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I think I screwed up the paste. Trying again: Greetings, everyone, I am copying here a fairly long article. I do believe it is
worth a careful read. It describes a health insurance approach being
adopted by a unique group, Christian evangelicals. The characteristics that
make them unique are the characteristics that make the approach work. I think
we are going to see a lot more of this; it may be a harbinger of a gradually
disintegrating society. In a sense, it is similar to gated communities;
some, well-off, simply say they are tired of carrying those less so, or those
who represent a special burden. Lawry Here it is: Seeking Divine Protection Some Believers Put Faith in Church Plans Instead of
Standard Health Insurance By Sandra G. Boodman Washington Post Staff Writer When his wife spent a week in Georgetown University
Hospital's intensive care unit last year recovering from life-saving brain
surgery, Joe Huff never worried about who would pay her $120,000 hospital bill,
even though his family has no health insurance. Huff, a 52-year-old Laytonsville real estate agent,
said he trusted that a bill-sharing cooperative of evangelical Christians he
joined 10 years ago -- and to which he faithfully mailed a $346 monthly check
-- would come through, just as it had when the youngest of the couple's seven
children was hospitalized with spinal meningitis two years ago. After a $250 deductible, Huff said, Christian Care
Medi-Share paid for everything. "We also got about 20 cards and letters
from people saying they were praying for us," he added. Huff and his family are among the 60,000 members of
Medi-Share, the largest of a little-known group of nonprofit organizations that
market themselves as faith-based alternatives to health insurance. The
half-dozen plans, which claim a total membership of more than 120,000
Americans, are especially popular in the South. The appeal of these "church plans," as they
are known in the insurance industry, is both economic and religious. Because
their monthly cost is roughly half that of conventional health insurance
premiums, they appeal to those who find medical insurance difficult or
impossible to afford. And because their membership is strictly limited to
evangelical Christians certified as regular churchgoers by their pastors, they
cater to people opposed to "subsidizing high-risk, sinful lifestyles,"
in the words of Medi-Share's Web site. "A nonbeliever doesn't have an obligation to
follow through" by sending a check each month, said James K. Lansberry,
executive vice president of the 35,000-member Samaritan Ministries
International of Peoria, Ill. All three of the largest plans -- Medi-Share,
Samaritan and the Christian Brotherhood Newsletter, headquartered in Barberton,
Ohio -- impose strict limits on treatment, restrictions that would be illegal
under regulations that apply to conventional insurance. Tobacco use, immoderate drinking, homosexuality and
extramarital sex are strictly forbidden, and anyone caught violating these
proscriptions can be expelled. The plans don't pay for abortion,or treatment of
sexually transmitted diseases or HIV that was not, as Samaritan puts it,
"contracted innocently." While each plan's rules differ, most exclude
coverage of preexisting conditions, as well as treatment related to cancer
recurrence, serious heart disease, obesity, psychiatric disorders or vision
problems. "Our [members'] greatest sin is racing down to
the buffet after the sermon," quipped E. John Reinhold, a former insurance
executive who is the founding chairman of Medi-Share, a subsidiary of the
American Evangelistic Association, based in Melbourne, Fla. Although church plans differ, their basic premise is
simple: Members send a monthly check -- a "share" -- ranging from
$200 to $400, either to the plan or directly to those the plan designates with
"needs," as medical bills are known. They also agree to send cards
and letters or to pray for those in need; in some cases the names and addresses
of those in need, along with a brief description of their medical problems, are
published in a monthly newsletter. No
Guarantees While Medi-Share has many of the characteristics of
insurance -- including annual deductibles, a medical advisory board, the
practice of negotiating discounts from hospitals and a requirement that
non-emergency treatment be approved -- Reinhold insists it is not insurance and
therefore is exempt from state regulation. Medi-Share, he said, is a voluntary arrangement
between like-minded people to share medical expenses according to rules they
devise, in fulfillment of the New Testament exhortation that Christians should
bear each other's burdens. "There are no reserves and there is no guarantee
a need will be paid," Reinhold said. Insurance, he added, requires a
contractual transfer of risk in exchange for payment. Critics disagree. They say Medi-Share and other church
plans are essentially unlicensed health insurers operating without regulation,
protection for unsuspecting consumers or public accountability. Consumers, they
say, may not understand what is not covered, know that they are surrendering
their medical privacy or that they could be stuck with huge medical bills. "These plans function just like health insurance,
but they operate in a regulatory black hole," said Mila Kofman, an
assistant research professor at Georgetown University's Health Policy
Institute. "There is no accountability, no oversight, and the people who
participate have no protection." Unlike insurance companies, which are
required to have reserve funds to pay claims, church plans do not maintain
reserves. State regulators, Kofman and others say, have been
slow to take action because they are leery of the plans' religious affiliations
and because complaints by subscribers have been uncommon. Christian Brotherhood Newsletter did run afoul of Ohio
authorities after complaints about unpaid claims; it is operating under a
court-ordered receivership imposed in 2000. Last year a jury in Akron ruled
that its founder, Rev. Bruce Hawthorn, and other former officials defrauded the
ministry and ordered them to repay nearly $15 million they spent on luxury
houses, motorcycles, expensive cars and high salaries, including one for a
stripper whom Hawthorn said in an interview he was "trying to help." "Insurance companies have to file financial
reports to regulators every year -- these plans don't," Kofman said.
