A Christian Approach to Covering Healthcare
Through medical sharing ministries, members cover each other's bills
State regulators say they face particular challenges when it comes to faith-based groups. "Candidly, it's very difficult when an organization plays the Christian card," says Kim Holland, Oklahoma's commissioner of insurance. "Nobody in elected office wants to interfere in people's ability to express their faith." Last year, an Oklahoma court issued a cease-and-desist order barring Medi-Share from writing any new business in that state.
Officials say these ministries often come to their attention when a consumer complains about lack of payment. Michael Rowden, a former pastor in Big Fork, Mont., filed suit in 2006 when Medi-Share refused to pay approximately $154,000 for heart valve surgery he had following an infection. According to court documents, the group claimed a pre-existing medical condition because Rowden had an undisclosed heart murmur. A jury awarded Rowden $835,000. The parties later reached a confidential settlement.
Although Medi-Share eventually paid his bills, Rowden says the experience has been very traumatic for his family. In Rowden's complaint, he describes a letter Medi-Share sent to Montana members outlining the lawsuit and claiming he had lied on his application. As a result, he received "belligerent and threatening contact," according to the complaint, and was ostracized from his religious community. This February, Rowden and his wife left Montana to start over in another state (he prefers not to say where). "We felt we could be going on for years trying to tell our side," he says. Medi-Share's Baldwin says that he "obviously" wishes the outcome of the lawsuit had been different. However, "as a result, we've made some changes that will prevent that from occurring again," he says, noting that a member whose request for sharing is denied can now appeal that decision to a group of seven other members who can overturn the denial by majority vote.
Protections. The conflict might have been avoided if Rowden had had regular health insurance, say experts, since group plans can't deny claims at will based on pre-existing conditions. "People in these plans aren't getting any protections of state law, including knowing that if their claim gets denied, they can appeal it to an external group," says Mila Kofman, Maine's superintendent of insurance, who studied these organizations while an associate research professor at Georgetown University's Health Policy Institute. State-licensed insurers ensure that plans cover mandated benefits and also contribute to a guarantee fund that pays claims in case of insolvency. In a licensed insurance plan, "basically, you know that at the end of the day if you have a claim, it will get paid. That's what regulators do," says Kofman.
Medical sharing programs operate much more loosely than insurance, typically using previous months' shares to pay the current month's claims. At Samaritan, if there's a big spike in needs one month that depletes the amount available for sharing, the group reduces the amount that it shares, says Lansberry. The groups also encourage members to send in extra money for needs that may not be eligible for regular sharing.
Sheila Hutcheson says she's had no difficulty getting her Medi-Share claims paid. She and her husband run a small advertising products business out of their Mount Dora, Fla., home. Although her husband receives health coverage through the U.S. Department of Veterans Affairs, Sheila had been uninsured for several years when they discovered Medi-Share in 2002. Her $414 monthly share covers her bills over $250. A few years ago when she needed an emergency appendectomy, the program covered the entire $26,000 bill, no questions asked.
But it's not just having her medical needs taken care of that gives her peace of mind. "From a Christian perspective, this is neat," she says. "When you grow up in the church, when you get older, you try to use Christian businesses." Never mind the regulators' consumer-protection concerns. Members are happy to take it on faith.
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