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Health

'It Appears This Is A Scam:' Complaints Accelerate Against Health Care Sharing Ministries In Conn.

Paloma Munoz
Yehyun Kim
/
CTMirror.org
Paloma Munoz said every time she goes to a doctor, she gets a surprise bill.

Last March, days after returning home from a family trip to Spain, Paloma Munoz’s 4-year-old son started to cough.

He spiked a fever overnight and began feeling short of breath. Alarmed, Munoz found a hospital with drive-up COVID testing and took her son to get swabbed.

When the results came back negative, she was relieved. Then a bill for $270 arrived in the mail.

“I was just speechless,” she recalled.

Her husband had changed jobs a few months earlier, forcing her family to shop for new health insurance. Unable to afford a policy through their employers or elsewhere, Munoz found an advertisement online for a cheaper, non-traditional type of coverage. For $500 a month, she joined Alliance for Shared Health, a religious health care sharing ministry that pools its members’ premiums to pay out some of their medical bills.

“Alliance for Shared Health members share a common set of deep-seated ethical and religious beliefs,” the company’s marketing materials say. “Members place supreme importance on the pursuit of sharing in each other’s health care needs and the sharing of those expenses as it relates to those needs.”

But Munoz said her son’s coronavirus test was denied because it was considered an outpatient service – something her ministry doesn’t cover. COVID tests are free to those who don’t have health insurance and those that do. But Munoz was caught in an unusual situation: she gave the hospital her Alliance card, and the hospital billed the ministry for the test. When the ministry refused to cover it, Munoz was stuck with the bill.

She reluctantly paid.

“We just feel helpless,” she said. “We feel like nobody’s looking out for us. But what can we do? At this point, I signed that contract.”

Alliance for Shared Health did not return a call seeking comment.

Munoz, who brought her concerns to a state legislator, is not the only person dissatisfied with a health care sharing ministry. Complaints against the companies were already on the rise in Connecticut, but they have accelerated since the pandemic hit. In a 10-month period from March to December 2020, the state Department of Insurance recorded 10 complaints of its own – nearly the same number it received over a two-year stretch before the pandemic.

Between January 2018 and February 2020, the insurance department fielded 11 grievances against ministries that market to Connecticut residents. That amount nearly doubled after COVID-19 spread through the state.

Paloma Munoz
Credit Yehyun Kim / CTMirror.org
After not being satisfied with the coverage her ministry offers, Paloma Munoz has been looking for a traditional insurance policy that her family can afford. She hasn't yet found one.

“These [groups] have always been a concern,” said Gerard O’Sullivan, director of consumer affairs for the insurance department. “I work with my counterparts in other states and when we see these entities, we try our best to advise consumers that they’re not insurance. There is no protection under state law for people who sign up for these programs.”

In recent years, more people have turned to health sharing ministries as the cost of medical care continues to increase. A representative for the ministries estimated that 1.5 million people nationwide have signed up for their coverage. Many of the plans market themselves as lower-priced alternatives to policies that must meet tougher mandates under the Affordable Care Act, such as coverage for pre-existing conditions.

The ministries offer cheaper rates because they are not considered to be insurance and are not required to pay claims. Members make monthly contributions, with the assumption that the money will be pooled and shared as medical bills are submitted.

Because they are unregulated, there is no way to tell how many people in Connecticut have joined the ministries. Last year, industry officials estimated that more than 5,000 state residents belonged to these organizations. But as the pandemic caused hundreds of thousands here to lose their jobs – and for many, their health insurance – that number could now be far higher.

In October, state Insurance Commissioner Andrew Mais put out an alert warning consumers of the risk of buying coverage through a health sharing ministry. His office had previously issued a cease and desist order against two of these groups – Aliera Healthcare and a company it marketed, Trinity HealthShare – saying they illegally advertised their plans as health insurance. Mais accused them of “misleading consumers and trying to avoid insurance regulation.”

In his October alert, he urged residents to do their research before signing up with a ministry.

“These offerings are either not health insurance plans, or they are unauthorized insurance products,” he said. “The group may pay part of a health care bill by sharing funds from other members. However, they are not legally required to do so.”

Ted Doolittle, Connecticut’s health care advocate, said as the pandemic wears on, he worries more people are choosing this coverage believing it is insurance. In complaints to state agencies, some residents have reported being duped into buying the policies. Others said they were aware that it wasn’t traditional insurance, but still expected that all of their medical bills would be paid – only to find out they were not.

