Provider Relations specialist educates, advocates, negotiates

Part 2 of 2.

Karen went from supporting Samaritan Ministries staff to supporting Samaritan Ministries members.

She was hired in 2017 as staff support team lead, but a move back to Wisconsin in 2020 afforded her a new role in a ministry that she just didn’t want to leave. Now as a Provider Relations specialist, she educates, advocates, and negotiates on behalf of members.

As a part of the Provider Relations Department (PRD), Karen works with health care providers and Samaritan members to help get fair pricing on procedures. In the process of negotiating on members’ behalf, she informs and educates members on how they can advocate for themselves.

Her team of 12 also works to confirm payments are being made by members to providers.

“As PRD specialists, our job is to try and step in when members have difficulty getting a fair price,” Karen said. “Our job also is to make sure the Guidelines are being followed in timely payment of bills, as this builds trust with providers that our members will pay their bills and pay them promptly. We also take the opportunity to build relationships with providers and educate them on who we are and how the ministry works in the hopes of securing fair pricing for our members.”

‘We’re not insurance’

Karen’s biggest message to both members and providers is the same thing: Samaritan is not insurance; it is a ministry.

“In conversations with providers, we are representing the ministry and we’re representing Christ,” Karen said. “We are explaining who we are and that we’re not insurance, that our members are helping each other pay medical bills.”

Since PRD launched in 2019, the team has developed a database of providers they have worked with. That helps them keep track of which providers cooperate well with health care sharing ministries and offer quality services at fair prices.

“We know what discounts providers should be giving and how they do it,” Karen said. “For smaller bills, members have to ask. You have to ask for that discount when you have the service.”

Member responsibility

“One responsibility of Samaritan members is to be good stewards with their medical needs,” Karen said. That responsibility includes:

• using the resources available to try and get the best price possible;
• always asking for discounts before, during, and after service;
• being aware of prompt pay discount opportunities;
• and getting bills submitted in a timely manner.

In addition, Karen shared that members should quickly update any discounts that may occur after a bill is approved or even shared and stay up to date on recording Shares they have received.

“Check your email and respond in a timely manner,” she said. “Keep lines of communication open and don’t be afraid to ask questions.”

When members receive a Share from another member, Karen said to remember that it is a gift from another member intended to help you pay your bills.

“If you get Shares, you need to pay your bills right away,” she said. “If you send a Share, pray for that person. Send a message with your Share. We have amazing members, and we have story after story of members seeing a prayer request or a situation and sending a gift above and beyond that Share amount to perhaps a Special Prayer Need. That’s where we’re not insurance. It’s just God calling them to send something above and beyond.”

Karen also advises members to get involved in the Samaritan Ministries Facebook Group and talk with other members about what’s working for them. Find out how other members are saving money and getting good service.

“We are a community of believers who are there for one another and, you know, members should take advantage of that,” she said.

God is in control

Karen and her team work hard to help members with their situations. In some cases, they must send in a single-case agreement to the provider when Samaritan asks the provider to make an exception and give a larger discount. The team does that when it knows from research that the provider in question isn’t offering a fair price.

“We know that providers need to make some money, but we don’t want them to gouge our members,” Karen said.

If the single-case agreement is denied, the team remembers God is in control.

“A member might be upset, or they might have missed a discount or something and feel really bad,” Karen said. “I tell them ‘No, don’t feel bad. You just have to remember that this is a ministry and when we lose the discount where we think we should get one, God does provide in really big ways and in other areas sometimes.’

“He really is sovereign over this, and we just have to do our best to be good stewards.”

God has shown up time and again, saving members even millions of dollars at times, Karen said. It’s in that knowledge and dependence on the Lord that she ministers to members.

“It’s just praying consistently for discernment when I’m interacting with a member,” she said. “What does that member need from me right then? Sometimes a member doesn’t need me to ask them what they’re going through because they’ve been living it. They need a break. They just need to focus on the dollars and cents in front of them. But sometimes they do need somebody to ask them and somebody to say, ‘Let me pray for you.’”