A few years ago, I failed to make my December payment for my drug insurance plan on time, and got kicked off of it for a year (government rules); I panicked, but everything turned out great. During the next year, I paid about $1,000 less for my prescriptions. It turned out that by not having prescription insurance, I was eligible for various discounts, and have saved over $6,000 since then. Took a little work and research on my part, at first, but now I’m just coasting.
So much about medical costs, just doesn’t make sense (I had an interesting discussion with my pharmacist about this yesterday). Medical treatment is a cash cow. Walking into a lot of hospitals is like walking into a casino, run by a hedge fund.
I've heard the issues you faced (small groups scattered across different regions, no network agreement = no access, etc) as reasons why "that can never work!" I once spoke with a small (<150 members) ironworkers union that literally just paid all claims directly with some very lightweight administrative assistance which included rate negotiation wrapped around it and they had similar savings over the "community-rated" plan they had left. They were small, not particularly healthy, and spread geographically. Not the same model you used, but similar issues solved innovatively.
I love that you took it on anyway and figured out how to navigate the issues. Hard? yes, but worth it? also YES! And as you note, this won't be the model for everyone. But the point is not "this is the way to save healthcare for the US" but rather that it's going to take creativity and a little effort but for many there are options.
So here's the question that pops into my head as I think about the longer term impacts. If more and more groups take this kind of approach and it begins to cut into the BUCAH business enough to get noticed, do you think they will try to duplicate it in some (likely mangled manner) to keep more groups from jumping ship?
So here's the followup - were the plan versions the free market at work - innovation pushing the industry to be better overall - or was it protectionism via an industrial scale shell game? We've seen that before. TPAs recovering provider overpayments for self-finded employers and then sharing it with them and thinking they should be happy!
As a healthy woman in my early-60s, running my own solo consultancy, I'm paying about $1,500 a month for terrible insurance. I pay everything out of pocket except prescription meds as none of my docs want to deal with the insurance system. I'm seriously considering going without insurance altogether for the next couple of years until Medicare kicks in. Barring a catastrophe, I would save a lot of money. There's got to be a better way.
I used Samaritan Ministries Healthcare sharing for several years, and when I had a serious need, they were wonderful. I was in a fortunate position because I had money to make a few deposits to get a major surgery moving onto the schedule quickly, but had I not been, they would have helped me with that too. They negotiated everything for me. Long story short, I got all of it back and every penny was covered, along with lots of notes, poems, letters and prayers from other members. It was healing for the soul from other believers as well as for the body. And it was done for about 20% of what the insurance model would have charged.
Yes SMI is wonderful. Great solution for mostly healthy people. Groups that have members or employees with significant health needs, though, need more robust RX and mental health options, as well as pre-existing conditions coverage.
You’re confusing fully insured plans with self-funded plans. Fully-insured plans are where you pay a premium and if everyone pays more than they cost the company, the company wins, and vice versa. Self-funded plans are where the company (or in this case, the religious order) just pays their own claims as they arise and they don’t send premiums anywhere except to their own savings account. There’s no risk pool except their own employees and they pay everything for them.
Never has reading about insurance been so delightful. We ditched insurance a year and a half ago and opted for health sharing (via Zion). Excellent option for someone who does not have chronic health needs (ie disbetes) and treats most all health issues with holistic medicine at home. But we still get preventative care covered (ie annual check ups etc). Curious if you’ve compared the benefits of health sharing with your health insurance approach. Anyhow, excellent article and writing. Love your substack.
Hi Paola, yes, health care sharing is great. I ran the trade group for sharing orgs for six years and now sit on the board of one. So I think they're amazing for the right individual. But they aren't the right fit for every employer or family - so it's very important to have all options on the table! Thanks for reading!
All I can say is... this is so freaking cool. Keep sharing the secrets.
Feels good to beat Blue Cross!
A few years ago, I failed to make my December payment for my drug insurance plan on time, and got kicked off of it for a year (government rules); I panicked, but everything turned out great. During the next year, I paid about $1,000 less for my prescriptions. It turned out that by not having prescription insurance, I was eligible for various discounts, and have saved over $6,000 since then. Took a little work and research on my part, at first, but now I’m just coasting.
