Home 
Guidelines Christian Health Care Newsletter Section VI
Medical needs are submitted on a per person per incident basis for illnesses or injuries resulting in visits to medical doctors, emergency rooms, or hospitals (inpatient and outpatient). 1. Minimum Amount to be a Publishable Need Needs of less than $300 are not considered burdens that should be borne by other members. If a need of this size is a burden that the member cannot bear alone, help can be sought from family, friends, local church, or it can be submitted as a Special Prayer Need. 2. Initial Unpublished Amount When a need is greater than $300, the portion of the need that exceeds $300 will be eligible for publication. 3. Maximum Amount The maximum publishable amount for each need is $100,000. (If you desire to participate in a need sharing ministry for needs greater than $100,000, see the Save to Share™ program Guidelines on page 24.) 4. Need Defined Bills related to the same condition, including those for separate incidents, (e.g. separate treatments or episodes of symptoms) will be published as one need and accumulate towards the $100,000 maximum amount. If at least twelve months pass without any treatments or symptoms, and a cure has been shown by a doctor's written opinion or a test proving the absence of the condition, and the condition reoccurs, a new need will be started. 5. More than Three Needs in Twelve Months If a member household has more than three publishable needs in any twelve month period, the initial unpublished amount of $300 will apply only to the first three needs. Needs less than $300 will still not be published. 6. Effect of Discounts and Special Exceptions Payments by other agencies and reductions by health care providers will be applied first, dollar for dollar, to the initial $300 unpublishable amount of each need. If a discount or other special exception (e.g. IX:B:2 and 3 regarding homebirths and certain vaginal births) has the effect of making the initial unpublishable amount of a need zero, that incident will still count towards the three per twelve month limit. 7. Multiple, Simultaneous Needs If more than one publishable condition is treated during the same time period, the member may submit separate needs for each condition. Each need must be submitted with a separate Need Processing Form. The initial unpublished amount will apply to each need. 1. Others Obligated to Pay a. Insurance Type Arrangements Bills must be submitted to insurance, Medicare, Worker’s Compensation, and any other responsible payer before submitting them to Samaritan Ministries. Members who are 65 years old or older must have Medicare Part A, if eligible, unless the member demonstrates that this would violate his biblically based conviction. Members must receive notice of payment or rejection, and submit documentation thereof, before Samaritan Ministries will consider publishing the need. Any amount paid by insurance, Medicare, Worker’s Compensation, or any other responsible or liable party will not be published. b. Pursuing Legal Remedy If a member suffers injury and the liable party or his insurance refuses to pay unless sued, the member must sue. If the member decides not to sue, the member has chosen not to have the need considered for publication, unless the member demonstrates a Biblically based conviction against initiating a lawsuit. (See section XII) 2. Other Available Assistance If a secular, religious or fraternal organization is willing to pay any portion of a qualifying medical bill and the member refuses to accept this payment, the member has then chosen not to have that portion of the bill published. The amount the organization would have paid will not be published unless this would violate a member’s Biblical conviction. Discounts given by any health care provider should be listed in the Discounts column on the Bill List and will not be published. There are some special, specific dollar limitations for a few situations which are explained at VIII:A Congenital Defects, and IX:A Maternity Needs The amount of a need that is published may be affected by the amount of other members’ needs. Each month there is a fixed amount of committed shares available from members to be sent out to meet needs. However, the needs of members fluctuate, and in any one month may be greater, or less, than the shares available. Needs take varying amounts of time to process to be ready for publication, and there is never an exact match between the amount of shares available for a month and the needs that have been received. Many times the mismatch between needs and shares is remedied by overlapping needs received in two months, but occasionally the discrepancy is too large for this simple adjustment. The handling of large fluctuations is described below: 1. When Shares Are Greater Than Needs If the shares available for a particular month are greater than the needs to be published, and all of the unpublished pro-rated needs from the previous month are also met, needs for the following month may be published or the share amounts assigned to the members may be reduced for the month. 2. When Needs are Greater than Shares/Pro-rating It is our goal that all qualifying needs presented by the members will be published. However, in the event that the publishable needs are significantly greater than the shares available for that particular month, we may use a pro-rating contingency plan. For example, if $1,000,000 in total needs are to be published in a given month, but only $900,000 in shares are available, we will take the percentage of shares as compared to needs—900,000/1,000,000 = 90 percent—and apply that percentage to each need. Thus, we will publish 90 percent of the normal publishable amount of each need presented for that particular month. If you have a need for which SMI would normally publish $1,000.00, only $900.00 would actually be published. We will ask members to pray that God will provide for the unpublished portion of these needs in the following month. Members will also be encouraged to give more than their normal monthly share to help make up the shortfall. If in the month following the pro-rating we find that the published needs are less than the shares available, we will consider carrying over the unpublished portion of pro-rated needs from the previous month. Once a deficit has run and one month has passed, we will not usually carry over the unpublished needs to subsequent months. However, we will consider publishing pro-rated needs that are an excessive burden to a member as a Special Prayer Need. See Section V. There are additional procedures that affect pro-rating Maternity Needs. If medical providers have given you discounts on your bills, the discounts will be applied first to the initial $300 unpublished amount, and then to the amount that is pro-rated, reducing or eliminating the impact of pro-rating on your need. |
||
Call Us at 1-888-2OTHERS (1-888-268-4377) today!
Copyright ©2005 Samaritan Ministries International.
If you have any problems with this website, please email the webmaster.