Health Sharing Ministry Troubles...again

[The White Coat Investor]

[QUOTE=snowcanyon;n175602]

I have come to believe that discussing HSMs is just a proxy war for discussing religion.

Only religious people really find this model at all compelling or reasonable. There's a whole cottage industry in America of Christians marketing themselves to other Christians as Christians.

I don't think there's anything wrong with it, it just doesn't land at all on those of us who aren't in the tribe. It's such a uniquely American product and, at the end of the day, a fairly silly one as multiple threads have I think borne out -- others will disagree I'm sure.

Would you rather have a plumber or a Christian plumber with a fish on his van? I don't care but many, many, many do. [/QUOTE

In that case it's still a plumber, fish or no fish. That's what I don't get- this isn't health insurance. It's not the same product. It is, by any reasonable analysis, a far inferior product, fish or no fish, faith or no faith. That's what I don't understand. But perhaps your analysis is the only "logical" explanation. Because this product seems pretty scary if one looks at it logically.

I'm relieved others are skeptical; I've seen only positive threads in the FIRE community.

There's definitely a religious schtick to it. But honestly, I'm completely ignoring the religious, emotional, political, anti-government sentiment that is there. We look at it completely from a dollars and cents standpoint (and I'm surprised that there aren't any of these that aren't specifically Christian).

I agree it isn't health insurance. It's an alternative way to pay for health care that sits somewhere between health insurance and being completely self-pay. I disagree that it is "far inferior." Especially once you consider the price, I think it is far superior for many people and that's why they're buying and using it quite happily year after year after year. I've got a retired partner using it. He's very happy with it and he's plenty financially savvy (he retired at 50 after selling a multi-million dollar company.) Here's his quote he left on my blog post on the topic a few years ago:

https://www.whitecoatinvestor.com/he...comment-454926

The biggest concern when I decided to leave medicine and spend time pursuing my true passions (climbing, skiing, white water adventures, wilderness canoeing) was my ability to obtain affordable (or any) health insurance. I have struggled with health insurance since I retired and was no longer eligible for my physician group health insurance plan. ACA insurance became a bit of a hassle since I have no earned income but substantial assets – each year they denied me as they felt I was Medicaid eligible leading to delays and loss of insurance at times. Furthermore, my ACA bronze plan with a high deductible (between $11,500 and $13,500 deductible each year) increased in cost from around $900/month for a family of 5 to $1240/month. While we are very active and mostly “healthy”, we are in our mid 50’s and little things come up that tend to cost more than you would think. Last year our combined medical expenses including insurance were $22,700 up from about S16,000 the year prior. Our projected insurance costs for 2017 were $14800 plus the $11500 deductible. While I understand that insurance is expensive, these spiraling costs made me begin to investigate other alternatives as these expenses make up a fairly sizeable portion of our retirement budget. I read the post on this site relating to healthcare co-operative in February and was intrigued by the concept. Then I went on a humanitarian mission to Columbia where the other participants all were members of Christian Health Ministries. They felt it was a fair and reliable plan so I investigated further. My family of five could get their gold level plan for $450/month plus $40 month for the “brother’s keeper” which basically is disaster or major medical insurance. The deductible is $500/incident. As previously noted it does not cover routine medical care or medications, but neither does a bronze ACA plan with an $11,500 deductible for all intents and purposes.

Long story short, I switched insurance to Christian Health Ministries. I admit I had some concerns as it is not actually insurance and they can refuse payment, but I felt that all the reviews were positive and decided to take a chance. Unfortunately, 3 months after the switch we had a major medical expense. Our son suffered a significant hand injury on one of our kayaking trips. He required extensive surgery and our out of pocket expenses after negotiating a 30-60% fee reduction for cash payments exceeded $15,000. Christian Health Ministries was great. I simply had to obtain each bill with its discount listed, fill out a form, write a brief letter explaining the event and submit it to CHM. Within a few weeks, with NO hassles and NO denials, I was cut a check reimbursing me for 100% of expenses minus my deductible. In my entire career as a healthcare consumer and as a healthcare provider I have never had this type of experience with insurance companies. I swear part of their business plans is random denial of payments as many of those denials result in the patient assuming the cost and the insurance getting out of the bill. (Among several of my bad experiences, our first child’s delivery costs were denied for failure to get prior approval to have the baby – this despite paying for maternity insurance for years prior).
I cannot say enough good about the Christian Health Ministries plan. They are honest, reliable and affordable. I strongly encourage those interested in a change to consider this group as the provider of their health care coverage.