"These guys are preying on people who are desperate. This is a major problem, and we need to solve it."<br><em>Sen. Matt Lesser, D-Middletown</em>

“We tell people: only get this if you’re very healthy and have plenty of cash saved up to pay the out of pocket expenses,” Doolittle said. “It’s hard because insurance is so expensive that maybe it’s better than nothing to have a health care sharing ministry. It probably is for some people. But at the same time, you’re on your own.”

Ministries that have been the target of criticism defended their practices. David White, a spokesman for Aliera Healthcare, one of the groups Connecticut residents have complained about, said the companies provide “a vital alternative to more expensive, traditional health insurance plans.”

“As health insurance premiums continue to rise and make traditional insurance too expensive for millions of Americans, it’s deeply disappointing to see state regulators working to deny their residents access to more affordable alternatives offered by health care sharing ministries,” White said in an emailed statement.

For Munoz, though, the coverage has been anything but affordable. Stung by the surprise bill, she has avoided getting herself tested for COVID, even though she works as a dental assistant and is regularly in close contact with patients. She worries about catching and spreading the virus, but said she can’t afford all the out-of-pocket costs.

“Unfortunately, I have to be a bad citizen,” she said. “Unless we have shortness of breath, I’m not taking anybody to get tested. I can’t be paying $300 weekly.”

Complaints Accelerate

Many of the complaints received by Connecticut’s insurance department during the pandemic are for denial of coverage and unpaid medical bills.

In one case, a woman went to the emergency room at Bridgeport Hospital and needed to have her appendix removed. Her ministry, OneShare Health, deemed her appendectomy a pre-existing condition and would not pay the more than $24,000 she owed in medical bills, records show.

“[I] have continued to request medical records to support this was not pre-existing,” the woman wrote in a complaint obtained by The CT Mirror. “[I] and the provider/hospital continue to send this information to their offices, but they don’t acknowledge it as received.

“No one has a real answer as to what is going on. It appears this is a scam.”

Another complainant reported having more than $200,000 in medical bills from Yale New Haven Health and a $663 invoice for lab work at Middlesex Hospital that Aliera Healthcare wouldn’t cover.

“I cannot file for financial aid until these bills are processed through the insurance company,” the person wrote. The insurance department later noted that the ministry paid $29,137 toward the bills.

In a November complaint, a man said his wife had wrist surgery a year earlier and that Trinity HealthShare still hadn’t paid the $29,000 in medical expenses. Over time, the ministry gave different reasons for the delay, he said, including continuing to request hospital records that had already been provided, and saying the payment was held up by “paperwork.” At one point last spring, he said, “the reason for not paying was that the company changed their name.”

The man noted other unusual interactions.

“I have gone for office visits and submitted my cards; later received bills from the [doctor’s] office with notes that the insurance company is saying ‘this person was not insured with us at time of visit,’” he wrote. “When I call, I’m told there is certainly coverage and the [doctor’s] office has made a filing error.

“When I get prescriptions, I’m told that my card is not active. Have not missed a payment since enrolling in this program over two years ago. This has adversely affected our credit.”

In a December complaint, a woman said she was left with a $3,438 medical bill after Aliera “incorrectly” classified her hospital visit as a “wellness and preventative care” service. She had gone to the emergency department at Saint Francis Hospital for a puncture wound in her right foot.

“The infection was becoming systemic and life threatening,” she wrote.

The insurance department redacted the names associated with the complaints.

Paloma Munoz
Credit Yehyun Kim / CTMirror.org
Paloma Munoz puts away her son's medicine.

Officials at OneShare could not be reached. A representative for Trinity referred calls to another phone number – the main line for Aliera.

White, the Aliera spokesman, did not comment directly on the complaints, but said the company, through its subsidiaries, has “successfully processed more than 1.2 million share requests, totaling more than $250 million shared to help its clients’ members meet their health care needs.”

“We’re proud of the work we do to help ministries provide a more flexible method for securing affordable high-quality health care, and we will continue to vigorously defend against the false claims about our company, just as we expect the health care sharing ministries we serve to defend their members’ right to exercise their religious convictions in making health care choices,” he said.

Since the pandemic began, at least four complaints against Aliera have been filed with the state attorney general’s office, and one has been filed with the health care advocate’s office against another ministry, Liberty HealthShare. Both offices have fielded grievances in recent years against the ministries.

Scrutiny over these groups intensified during the last year. Aliera and Trinity face lawsuits in four states, accused of making false or misleading claims about plans they offered consumers and of denying coverage when it should have been approved.

Insurance officials in Washington ordered Aliera to pay a $1 million fine for illegally selling health insurance in that state.

