Insurance regulators across the country are taking action against a Georgia-based company that markets and administers programs on behalf of health care sharing ministries.
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. Those violations include failing to make its religious affiliations clear and selling plans outside the markets allowed by statute.
Members of health care sharing ministries pay monthly premiums, with the expectation that the money will be shared when medical bills arise. Though no exact figures exist, industry groups say close to 1 million Americans get their health coverage through these Christian-based entities.
"There are legitimate health care sharing ministries that offer coverage for their members, but Aliera and Trinity are not one of them," said New Hampshire Insurance Commissioner John Elias, who accuses the companies of selling illegal insurance products.
One New Hampshire customer who signed up for Trinity's health care sharing ministry is Keith Meehan, 49, an international rice salesman whose company doesn't provide health insurance.
After his doctor recommended back surgery for a disk issue, Aliera and Trinity HealthShare assured Meehan the procedure didn't require preapproval. But after the surgery, it declined to pay approximately $200,000 in medical bills, contending his back pain was a preexisting condition.
"I feel like I was sold a bad bill of goods," Meehan says. "I had no idea."
Health care sharing ministries don't have to follow the same rules as insurers, and they face no requirements to pay claims. To industry watchers, their marketing materials don't lay out these risks clearly enough.
"Having a disclaimer somewhere on Page 17 saying this is not insurance and there is no guarantee to pay is not necessarily going to turn people away," says JoAnn Volk, a researcher at Georgetown's Center on Health Insurance Reforms.
But to many families, health care sharing ministries offer a lower-cost alternative for coverage that also aligns with their values.
"The cost was typically a fraction, typically well under half and usually closer to a third of what the cost of conventional insurance was," says Fenton Groen, a builder in Rochester, N.H., who has been happily enrolled in health care ministries since the early 1990s.
Along with the lower sticker price, Groen believes the popularity of health care sharing has grown in recent years because most ministries won't cover abortion services. Many also offer prayer hotlines for members.
Groen says he supports regulators stepping in to stop a company like Aliera if, as alleged, it is not adhering to the few regulations these entities must follow.
"Given the explosive growth of health care sharing ministries, it is not surprising to me that someone would try to cut in on that," says Groen.
Other health care sharing groups say Aliera's actions are harming the reputation of the broader industry.
"The sharing ministries have been very alarmed, very concerned about the press reports and the misconceptions that people can have about the sharing ministries and the legitimate work they actually do," said Dr. Dave Weldon, president of the Alliance of Health Care Sharing Ministries.
Investigative reporting by the Houston Chronicle revealed that the co-founder of Aliera, which is based in Georgia, 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 both deny violating New Hampshire law. Aliera says it plans to appeal the cease-and-desist order.
"Aliera will continue to vigorously defend against false claims made about the administrative, marketing and other support services we provide to health care sharing ministries (HCSMs), and we're confident the HCSMs we support will defend the right of their members to exercise their religious convictions in making health care choices," wrote the company in a statement.
Meehan, the rice salesman with $200,000 in unpaid medical bills, says he wishes he had read the fine print before signing up.
"I mean, I'm not trying to skate on my responsibilities," he says. "Had I known that this was the way it was going to turn out, I would have suffered. I can endure some pain, both physical and mental. But I would have never gone through with the surgery."
More pain is on the way. Meehan says he is considering filing for bankruptcy.
RACHEL MARTIN, HOST:
Nearly 1 million Americans rely on health care sharing ministries to cover their medical bills. Members of these Christian organizations typically chip in money every month with the expectation that they will be reimbursed when they get treatment. But multiple state regulators have accused one company of violating federal and state requirements. New Hampshire Public Radio's Todd Bookman reports on the efforts to rein in one of those companies.
TODD BOOKMAN, BYLINE: Spread out on Keith Meehan's kitchen counter, there's a mess of unpaid bills with very large numbers.
KEITH MEEHAN: Eleven thousand eight twenty-six (ph) for - looks like an anesthesiologist. The surgeon - $18,854. A hospital stay - $150,014.69.
BOOKMAN: Meehan is 49 years old, a divorced dad living in Rochester, N.H. His job as an international rice salesman doesn't provide health insurance. So last year, a broker sold him on a company called Aliera that markets what's known as a health care sharing ministry. It's not traditional health insurance.
MEEHAN: Clearly not, which I've (laughter) come to find out.
BOOKMAN: Meehan signed up. A few months later, he had back surgery. He says Aliera and an entity it contracts with called Trinity HealthShare assured him the procedure didn't need preapproval. But afterwards, it declined to pay close to $200,000 in medical bills, contending his back pain was a preexisting condition.
MEEHAN: I feel like I was sold a bad bill of goods, you know? Just - I had no idea.
BOOKMAN: After receiving a wave of complaints from customers like Meehan, New Hampshire's Insurance Department issued a cease-and-desist order last month against Aliera and Trinity for selling what the state calls illegal health insurance. Earlier this year, regulators in Texas, Colorado and Washington also took action against Aliera. The company declined an interview request, but in a statement, Aliera forcefully denied the allegations and says it will appeal the New Hampshire cease-and-desist order.
Other health care sharing groups say Aliera's actions are harming the reputation of the broader industry. These ministries have seen rapid growth in recent years, in part because of their lower cost.
FENTON GROEN: The cost was typically a fraction, typically well under half and usually closer to a third of what the cost of conventional insurance was.
BOOKMAN: This is Fenton Groen, a New Hampshire contractor who's been a member of a ministry since the early 1990s. He says, along with the savings, many Christians are drawn to ministries because they don't cover abortion services and offer perks like prayer hotlines for their members. Groen says he supports regulators stepping in to stop a company like Aliera if it's violating the law.
GROEN: Given the explosive growth of health care sharing ministries, it's not surprising to me that somebody would try to cut in on that.
BOOKMAN: An investigation by the Houston Chronicle earlier this year noted that the co-founder of Aliera previously served time in prison for securities fraud. The company is facing a proposed class action lawsuit in Washington state for alleged deceptive practices. JoAnn Volk with Georgetown's Center on Health Insurance Reforms says some consumers are drawn to ministries because of the belief that they'll be better taken care of.
JOANN VOLK: There's a lot of frustration with insurance companies and some of the hoops you have to go through to get your health care bills paid. And it feels like it's just another hoop, but at least it's with people that share my beliefs.
BOOKMAN: Keith Meehan, the guy with $200,000 in unpaid medical bills, says he wishes he had done his homework on Aliera.
MEEHAN: I'm not trying to, like, skate on my responsibilities. Had I known that this was the way it was going to turn out, I would have suffered - I can endure some pain, both physical and mental (laughter). But I would have never gone through with the surgery.
BOOKMAN: More pain may be on the way. Meehan says he's considering filing for bankruptcy.
For NPR News, I'm Todd Bookman.
(SOUNDBITE OF CODES IN THE CLOUDS' "TIME CREEPS LIKE A THIEF") Transcript provided by NPR, Copyright NPR.