SACRAMENTO, Calif. —Rebecca Gertner believes her faith will help pay the medical bills. That's why every phone call with her health care representative ends the same.
"We pray to remember that God is in control and not to worry about the bills," Gertner said.
Gertner signed up with Medi-Share, part of Christian Care Ministry in Florida, and one of several faith-based health care sharing ministries across the country. Bill sharing, they believe, is rooted in Scripture such as Galatians 6:2. "Carry each other's burdens, and in this way you will fulfill the laws of Christ."
Gertner lives in Sacramento with her husband, Luke, a pastor at Hillsdale Blvd. Baptist Church, and she home schools their three children. Their small evangelical congregation does not offer employees health insurance.
So she asked friends and family about their coverage. Her mother-in-law told her about a plan where members share medical costs and religious beliefs.
An estimated 100,000 people across the country belong to these ministries, according to industry experts. While small, it's a growing alternative to traditional health care insurance.
Promoted at churches and on TV, health care sharing programs have been around for decades and are more common in the South.
Interest has increased since passage of the federal health care reform bill last year. That's because members of health care sharing programs are exempt from the law's requirement — which goes into effect in 2014 — that every adult American have health insurance.
"People want an alternative," said Tony Meggs, president of Christian Care Ministry. "We are up 150 percent."
Gertner said she pays about $200 a month for health care. For the past five years, her medical needs have been covered, including expenses related to two pregnancies. "It has been a major blessing for us," she said.
How does it work?
Medi-Share members deposit monthly fees into an account as they would with a traditional health premium. Medi-Share oversees the money flow to pay other members' health costs. The company does not receive the money directly, Meggs said.
That's one difference between the health care sharing ministries and traditional insurance, a distinction Meggs wants to make clear. The law says health care sharing ministries must be nonprofit and medical expenses must be shared among members.
State officials in Oklahoma and Kentucky have challenged Medi-Share, questioning whether the company is operating as an insurance company.
"They make conservative insurance commissioners quite nervous," said Timothy Jost, professor of health law at Washington and Lee University. "The concern is that people may not really understand that they are not insurance companies ... and they don't have the same regulations or, if something goes wrong, the reserves."
Robert Niles of Blackwell, Okla., said Medi-Share refused to cover brain surgery treatment for his wife, Karen, in 2008, although it had previously paid. "They just stopped," he said.
Oklahoma regulators had ruled that Medi-Share was acting as an insurance company and temporarily closed the program in the state.
Medi-Share had already paid $450,000 for Niles' care, Meggs said in a statement. It said it could no longer operate in Oklahoma after the ruling. The company resumed operations there in 2009.
"We are disappointed with the hardship the Nileses experienced," Meggs said. Medi-Share offered to ask members to contribute to their medical expenses. They also suggested the couple move to Kansas, where they could become Medi-Share members.
"Regrettably, we did not receive a response from the Nileses until they sued," he said, adding that the couple's experience is not typical.
Niles is bitter toward the ministry now. "I was never late on a payment all those years." His wife died nearly three months ago.
The ministry is now available in all states but Montana.
"More than 15,000 households from all 50 states and several foreign countries are actively sharing health care needs of more than $3.5 million each month," the ministries' website says.
Not all of the programs are alike. They have different ways of working and eligibility requirements, although most say members must live by biblical standards.
Medi-Share, for example, requires applicants to sign statements that they are Christians. The company may ask their pastors to verify their statements. Participants in the program must agree not to use drugs, abuse alcohol or have sex outside traditional Christian marriage. AIDS and HIV are covered if the member contracted the disease through blood transfusions. Abortion is not covered.
How does the company know if members are living according to the Gospel?
Meggs said they take members at their word. The company also has an internal review process that periodically checks medical reports to make sure members adhere to the statement of faith.
For example, he said, let's say a member filed a claim for a broken leg saying it was broken in a car accident. But if company representatives later learned the leg was broken because the member was intoxicated, then that bill wouldn't be eligible for sharing, Meggs said. Members are responsible for their own medical bills, he added.
Auburn, Calif., landscaper Marc Booth said promising to live a biblical lifestyle was something he liked about the plan. "It's what I believe in," Booth said.
He was skeptical about the ministries at first and was reluctant to drop his wife's insurance plan at Kaiser.
When his 18-year-old son broke his ankle in a dirt bike accident and needed surgery in September, Booth said all he paid was $250 of the $6,000 surgery bill. "It has worked really well for us."
What about catastrophic illnesses?
Meggs said the ministry has been around for 18 years and members have shared more than $400 million in medical expenses.
Members also share emotional support.
They pray for others who are sick and often send get-well cards. They have a concept similar to Twitter called Prayer Stream where members post prayer requests and words of encouragement.
Gertner said her family has been fortunate that they are healthy. But she worries about the rising costs of health care. She said talking to her Medi-Share representative helps ease her anxiety, especially after they pray.
"Like it or not, this is something all of us have to deal with," she said. "And when I hang up, I feel like I've been to church."