"Who knows how much money they're taking in or paying out? I think they're
taking advantage of religious people who are desperate" because they can't
afford other health coverage. Officials of all three plans insist that they are
scrupulous about handling members' money. Each plan essentially tallies medical claims each
month, then divides by the number of members, officials say. After subtracting
for overhead and administrative expenses, the rest goes to pay claims. In
Medi-Share's case, 18 to 22 percent of annual revenue is earmarked for administrative
expenses, including salaries, Reinhold said. Last year, according to its annual
audit, Medi-Share paid nearly $43 million in medical bills, up from $37 million
in 2004. In its 12-year existence Medi-Share has paid out about $200 million in
medical bills, according to Reinhold. While many states have investigated church plans in
the past 15 years, few have taken action against them, according to the
National Association of Insurance Commissioners. In a few states, including
Maryland and Wisconsin, where regulators temporarily suspended the operations
of Christian Brotherhood Newsletter, state legislators subsequently stepped in,
passing specific regulatory exemptions that allowed the plan to do business. Kentucky officials have taken a different approach.
Regulators there are embroiled in a long-running legal battle with Medi-Share.
In 2002 the state obtained a restraining order to halt the sale of Medi-Share
memberships, which it said was unauthorized insurance. The order was
subsequently overturned, but the two sides are still in court. Last January, state insurance commissioner Glenn
Jennings issued a "consumer alert" warning Kentucky residents that
church plans do not give consumers the protections of health insurance.
"We take very seriously our job of protecting consumers," he said. Although Jennings said there had been complaints about
Medi-Share in Kentucky, they are rare elsewhere. One reason may be the threat
of exclusion. Nearly 95 percent of Medi-Share members last year voted to
immediately drop members who "choose to ignore the finality of the three
Christian doctor appeal" and who pursue arbitration or "use the
secular courts" to settle disputes. Affordable,
in a Way Matthew Gregory, the 33-year-old pastor of the Soul
Purpose Church in Fauquier County, said his family has never had health
insurance. They couldn't afford a Blue Cross policy offered through a Southern
Baptist group that would have cost $500 per month to cover Gregory, his wife,
and their three young sons. The family's annual income is about $40,000.
Instead, Gregory pays $225 each month to Samaritan. "Many of our members would qualify for Medicaid
but are not using it" because they joined Samaritan instead, said
Lansberry, the plan's vice president. "We're providing a public
service." At least four times in the past 10 years, Gregory
said, his family has sought help paying bills that exceeded $300 -- the plan's
minimum allowable claim. The most recent incident occurred last year when his
youngest child, then 4, suffered complications from the West Nile virus and
spent nearly two months at the University of Virginia Medical Center in
Charlottesville. At that time the Gregorys received more than 100
checks from fellow members to pay the hospital bill, as well as cards and notes.