So much about medical costs, just doesn’t make sense (I had an interesting discussion with my pharmacist about this yesterday). Medical treatment is a cash cow. Walking into a lot of hospitals is like walking into a casino, run by a hedge fund.
Great article!
So true, all your conclusions, Fritz!! Thanks for the read!
Well done !
Every day it used to be such a slog! Now that our shared partner in Tyler is paying cash and doing advocacy, the nuns have no complaints!!
Wow. My head is spinning! Thank you for your passion and service.
LOL thank you for YOUR service!
I've heard the issues you faced (small groups scattered across different regions, no network agreement = no access, etc) as reasons why "that can never work!" I once spoke with a small (<150 members) ironworkers union that literally just paid all claims directly with some very lightweight administrative assistance which included rate negotiation wrapped around it and they had similar savings over the "community-rated" plan they had left. They were small, not particularly healthy, and spread geographically. Not the same model you used, but similar issues solved innovatively.
I love that you took it on anyway and figured out how to navigate the issues. Hard? yes, but worth it? also YES! And as you note, this won't be the model for everyone. But the point is not "this is the way to save healthcare for the US" but rather that it's going to take creativity and a little effort but for many there are options.
So here's the question that pops into my head as I think about the longer term impacts. If more and more groups take this kind of approach and it begins to cut into the BUCAH business enough to get noticed, do you think they will try to duplicate it in some (likely mangled manner) to keep more groups from jumping ship?
Good question!! We’ve seen this in the PBM space. Where the big 3 start trying to offer programs that look like what we do to get around them.
So here's the followup - were the plan versions the free market at work - innovation pushing the industry to be better overall - or was it protectionism via an industrial scale shell game? We've seen that before. TPAs recovering provider overpayments for self-finded employers and then sharing it with them and thinking they should be happy!
Can I just say that I hate that Substack doesn't allow editing, especially for auto-corrupt?
As a healthy woman in my early-60s, running my own solo consultancy, I'm paying about $1,500 a month for terrible insurance. I pay everything out of pocket except prescription meds as none of my docs want to deal with the insurance system. I'm seriously considering going without insurance altogether for the next couple of years until Medicare kicks in. Barring a catastrophe, I would save a lot of money. There's got to be a better way.
If you’re really healthy, then a much more affordable health care sharing org would likely be a good fit!
What a great story! I won't pretend I understood the details, but I always enjoy your perspective.
Thanks Moorea!
I used Samaritan Ministries Healthcare sharing for several years, and when I had a serious need, they were wonderful. I was in a fortunate position because I had money to make a few deposits to get a major surgery moving onto the schedule quickly, but had I not been, they would have helped me with that too. They negotiated everything for me. Long story short, I got all of it back and every penny was covered, along with lots of notes, poems, letters and prayers from other members. It was healing for the soul from other believers as well as for the body. And it was done for about 20% of what the insurance model would have charged.
Yes SMI is wonderful. Great solution for mostly healthy people. Groups that have members or employees with significant health needs, though, need more robust RX and mental health options, as well as pre-existing conditions coverage.
Insurance always has to make money... so the contributers must pay more than the company spends- or the company would collapse? 🤔
You’re confusing fully insured plans with self-funded plans. Fully-insured plans are where you pay a premium and if everyone pays more than they cost the company, the company wins, and vice versa. Self-funded plans are where the company (or in this case, the religious order) just pays their own claims as they arise and they don’t send premiums anywhere except to their own savings account. There’s no risk pool except their own employees and they pay everything for them.
Never has reading about insurance been so delightful. We ditched insurance a year and a half ago and opted for health sharing (via Zion). Excellent option for someone who does not have chronic health needs (ie disbetes) and treats most all health issues with holistic medicine at home. But we still get preventative care covered (ie annual check ups etc). Curious if you’ve compared the benefits of health sharing with your health insurance approach. Anyhow, excellent article and writing. Love your substack.
Hi Paola, yes, health care sharing is great. I ran the trade group for sharing orgs for six years and now sit on the board of one. So I think they're amazing for the right individual. But they aren't the right fit for every employer or family - so it's very important to have all options on the table! Thanks for reading!