I'm going to tell you my experience with health insurance.

My wife and I both worked at a private Christian school which didn't pay well. However, we wanted to have a baby, and seeing as how we didn't have thousands laying around, I figured that the prudent thing to do was to get insurance at least for my wife.

We signed her up for a plan that cost $260 a month just for her that covers maternity. It was a $1,500 deductible and then would cover 80% of the remaining bill. Each visit to the doctor was a $20 co-pay.

So, baby time came. It was an emergency c-section. It was about $20,000 that was billed to insurance. We pay our $1,500 deductible. Our daughter is a separate $1,500 deductible, and we end up paying $1,000 out of pocket for her. Also, we had to pay the 20% of $18,500 which is around $3,700.

My out-of-pocket for the hospital stay with insurance:
$1,500 (mom's deductible)
$1,000 (baby's deductible)
$3,700 (20% insurance didn't cover)
-----------
$6,200 out of pocket

My out-of-pocket for prenatal visits with insurance (for 9 months):
$20 copay X 14 visits = $280
$260 per month premium X 9 months = $2,340
------------
$2,620 out of pocket

GRAND TOTAL FOR 9 MONTHS & A BABY WITH INSURANCE:
$8,820


With Samaritan, we pay an average of $300 a month for the whole family to be covered. Each "incident" is to be paid out of pocket up to $300. An "incident" in this case is all prenatal care, office visits and birth. Beyond $300, the rest of the bill is shared and paid for with cash from other members in the co-op. Essentially, it's a $300 deductible. I called and asked how a c-section would work. Here's how it would...

A prepaid uninsured c-section goes for around $8,000. With Samaritan I would be responsible for the first $300. The rest ($7,700) is shared amongst the members. Splitting $7,700 among members is better than the $18,500 burden for the exact same procedure that members of health insurance have to split. My out-of-pocket for the hospital stay and all prenatal visits with Samaritan: $300. Even adding in the $300 per month for the 9 months, it is still MUCH MUCH less out of pocket than having insurance.

With Insurance: $8,820
Samaritan: $3,000

If anyone is interested check out the guidelines PDF:

http://www.samaritanministries.org/guidelines/html/SMIGuidelines.pdf

Just seems like a better way.

Congrats to you and your wife on the new baby. The out-of-pocket cost information you shared on your post is really helpful for consumers. Thank you for sharing this.

In my frustration with the current health care system, and the lack of price transparency, I developed a community search engine called www.outofpocket.com to help consumers look up prices for health care services, compare what other consumers paid for similar services, and find the best value. Because insurance plans and providers do not share price information in a meaningful way for consumers, we are relying on consumers to collaborate and post/share prices they paid for actual services, to share with other consumers. Would you be willing to post the prices and services from your exerience in our free directory to benefit other consumers? I invite you to check out outofpocket.com and I welcome any comments you would like to share.

Mona Lori
Founder
www.outofpocket.com
info@outofpocket.com

Here's something from today's Consumerist blog...

Health Insurance: Faced With A Broken Health Care System, Some Doctors Are Opting-Out (http://consumerist.com/5069864/faced-with-a-broken-health-care-system-some-doctors-are-opting+out)

Congrats to you and your wife on the new baby. The out-of-pocket cost information you shared on your post is really helpful for consumers. Thank you for sharing this.

In my frustration with the current health care system, and the lack of price transparency, I developed a community search engine called www.outofpocket.com to help consumers look up prices for health care services, compare what other consumers paid for similar services, and find the best value. Because insurance plans and providers do not share price information in a meaningful way for consumers, we are relying on consumers to collaborate and post/share prices they paid for actual services, to share with other consumers. Would you be willing to post the prices and services from your exerience in our free directory to benefit other consumers? I invite you to check out outofpocket.com and I welcome any comments you would like to share.

Mona Lori
Founder
www.outofpocket.com
info@outofpocket.com


Sounds like you've got a good start.

Because a third party (health insurance) pays for the vast majority of any procedure or office visit, we never get to shop around. Wouldn't it be great if each clinic, doctors office or hospital had prices of procedures clearly listed like menus at restaurants?

Good luck with your web site.

I'd like to add another scenario we experienced in which people who have insurance are getting shafted.

We go for immunizations for my daughter. We go to pay and it tallies up to $580. The lady said, "But, since you have insurance, it's only going to cost your co-pay." I said, "I don't have insurance and this is not what I was quoted over the phone." She said, "Oh, you're private pay, OK." (Tallies new amount) "That's $130." I said, "So you bill insurance almost $500 more??

That's the way it works.

It's kind of freeing to be able to call around, ask how much this office or that office charges for X-Rays or a Dr. visit or immunizations, or whatever... It's much more freeing than being limited to a list of doctors that your insurance covers.

I'd like to add another scenario we experienced in which people who have insurance are getting shafted.

We go for immunizations for my daughter. We go to pay and it tallies up to $580. The lady said, "But, since you have insurance, it's only going to cost your co-pay." I said, "I don't have insurance and this is not what I was quoted over the phone." She said, "Oh, you're private pay, OK." (Tallies new amount) "That's $130." I said, "So you bill insurance almost $500 more??

That's the way it works.

It's kind of freeing to be able to call around, ask how much this office or that office charges for X-Rays or a Dr. visit or immunizations, or whatever... It's much more freeing than being limited to a list of doctors that your insurance covers.


That is the part that always troubles me. OF COURSE they are going to charge more if there is someone with deep pockets (in this case, insurance) willing to pay it.

Luke, out of curiosity, say (God forbid) that your baby ended up having severe complications from the c-section resulting in a lifetime spent in a vegatative state or something similar, longterm... how long would members continue to support that care?

Here's how it works.

Needs up to $100,000 are shared by all members.

Those who want coverage above $100,000 can enroll in what is called "Save to Share." What you have to do to be eligible for needs above $100,000 is simply put an extra month's "share amount" into a savings account one time per year. So, for me, it amounts to adding $300 per year to my savings account that can be accessed by those who have needs above $100,000. Those who have been on the program for many years have hundreds or thousands of dollars in reserve for situations like this.

That's how it works.

What do you guys think about this????

Uninsured Could Lose OU, OSU Football Tickets - Health News Story - KOCO Oklahoma City (http://www.koco.com/health/18034745/detail.html)

We go for immunizations for my daughter. We go to pay and it tallies up to $580. The lady said, "But, since you have insurance, it's only going to cost your co-pay." I said, "I don't have insurance and this is not what I was quoted over the phone." She said, "Oh, you're private pay, OK." (Tallies new amount) "That's $130." I said, "So you bill insurance almost $500 more??

This is because the insurance disallows (or adjusts down) the payable portion of the billed expense to something like 30% (or so) of what was billed, and the provider writes off the unpaid balance. This doctor would would probably get around $150 (+/-) from most insurers, I would think.

And, yes, it's patently ridiculous. Think about all the administrative nonsense and paperwork engaged to sustain that....

...don't get me started...

Anybody catch the special on KFOR regarding one of these "Christian" medical bill coverage scams? KFOR highlighted Medishare - What is Medi-Share? (http://medi-share.org/what_is_medishare.aspx)

Since they are not "real" insurance they have no governing body. In the case on KFOR they stopped paying for surgeries to save a woman's eyesight.

FOX did a story on one too where the "provider" stopped paying because the person needing their bills paid was not living a Christian enough life style. Of course, they had no problem taking their premiums for 3 years.

Beware of any business which claims to be "Christian."