[snowcanyon]

[QUOTE=The White Coat Investor;n175607]

There's definitely a religious schtick to it. But honestly, I'm completely ignoring the religious, emotional, political, anti-government sentiment that is there. We look at it completely from a dollars and cents standpoint (and I'm surprised that there aren't any of these that aren't specifically Christian).

I agree it isn't health insurance. It's an alternative way to pay for health care that sits somewhere between health insurance and being completely self-pay. I disagree that it is "far inferior." Especially once you consider the price, I think it is far superior for many people and that's why they're buying and using it quite happily year after year after year. I've got a retired partner using it. He's very happy with it and he's plenty financially savvy (he retired at 50 after selling a multi-million dollar company.) Here's his quote he left on my blog post on the topic a few years ago:

https://www.whitecoatinvestor.com/he...comment-454926

So, if you look at the law and regulations (such as they are) regarding HSMs, the "plans" allowed under the ACA are either grandfathered in or have to be associated with a grandfathered in plan, and at the time the law passed, they were all Christian, thus all "new" HSMs have to be Christian.

Sure, if you sell a multi-million dollar company, this is kind of a fun gamble- pay a small amount, you might get your bills paid for, and if you don't, you can probably self-insure until the next ACA cycle. That's not most people's situation. Your commenter hasn't experienced any major expenses (cancer, trauma, an ICU stay- 15k is peanuts). This one anecdote is not any more compelling than the multiple anecdotes from people who have really been screwed; how is this data? Of course some people will be OK, but the experiences of the non-covered breast cancer patient are just as valid, perhaps more so; don't most people buy insurance to avoid such a catastrophe? I would consider the state investigations and media investigations the closest we have to data.

[The White Coat Investor]

[QUOTE=snowcanyon;n175618]

So, if you look at the law and regulations (such as they are) regarding HSMs, the "plans" allowed under the ACA are either grandfathered in or have to be associated with a grandfathered in plan, and at the time the law passed, they were all Christian, thus all "new" HSMs have to be Christian.

Sure, if you sell a multi-million dollar company, this is kind of a fun gamble- pay a small amount, you might get your bills paid for, and if you don't, you can probably self-insure until the next ACA cycle. That's not most people's situation. Your commenter hasn't experienced any major expenses (cancer, trauma, an ICU stay- 15k is peanuts). This one anecdote is not any more compelling than the multiple anecdotes from people who have really been screwed; how is this data? Of course some people will be OK, but the experiences of the non-covered breast cancer patient are just as valid, perhaps more so; don't most people buy insurance to avoid such a catastrophe? I would consider the state investigations and media investigations the closest we have to data.

It's your money. Spend it how you like. There are far dumber insurance products to buy than health insurance!

Seriously though, I totally get the concerns. But I still think you're going too far to call them a scam or a Ponzi scheme. My insurance broker doesn't like them either, but she has a little bit of bias.

[Panscan]

Why are they not allowed anymore unless grandfathered?

[jacoavlu]

Our son suffered a significant hand injury on one of our kayaking trips. He required extensive surgery and our out of pocket expenses after negotiating a 30-60% fee reduction for cash payments exceeded $15,000. Christian Health Ministries was great. I simply had to obtain each bill with its discount listed, fill out a form, write a brief letter explaining the event and submit it to CHM. Within a few weeks, with NO hassles and NO denials, I was cut a check reimbursing me for 100% of expenses minus my deductible. In my entire career as a healthcare consumer and as a healthcare provider I have never had this type of experience with insurance companies.

I swear part of their business plans is random denial of payments as many of those denials result in the patient assuming the cost and the insurance getting out of the bill.

