to pray for my brother who's sick."

What you cannot say without consent is "I'd like everyone to pray for my brother who was just diagnosed with AIDS."

Although even reviewing this; say you pray for your co-worker who just got diagnosed with something and without her consent you say "...pray for Cindy Smith who's sick." If her boss is also attending he now knows something's wrong with Cindy however Cindy might not have wanted anyone to know she's sick.

[JamesLansberry]

Originally Posted by healthagent

If you're in church and want to offer a prayer you cannot be specific without consent. If there's no consent there's nothing wrong with "I'd like everyone to pray for my brother who's sick."

What you cannot say without consent is "I'd like everyone to pray for my brother who was just diagnosed with AIDS."

Although even reviewing this; say you pray for your co-worker who just got diagnosed with something and without her consent you say "...pray for Cindy Smith who's sick." If her boss is also attending he now knows something's wrong with Cindy however Cindy might not have wanted anyone to know she's sick.

I (and our attorney) am pretty sure you're way overblowing the extent of the authority of HIPAA. We have our members' permission to pass on what we do, and so I think we're fine there.

It's been a couple of days and I haven't seen any new questions. Unless I see something in the couple of days I'll bid you farewell. Thank you all for the interaction here. I'm glad I was able to engage in this dialog with you.

James Lansberry
Vice President
Samaritan Ministries International

[somarco]

Maybe the HIPAA violation is a stretch, maybe not. PHI rules are far reaching.

Even though members volunteer their information, broadcasting it to people who don't have a medical reason for knowing the details of the condition could be a violation. But that is not my problem.

The program has merit, but also has a lot of holes. And I still maintain you are short changing your members by not using the services of a PPO network.

[JamesLansberry]

Originally Posted by somarco

And I still maintain you are short changing your members by not using the services of a PPO network.

That assumes there's no value at all in the members having 100% control over their own medical choices and provider choices. I certainly believe there's value in it--not only utility value but also in the long term health of our members using providers they personally choose and trust.

James

[somarco]

Sorry, James, but you really don't understand my point. Insured patients, with PPO's, also have free choice. They just get to pay a lot less when they use par providers.

Keep over-charging your members, and have a nice day.