Multiple news outlets, including The Houston Chronicle, have reported that the FBI is investigating Aliera. One of the complainants in Connecticut reported turning records over to the FBI.

"We're proud of the work we do to help ministries provide a more flexible method for securing affordable high-quality health care, and we will continue to vigorously defend against the false claims about our company."<br><em>David White, Aliera spokesman</em>

“I became seriously ill and was hospitalized. Aliera Healthcare initially denied the claim, saying it was not life threatening,” the person wrote to insurance officials here. “I also filed a complaint with the Georgia state attorney general. Their representative … informed me Aliera companies are being investigated by the FBI, who will now handle my complaint. She encouraged me to file a complaint with CT as well.”

Aliera is based in Georgia.

In November, officials in New York filed civil charges against Aliera and Trinity, alleging the companies “deceived consumers while operating an illegal health insurance business,” according to the state’s department of financial services.

“Aliera and Trinity aggressively marketed these products … preying on uninsured New Yorkers,” department leaders said in a statement. “A substantial portion of customer premiums were diverted to so-called administrative costs, rather than retained for reimbursement of members’ medical claims. As a result, New York consumers were short-changed when requesting reimbursement for valid medical expenses.”

Residents were left with substantial medical debt, they said, including a leukemia patient whose emergency hospital admission in 2019 was not covered by the ministries. In another case, a man was denied coverage for a surgery he needed to correct nerve damage in his hand.

Cease and desist orders have been issued against Aliera and Trinity in at least four states, including Connecticut. The companies contested the order here, though an administrative hearing on the appeal is on hold. Insurance officials say they have reached out to Aliera and Trinity about scheduling the hearing and have not received a response. White said the two sides are in the process of negotiating procedures for the hearing.

“In the meantime,” he said, “Aliera and Trinity have abided by the terms of the cease and desist order.”

Medicine
Credit Yehyun Kim / CTMirror.org
Medicine that Paloma Munoz's 4-year-old son regularly takes. Her son has had asthma and allergies since he was one year old.

Legislative Action

Troubled by growing reports of problems with health care sharing ministries, Connecticut lawmakers are drafting a bill that would require groups selling plans here to comply with all provisions of the Affordable Care Act, meaning they would have to provide guaranteed coverage for pre-existing conditions.

A similar measure was raised last year and advanced out of the legislature’s Insurance Committee. But the regular session was suspended amid the pandemic, and the bill never came to a vote in the House or Senate.

Sen. Matthew Lesser, a co-chair of the Insurance Committee, said he has plans to revive the legislation this year. He has heard from constituents who signed up for coverage through a ministry and were stuck with medical bills.

“I get it, health insurance is way too expensive. And that’s why consumers are searching around for affordable alternatives,” said Lesser, a Democrat from Middletown. “But this isn’t an alternative. It’s not something that provides what insurance is supposed to, which is give assurance that when you get sick, somebody’s going to pick up the cost of your care.”

Some of the ministries have hired lobbyists as the issue reaches legislatures in multiple states. Lawmakers in at least one other state – Texas – have introduced a bill to regulate these groups and require greater transparency of their membership and finances, The Houston Chronicle reported. Under that proposal, ministries would have to register annually with the state and could not market themselves as traditional insurance. Members would not lose eligibility if they develop a medical condition, the paper reported.

Katy Talento, executive director of the Alliance of Health Care Sharing Ministries, a policy advocacy group, said her organization condemns fraudulent tactics used by some of the ministries to mislead consumers.

“Legitimate health care sharing ministries are upfront with consumers and transparently describe how they differ from insurance,” she said in an emailed statement to The Mirror. “In recent years, for-profit companies entered the marketplace and have been using the good name of health care sharing ministries, which have been around for decades, to confuse consumers.”

The Alliance’s website lists a series of standards for the health ministries that include making clear in marketing materials that the company is not insurance. Ministries should also establish regular payment amounts for their members, the group noted, and accept “only individuals and families who share a common set of religious beliefs.”

“Health care sharing is not for everyone, but it should be a choice for the people of Connecticut as it is for people across the country; 1.5 million Americans choose [the ministries] as a values-based alternative to the health insurance model for their medical expense needs, sharing more than $1 billion in medical expenses every year,” Talento said.

Still, Lesser said that in Connecticut, reform is needed.

“These guys are preying on people who are desperate,” he said. “Scam artists shouldn’t be operating in Connecticut. This is a major problem, and we need to solve it.”

This report was originally published at CTMirror.org.

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