(Among several of my bad experiences, our first child’s delivery costs were denied for failure to get prior approval to have the baby – this despite paying for maternity insurance for years prior).

neither situation sounds like much fun

negotiate with providers for discount

(fail to negotiate and claim likely denied bc of excessive charge master rate)

pay bills up front not knowing if HSM is going to reimburse or not

gather documentation and write letters to try to get reimbursed

child delivery denied for failing to get approval

no wonder it’s so much cheaper

edit: note this was not WCI’s experience but quote within quote doesn’t really work

[snowcanyon]

Why are they not allowed anymore unless grandfathered?

Essentially, someone lobbied for it to be grandfathered in, as these articles explain. The ministry had to have been in existence since 1999 to be eligible. I think they thought it was a niche issue for 100,000 or so people, many Amish or Mennonite. Apparently, there is one Jewish one.

https://www.npr.org/2013/09/28/22723...vidual-mandate
https://www.pbs.org/newshour/health/...or-health-care

It's funny, members always mention the praying as a huge benefit. They even spend members' dollars, and I quote, to build "prayer call centers in multiple time zones to keep up with demand." There are no words...seems like that might have paid for the poor woman's breast cancer....

[snowcanyon]

[QUOTE=The White Coat Investor;n175632]

It's your money. Spend it how you like. There are far dumber insurance products to buy than health insurance!

Seriously though, I totally get the concerns. But I still think you're going too far to call them a scam or a Ponzi scheme. My insurance broker doesn't like them either, but she has a little bit of bias.

Sure. I just think people aren't aware, for the most part, of how these operate, and I don't think they are as clear and open as they should be, and I think they intentionally mislead people as they've grown and lost sight of their original mission.

What is her bias? Many of these are sold through agents and pay commissions.

[MSooner]

My parents have used CHM for a few years now (3...maybe 4?) I also have two other friends who use it to cover all or part (the wife and kids for whom the premiums would be too high) their families. My parents and one of those friends are self-employed. The self-employed, but not super wealthy seems to be the person I run into the most that ends up on one of these plans. Their marketplace plan choices are cost-prohibitive and providing just preventative care and catastrophic coverage and they feel very frustrated.

They all seem to understand that it isn't insurance and so far they haven't had any surprises. My mom had a cardiac workup and a couple of other "bigger" things and they were covered 100%. She is always making calls coordinating the payments and constantly searching for the best prices for stuff like imaging (which might not be a horrible thing, all things considered). One of the friends has had 2 births covered with the OB/hospital of their choice with no issues. They do take FOREVER to pay, though. I believe for CHM you pay up front and they reimburse you, so if you cant float those bills for a couple of months that can be an issue.

Where it breaks down is people who have any sort of ongoing thing. In theory after the 3 years they would be covered, but that didn't help my brother when he needed his $500-$900 drug for ulcerative colitis THEN, not in 3 years. He got a job with good insurance ASAP. I believe they purchased another plan for my college aged sister when she started having major depressive issues a few years ago--I don't think it was covered due to the mental health aspect, but don't quote me on that because I'm not sure. So there you go, 2 unhealthy people out of their pool.

That being said, I'm not a fan. I've actually read through their policies and had some heated discussions with my parents about it. My mom doesn't claim it is the best thing since sliced bread anymore. I worry what could happen if they have something catastrophic. In theory they should be covered, but if they aren't it is going to be a mess. I've pointed out to friends that if their unborn baby is diagnosed with any sort of serious congenital issue they better get on a real plan yesterday as their plan only covers those up to an amount that would be laughable for something like spina bifida or HLHS. I don't like that things like well-checkups & vaccines aren't covered--when you have to go out of your way to get preventive care and pay extra, people tend to let it lapse.