"It's definitely a very warm system compared to the paperwork and the
wrangling I've heard about from regular health insurance," said Gregory,
who moonlights as a salesman. While some people might find keeping track of dozens
or even hundreds of checks onerous -- assuming payments of $225 from fellow
members, someone with a $100,000 claim would receive 444 checks -- that hasn't
happened, according to Lansberry. "I've never heard of anyone complaining," he
said. "The joy of the global community of Christians far surpasses the
administrative need. This feels like a community, like an Amish
barn-building." For Gregory, financial considerations were the reason
he joined. But religious factors have become equally important. "It's nice to be partnered up with other people
who have similar values and don't make the lifestyle choices that would make
our costs go up," he said. Such choices, in Gregory's view, include
"people in nontraditional family situations. There's more illness in
those." Not an
Insurance Card Because of the two- to three-month delay in paying
claims, most plans advise members to set up an installment plan with a doctor
or hospital. Medi-Share issues wallet-sized cards to its members that they can
present at the time of treatment. Robert "Chip" Ward, a Medi-Share member who
lives in Montgomery County and is the father of seven, said he has never been
questioned. "It looks like an insurance card and when I
present it, I say, 'This is my medical provider,' I don't say it's
insurance," he said. "But I've never been asked about it." Carna Reitz said she routinely explains Samaritan to
new doctors who treat her family, which includes five children. Her husband, a building contractor in Fauquier County,
was recently diagnosed with acute leukemia and has spent the past month in
Prince William Hospital undergoing intensive chemotherapy. Reitz said she has
told hospital officials that the family belongs to a medical sharing group that
will pay the bill, an explanation they have accepted. "We really don't feel like his treatment has been
limited," she said. "I guess this will be the biggest test."
Samaritan covers treatment for cancer that is unrelated to a preexisting
condition. Reitz said she hopes his bill will not exceed
Samaritan's maximum of $100,000 per incident. If it does, she said, they will
seek help through another Samaritan account to which they have contributed,
which is supposed to provide additional coverage. One way Medi-Share controls costs is by requiring its
members to seek approval by telephone before non-emergency treatment, or pay
$250 to the plan. Callers are routed to a medical panel headed by John E.
Evans, a retired orthopedic surgeon from Vicksburg, Miss., who also sits on
Medi-Share's 55-member board of overseers. "Members are asked to give us the information we
need to determine whether care will be covered, Evans said. The goal, he said,
is to steer subscribers to the most appropriate treatments. In some cases Evans's suggestions, published in
Medi-Share newsletters, have been unconventional and do not include medications
or surgery. Recently he suggested that Larry McFall, a middle-aged
runner with a torn meniscus, do stretching exercises to avoid surgery
recommended by an orthopedic surgeon. McFall wrote that the treatment worked
and noted that the advice "saved the $6,000 cost of my surgery and
physical therapy" and spared him "possible infection and other side
effects of surgery." In another case, Evans advised 62-year-old Marianne
Petersson, who has high cholesterol and had been hospitalized after a series of
mini-strokes, to adopt a dietary regimen that included a water-only fast for
three days, followed by 11 days of a water-and-fruit diet. Evans, who does not have a Florida medical license,
said he is not practicing medicine by dispensing such advice. He likens it to
what he would tell "someone who stops me at church and asks me what to
do." Evans, 71, declined to disclose his Medi-Share salary
except to say, "I'm paid significantly less than I would ordinarily be
paid." He said he is not enrolled in Medi-Share, but has health insurance
coverage through Medicare and the American Medical Association. Plans
Behaving Badly Officials of the three major church plans say they
have installed financial controls, including independent audits, to prevent the
kind of fraud that engulfed the Christian Brotherhood Newsletter, the oldest of
the plans. Sherry Phillips, a lawyer in the Ohio attorney
general's office, said authorities are still trying to collect the nearly $15
million awarded by the jury last year from the sale of foreclosed properties
once owned by Hawthorn and other ousted officials. The newsletter's new
management team, she said, has been whittling down unpaid claims; about $2
million remain. Rev. Howard S. Russell, the newsletter's new executive
director, described its standards as "impeccably aboveboard" and said
the group is anxious to rebuild. The newsletter, he said, is now governed by an
independent board of trustees and a strict conflict of interest policy is in place. "In the last 10 years alone, even with the
troubles, we have paid $400 million in medical bills," he said. Our
"problems are in the past. It is a new day at the ministry." To comment on this article, send
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