Regulators Alle Christian Health Care Provider Broke State, Federal Rules: NPR

0

Keith Meehan is one of more than 1 million Americans who receive medical coverage through a shared health care ministry. After Meehan’s back surgery, Aliera and Trinity HealthShare refused to pay around $ 200,000 in medical bills, claiming back pain was a pre-existing condition.

Todd Bookman / RPSN


hide caption

toggle legend

Todd Bookman / RPSN


Keith Meehan is one of more than 1 million Americans who receive medical coverage through a shared health care ministry. After Meehan’s back surgery, Aliera and Trinity HealthShare refused to pay around $ 200,000 in medical bills, claiming back pain was a pre-existing condition.

Todd Bookman / RPSN

Insurance regulators across the country are taking action against a Georgia-based company that markets and administers programs on behalf of shared health care departments.

State officials in Texas, Colorado, Washington and, most recently, New Hampshire accuse Aliera, as well as Trinity HealthShare, an entity with which it contracts, of violating state and federal requirements. These violations include not clearly indicating one’s religious affiliations and selling plans outside of legally permitted markets.

Members of health care sharing ministries pay monthly premiums, with the hope that the money will be shared when medical bills arise. While there are no exact figures, industry groups say nearly one million Americans have health coverage through these Christian entities.

“There are legitimate health care sharing departments that provide coverage for their members, but Aliera and Trinity are not among them,” said New Hampshire Insurance Commissioner John Elias, who accuses the companies of sell illegal insurance products.

A client from New Hampshire who has signed up for Trinity’s shared health care department is Keith Meehan, 49, an international rice seller whose company does not provide health insurance.

After her doctor recommended a back operation for a disc problem, Aliera and Trinity HealthShare assured Meehan that the procedure did not require prior approval. But after the operation, he refused to pay around $ 200,000 in medical bills, claiming his back pain was a pre-existing condition.

“I feel like I was sold a bad bill,” Meehan said. “I had no idea.”

Health care sharing departments do not have to follow the same rules as insurers and they are not required to pay claims. To industry watchers, their marketing materials don’t present these risks clearly enough.

“Having a disclaimer somewhere on page 17 that says it’s not insurance and there’s no guarantee to pay isn’t necessarily going to turn people off,” says JoAnn Volk, researcher at the Center on Health Insurance Reforms in Georgetown.

But for many families, shared health care departments offer a lower-cost alternative for coverage that also matches their values.

“The cost was usually a fraction, usually well under half and usually closer to a third of the cost of conventional insurance,” says Fenton Groen, a builder in Rochester, New Hampshire, who is luckily enrolled in government departments. health since the early 1990s.

Along with the decline in the sticker price, Groen believes the popularity of healthcare sharing has increased in recent years because most departments do not cover abortion services. Many also offer prayer lines for members.

Groen says he supports intervention by regulators to shut down a company like Aliera if, as it is claimed, it does not comply with the few regulations that these entities must follow.

“With the explosive growth of shared health care ministries, it’s no surprise to me that someone is trying to get involved,” Groen says.

Other healthcare sharing groups claim Aliera’s actions are damaging the reputation of the industry at large.

“Sharing Ministries have been very alarmed, very concerned about the news articles and misconceptions people may have about Sharing Ministries and the legitimate work they actually do,” said Dr. Dave Weldon, President of the Alliance of Health Care Sharing Ministries. .

An investigative report from the Houston Chronicle revealed that Aliara’s co-founder, who is based in Georgia, had previously served time in prison for securities fraud. The company is facing a proposed class action lawsuit in Washington state for alleged deceptive practices.

Aliera and Trinity deny breaking New Hampshire law. Aliera has announced plans to appeal the cease and desist order.

“Aliera will continue to vigorously defend itself against false claims regarding the administrative, marketing and other support services we provide to Shared Health Care Ministries (HCSMs), and we are confident that the HCSMs we support will defend the right of their members to exercise their right religious beliefs to make choices in health care, ”the company wrote in a statement.

Meehan, the rice seller with $ 200,000 in unpaid medical bills, says he wished he had read the fine print before signing up.

“I mean, I’m not trying to skate on my responsibilities,” he says. “If I had known this was going to happen, I would have suffered. I can endure pain, both physical and mental. But I would never have had the operation.”

More pain is on the way. Meehan says he plans to file for bankruptcy.


Source link

Share.

Comments are closed.