I also just disagree with it on a moral level as a Christian. I don't feel the model is all that Christian when it is really only sustainable for mostly healthy people that can afford it. As someone who is pro-life, I also find the exclusion of coverage for unwed pregnancies and the congenital issue mentioned above especially distasteful. Ectopic pregnancies are treated problematically by some of the plans as well. Samaritan comes to mind particularly--based on the blog post and their own guidelines below, I read that they basically want you to wait for your tube to rupture? (I'm not a physician--feel free to correct me)

https://samaritanministries.org/blog...ubal-pregnancy

Ectopic Pregnancies—

1. Expenses Shared—Procedures related to a ruptured fallopian tube (including post-operative recovery of the mother, follow-up care, and treatment of any complications), and, where an ectopic pregnancy is diagnosed before a rupture, all pre-operative tests and consultations and expenses related to keeping the mother under medical care while determining what care should be offered for the mother and child.
2. Expenses Not Shared—Procedures directly related to the termination of a living, unborn child and/or removal of the living, unborn child from the mother due to an ectopic pregnancy are not shared (e.g. methotrexate, salpingectomy, salpingostomy), unless the removal of the child from its ectopic location was for the primary purpose of saving the life of the child or improving the health of the child.

So overall, I don't like them at all, but I get why people end up there. It's hard to judge too much when I've had access to high quality plans my entire adult life.

[G]

Fun example!

[snowcanyon]

My parents have used CHM for a few years now (3...maybe 4?) I also have two other friends who use it to cover all or part (the wife and kids for whom the premiums would be too high) their families. My parents and one of those friends are self-employed. The self-employed, but not super wealthy seems to be the person I run into the most that ends up on one of these plans. Their marketplace plan choices are cost-prohibitive and providing just preventative care and catastrophic coverage and they feel very frustrated.

They all seem to understand that it isn't insurance and so far they haven't had any surprises. My mom had a cardiac workup and a couple of other "bigger" things and they were covered 100%. She is always making calls coordinating the payments and constantly searching for the best prices for stuff like imaging (which might not be a horrible thing, all things considered). One of the friends has had 2 births covered with the OB/hospital of their choice with no issues. They do take FOREVER to pay, though. I believe for CHM you pay up front and they reimburse you, so if you cant float those bills for a couple of months that can be an issue.

Where it breaks down is people who have any sort of ongoing thing. In theory after the 3 years they would be covered, but that didn't help my brother when he needed his $500-$900 drug for ulcerative colitis THEN, not in 3 years. He got a job with good insurance ASAP. I believe they purchased another plan for my college aged sister when she started having major depressive issues a few years ago--I don't think it was covered due to the mental health aspect, but don't quote me on that because I'm not sure. So there you go, 2 unhealthy people out of their pool.

That being said, I'm not a fan. I've actually read through their policies and had some heated discussions with my parents about it. My mom doesn't claim it is the best thing since sliced bread anymore. I worry what could happen if they have something catastrophic. In theory they should be covered, but if they aren't it is going to be a mess. I've pointed out to friends that if their unborn baby is diagnosed with any sort of serious congenital issue they better get on a real plan yesterday as their plan only covers those up to an amount that would be laughable for something like spina bifida or HLHS. I don't like that things like well-checkups & vaccines aren't covered--when you have to go out of your way to get preventive care and pay extra, people tend to let it lapse.

I also just disagree with it on a moral level as a Christian. I don't feel the model is all that Christian when it is really only sustainable for mostly healthy people that can afford it. As someone who is pro-life, I also find the exclusion of coverage for unwed pregnancies and the congenital issue mentioned above especially distasteful. Ectopic pregnancies are treated problematically by some of the plans as well. Samaritan comes to mind particularly--based on the blog post and their own guidelines below, I read that they basically want you to wait for your tube to rupture? (I'm not a physician--feel free to correct me)

https://samaritanministries.org/blog...ubal-pregnancy



So overall, I don't like them at all, but I get why people end up there. It's hard to judge too much when I've had access to high quality plans my entire adult life.

Wow. That is insane. They certainly don't value pregnant people- ectopics aren't even pre-viable. I'm fairly certain commercial insurance has to cover ectopics. This is common in Latin America. Horrible that it's coming here. Ectopic treatment is one of the greatest medical successes of the last forty years.

[AR]

The 25X is made up as a gross overexaggeration to illustrate the point.

