Of the 44 million Americans without medical insurance, half a million may choose to abstain from coverage based on their religious beliefs, according to data from the Kaiser Family Foundation, in Menlo Park, Calif., Menno-Hof center in Shipshewana, Ind., and Mennonite Mission Network in Elkhart, Ind.
Anabaptists, a religious movement more commonly known by its individual groups such as Mennonites and Amish, believe in communal support from their brethren. When one member of the community racks up medical bills, everyone else pitches in to pay.
Dr. Edwin L. Nirdlinger, general surgeon and hernia specialist, discovered the financial consequences of such a doctrine and decided to take action. He and co-founder Wolfgang Drescher established Immergrün Inc., a nonprofit organization in Sylvania that helps provide medical services to those without insurance because of religious convictions.
The word has spread, and the Toledo area has become an epicenter of Anabaptist medical care. Between January 2003 and December 2004, 855 Immergrün patients, most from Pennsylvania, Ohio and Indiana, obtained medical procedures from hernia operations to hip replacements to cancer surgery at costs reduced by as much as 80 percent, according to Nirdlinger.
The reason behind the huge slash in medical bills, he explained, lies in the methods hospitals and doctors use to set their rates. Uninsured patients are charged higher fees than insurance companies, which typically pay a small percentage more than established Medicare costs.
“It just became evident over time that what was happening to them is that they were being billed by hospitals and by doctors at their undiscounted rates.” Nirdlinger said. “I had a person in today, and he was quoted five times [what] his price would have been, 500 percent, of what he was paying here, to be done in Wisconsin.”

A look at the chart
Most area hospitals, two area clinics and numerous doctors have working relationships for reduced fees through Immergrün, he added, but such was not always the case. Before incorporating, the organization met resistance from hospital administrators who feared that rates would be forced down universally for uninsured and insured patients alike.
Incorporation cured the financial anxiety, putting Immergrün at the same negotiating level as insurance companies.
Significantly lower rates have saved individual Anabaptists, for example, as much as $20,000 for a hip replacement, which can cost about $40,000 at hospitals outside of the Immergrün sphere of influence. Because their lifestyles and beliefs equate community with church, they submit large medical bills to church leaders, who assume responsibility to cover them by collecting donations from members.
The practice culminated in substantial debts owed by a few Anabaptist churches, one in Wooster County, Ohio, in particular that Nirdlinger said had medical liabilities hovering at $300,000.
Currently, the church has paid off its bills as a direct result of Immergrün’s intervention into the patient-doctor-hospital financial relationship.
“We save them millions of dollars, their communities, in medical fees which basically were on the verge of bankrupting them,” he continued.

Health benefits
The financial advantages favor local doctors, hospitals and clinics as well. Physicians and facilities join into the program at set fees for procedures within their specialties, with patients paying in advance directly to Immergrün. The increase of patients seeing local doctors has generated medical revenues surpassing $2.5 million since January 2003, according to Immergrün sales reports. The organization collected about $400,000 its first year, $1.37 million during year two and more than $750,000 this year.
The economic benefits magnify dramatically when considering the case-by-case savings individually.
Near the lower end of the financial spectrum, Dean Martin, a Mennonite from Nappanee, Ind., said his church paid $7,000 to a nearby hospital for hernia surgery two years ago for his wife, Marciel. The $1,400 for a second operation through Immergrün to repair the same hernia came from his own wallet. The difference, according to Martin, was a better repair at a much more reasonable price.
“It’s a dream come true to me,” he related. “Our church shares their medical bills, and we were discovering that we were paying a premium for them.”
The couple had considered Toronto for Canada’s lower medical costs; however, they were drawn to Toledo on advice from a friend to make the three-and-a-half hour drive. As an outpatient at the Toledo Clinic, Marciel arrived in the morning and was released by Nirdlinger about noon. Martin has served on the Immergrün board of directors since his wife’s recovery.
With nine children and three grandchildren in a “family of hernias,” they’re planning ahead for more visits to the Glass City for operations. Martin’s brother underwent hip replacement and several friends and acquaintances have had surgeries for cataracts, carpal tunnel and other common conditions.

Vital Signs
More serious cases arise, too, where minimizing costs for the same level of care translates into even greater financial relief. For Rufus and Alice Martin (no relation), the situation grew from a cancerous tumor in Alice’s kidney to a second tumor nearby that doctors suspected might have been malignant.
Local doctors in Arthur, Ill., decided it best to operate to remove the kidney first, then follow up with surgery or treatment to address the second tumor. Without insurance, the Martins received a quote of $35,000 to $37,000 for the first operation and reluctantly scheduled surgery a month in advance. A cousin who had hernia surgery through Immergrün then suggested the program, leaving the Martins with a decision.
“I said, ‘Why would we go all the way to Toledo when we have doctors in Illinois?’ — being naïve,” Rufus said. “We priced it, and it was thousands and thousands of dollars cheaper in Toledo.”
To be sure that factors such as the required surgery, hospital stay and recovery care from his local major hospital matched those from St. Anne’s Hospital, in Toledo, Rufus requested a comparison of CPT codes, universal identification of the medical procedures involved. The inquiry paid off, saving the couple more than 60 percent for the total cost of the operation.

Prognosis
Nirdlinger, who served as director of the Great Lakes Hernia Center at Flower Hospital for many years, is now director of Immergrün and chairs the board. Dr. Mary Ann Nirdlinger, his wife, works with patients regularly and publishes a newsletter with health tips geared toward the Anabaptist lifestyle.
Nirdlinger emphasized that it’s the board that steers the organization toward its goals of assisting its communities with health care issues.
“The board of directors is adamant that they want Toledo to survive because they know that without us being here, there wouldn’t be the pressure on their local hospitals to keep costs down,” he said.
With patient numbers rising, Nirdlinger soon may entertain plans for growth by finding larger offices solely for the organization. Immergrün currently shares space with his practice at Flower Hospital.

This entry was posted on Wednesday, May 25th, 2005 at 12:00 am and is filed under TFP Version 1.
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