Qualified expenses will be shared for all who are included in a household membership (see Section II) who meet the membership requirements (se Section I) when the expense occurs. For the person’s need to be shared, the household must be current with the annual membership continuation verification and all shares, through the time he was a member, even if he is no longer a member when the need is shared.
To submit your medical needs, please follow these instructions:
A. First
Verify that your medical need meets the shareable needs Guidelines (Sections VI–IX). If you would like a Need Processing packet mailed to you, call Samaritan Ministries toll-free at 877-764-2426 and you will be directed to your Member Services team. Read the instructions in the Need Processing packet mailed to you and follow them carefully.
B. Online
If you prefer to submit your bills online instead, you can use your Samaritan Dashboard. Go to your Dashboard apps, click the Needs app, and then follow the online instructions.
C. Itemized Bill
Along with your Need Processing Form, you must submit itemized bills to Samaritan Ministries. Ask your health care provider to itemize all bills, and make copies to keep for your own records. If you are submitting your need online, you will need to have electronic versions of your itemized bills, to upload them when prompted. An itemized bill will contain the following information:
- Name, address, and phone number of the provider
- Name of the patient
- Date(s) of services provided
- Cost of each individual service or item
- Description of the services or item
- Account number if available
The most common need processing delays are caused by bills that do not provide specific and complete information about the services you received. Bills that merely give amounts or codes may not be accepted. Overbilling and errors are common in health care, and detailed bills allow you and Samaritan Ministries to verify that you are being billed correctly.
D. Read the “Common Questions”
This sheet is included in the Need Processing packet mailed to you. Seek reductions on your bills, using as a guide the “Suggestions for Negotiating Reductions” section and the Healthcare Bluebook available on your Samaritan Dashboard. Reductions may decrease the $2,000 initial unshareable amount in Samaritan Basic. Additionally, reductions help reduce the burden for all members.
E. Obtaining Fair Price
One of the reasons that the monthly share is kept low is the substantial reductions from original billings that members and our negotiators are able to obtain.
Please note: Almost no one pays a hospital’s “list price,” which is the price that is printed on the bill given to you. Hospitals’ “list prices” are three to five times what they expect most people to pay. Therefore, you may be able to obtain a cash-pay discount of as much as 75% off the “list price.” Physicians and other non-hospital services typically give cash-pay discounts of 20-40%. Thus, we encourage members to seek discounts even on small bills, but depending on the situation, often our negotiators are able to save even more. Your provider may also offer a prompt-payment discount if you are able to pay your bill within a certain time frame. Be sure to notify the Member Services department of any prompt-pay deadlines.
F. Cooperation Required
When you submit bills, you are committing to cooperate with Samaritan Ministries staff and partners to determine if the bills are shareable, to seek fair and reasonable prices from medical providers, and to document amounts you have paid to providers. You will be required to sign a medical release so that Samaritan Ministries or its partners can obtain records and communicate with your providers. Failing to submit a signed medical release, revoking a medical release, or declining to work with Samaritan staff and partners to obtain a fair price will prevent the sharing of your need.
In order to steward the shares of fellow Christians, Samaritan Ministries assists members to manage and control the costs of their health care. We are committed to protecting members from unfair and unreasonable charges. Samaritan reserves the right, on behalf of its members, to determine what charges or parts of a charge are unfair or unreasonable based on techniques, criteria, and standards adopted by Samaritan Ministries. Samaritan will limit the sharing of charges determined to be unfair or unreasonable and will advocate on behalf of sharing members against any health care provider demanding payment of unfair charges. This Guideline empowers Samaritan members to refuse to pay excessive charges, while also committing Samaritan to contend for fair prices on members’ behalf. Samaritan Ministries and its partners will work with members and their providers to reach a resolution on excessive charges through negotiation and, if necessary, protect members through legal action. Samaritan will not leave an open bill dispute unresolved.
G. “Bill List”
List the amounts you have been billed. Also list any payments by other agencies and discounts from the health care provider. These reductions will not be shared. Total the columns on the “Bill List” and number your bills according to the list.
H. Member Questionnaire
The person with the medical need should complete this section.
Exception: If the patient is a minor, parents may complete the Member Questionnaire. Your need will not be shared without it.
I. Explain the Need
Include a letter or note explaining the incident so we can better understand your need. Describe how we may pray for you or give praise for how God is already working in the situation. A short summary of your condition will be included in the Prayer Guide and in the assignment sheet sent to the members who will be sharing with you.
J. Send to SMI
Mail your need information to Samaritan Ministries in the need envelope provided (or submit it online via your Samaritan Dashboard). Members correctly submitting needs are generally receiving gifts from other members within two to three months after receipt of the bills by SMI, helping you to pay the medical bills in a timely fashion.
K. Payment Plan
If you have not arranged a payment plan with the provider, you should pay something on the bill monthly, even if it is only $10, so the provider knows you are not forgetting your responsibility.
L. More Bills
If additional bills for the same need arrive after you have submitted your need, call for an Add-on Form designated for your need, to submit the additional bills (or submit them online via your Samaritan Dashboard).
M. Overseas Bills
If you are treated for an illness or medical condition in another country, the entire itemized billing statement must be written or translated in English, and the cost must be converted to U.S. dollars.
N. Time Limit for Submitting Documentation
The sooner that bills are submitted to SMI usually means the larger the reduction in price that can be obtained from the provider through negotiations. When there are a number of bills related to treating the same incident, it is helpful for them to be submitted together if they all can be obtained within a 30-day period. With this in mind, itemized bills should be submitted to the Samaritan office as soon as possible (either by mail using the Need Processing Form or online via your Samaritan Dashboard). Ordinarily, bills submitted more than one year after the service was provided will not be shared.