I'm not sure that's the actual effect of gross exaggerations

The reality is we're not completely pooling risk in that scenario because you're putting in $1000 and I'm putting in $40. You have more to lose. We're only truly pooling risk if we're both taking the same risk. So I would argue you're only pooling risk with those in the same category with the same pricing. But I suppose if both policies come from the same company then in some ways we're pooling risk. Just two different ways to look at it.

You're really gonna die on this hill? The way insurance works is that everyone pays in and creates what we'll call, to keep it simple, "a pool of money". Now anyone who experiences the event being insured against, gets money from the pool. The fact that people may pay different premiums doesn't change the fact that they are pooling risk. Maybe you can argue that they are pooling it unfairly or inefficiently, but they're not just pooling it with those who paid the same amount. That's both ridiculous and illogical.

If you truly believe that you're only "pooling risk with those in the same category with the same pricing", think about logical consequences of that. Imagine two identical twins go to buy auto insurance. They're the same as far as driving history and everything else. They go to GEICO to get insurance. Twin A owns some Berkshire Hathaway stock, so he gets a small discount on his premium. Twin B doesn't own any, so he doesn't get the discount. So, they're paying different prices. Now, by your logic, GEICO is not pooling their risk because they don't have "the same category with the same pricing". Are you serious?

I get that you think it's unfair that you pay the same as a heroin addict, but you don't have to twist the definition of something as easy to understand as risk pooling to make your point.

[Panscan]

That ectopic policy is insane. So is the prayer center.

[snowcanyon]

Not to mention unethical....

[Lordosis]

Alright alright.
Tell you what. It appears us financially literate folk are probably a more healthy then average bunch. I think we can create our own pooled risk group. I will gladly take your money but I will decide what is and is not covered based on my morals. Oh and I do not want any legal obligation to have to pay anything. If it is much cheaper then other alternatives then it is a viable plan right? How does $10 a month sound?

[snowcanyon]

Ooh, ooh! Sign me up! Are you building yourself a richly-appointed prayer room from which you can render judgement on coverage?

[G]

Alright alright.
Tell you what. It appears us financially literate folk [and basically everyone that realizes bad health/accidents can be expensive] are probably a more healthy [or not] then average bunch. I think we can create our own pooled risk group [or jump on a plan from the exchange]. I will gladly take your money [premiums] but I will decide what is and is not covered based on my morals [or what I choose to pay the hospital/doctor, assuming they didn't fight with me about a contract]. Oh and I do not want any legal obligation to have to pay anything [or I may have a "legal" obligation, but I will make you make it your full time job to get prior authorization, proper documentation, and endure repeated denials hoping to wear you down before I finally pay]. If it is much cheaper then other alternatives then it is a viable plan right? How does $10 a month sound? [I'm not stupid: it sounds dubious, but maybe I can't afford an out of pocket of $13k/y, so I'll keep my fingers crossed that you will cover my kid's visit to the ER Tues night because I couldnt take off work to see his doctor in the middle of the day]

I added some thoughts above. You guys, commercial insurance has a ton of flaws too. Heck, so do all of the government programs. I don't disagree with any of the commentary on either side of things, but let's be realistic, the gilded prayer room (I'm (hopefully) making that up, but I like the image) ain't no different that the insurance bureaucrats taking home 8 digit incomes.

Yeah, I think HSM are ridiculous--and I'm not just saying that because I have like 34 different exclusion criteria--but it is good for some folks who are trying to make a go of it against a ridiculous system: Modern Medicine.

[snowcanyon]

I think the point is that commercial insurance pays for stuff like ectopics, not prayer rooms, and that we actually don't know WHERE the money is going for HSMs- it may well be going to seven figure CEO salaries. But yes, insurance companies are terrible, although they are at least terrible with some recourse for review.

[xraygoggles]

commercial insurance has a ton of flaws too. Heck, so do all of the government programs.

When it comes to health insurance, the government programs are vastly superior (and vastly cheaper) in every facet compared to the private insurance market. Bad example on your part.

[The White Coat Investor]

Why are they not allowed anymore unless grandfathered?

PPACA. Same reason I can't go back to that plan that excluded maternity coverage now that our baby is 4.