'Sham' Sharing Ministries Test Faith Of Patients And Insurance Regulators

Sheri Lewis, 59, of Seattle, needed a hip transplant. Bradley Fuller, 63, of nearby Kirkland, needed chemotherapy and radiation when the pain in his jaw ended up being throat cancer. And Kim Bruzas, 55, of Waitsburg, hundreds of miles away, needed emergency choose to stop sudden -and severe – rectal bleeding.

Each of those Washington state residents required medical treatment during the past few years, and each thought they'd purchased health insurance through an online site.

But if this was time for you to settle the debts, they learned that these products they bought through Aliera Healthcare Inc. weren't insurance whatsoever – and that the price of their care wasn't covered.

Lewis and also the others had signed up for what Aliera officials claimed was a healthcare sharing ministry (HCSM) – faith-based co-ops in which members accept pay one another's hospital bills.

But Washington insurance officials now said the firm doesn't meet the meaning of a sharing ministry and described Aliera's products like a “sham” targeted at misleading consumers. Other states, including Texas and New Hampshire, are poised to take similar action.

Insurance Commissioner Mike Kreidler on Monday ordered Aliera, which operates Trinity Healthshare Inc., each of Delaware, to halt operations in Washington, alleging the firm was selling medical health insurance illegally and interesting in deceptive business practices.

Aliera falsely represented itself as a sharing ministry, which would be exempt from insurance regulations, a study found. Though he wouldn't name them, Kreidler said he's investigating two additional firms over similar concerns.

“They don't have the direct affiliation having a particular religious group, a church, a pastor,” Kreidler said. “These seem to be ones which come in with a chance here to earn money.”

In an argument, Aliera officials disputed Kreidler's conclusions. The company has 3 months to request a hearing.

“Aliera has never misled consumer and purchasers agents about its health plans,” the statement said. “For example, our website, ads and other communications clearly state that Trinity's health sharing products are not insurance. Most importantly, they've never been represented as insurance.”

The Washington order followed complaints from nearly two dozen people, including Lewis, a dance teacher who had been informed her planned hip surgery would not be covered.

Across the U.S., several state insurance regulators report similar concerns.

Texas insurance officials have scheduled a hearing to think about a similar order against Aliera, that has 100,000 members nationwide and reported revenue of $180 million in 2021, documents showed.

New Hampshire insurance officials warned consumers about Aliera, saying these were concerned about “potential fraudulent or criminal activity.” Officials in a minimum of five other states told Kaiser Health News they're reviewing firms operating as “illegitimate” healthcare sharing ministries.

Aliera is operated by Shelley Steele of Marietta, Ga., and her husband, Timothy Moses, who had been convicted in 2006 of federal securities fraud and perjury. He was sentenced to six 1/2 years imprisonment and ordered to repay more than $1 million to victims.

Nationwide, nearly 1 million people are enrolled in more than 100 sharing ministries in a minimum of 29 states, based on the Alliance of Healthcare Sharing Ministries. But that is just a quote, said James Lansberry, executive v . p . of Samaritan Ministries International of Peoria, Ill. No comprehensive information is available.

“We try to track what's going on out there,” Lansberry said. “Anyone claiming to become a health care sharing ministry could spill over onto our reputation.”

Samaritan is one kind of what happen to be the 3 top players in the sharing ministries field. The oldest, founded in 1993, may be the Medi-Share program of Melbourne, Fla., operated by Christian Care Ministry. The 3rd is Christian Healthcare Ministries of Barberton, Ohio. Each one is explicitly religious and emphasize faith as the grounds for members to talk about medical burdens.

Those groups originally were certified by the Centers for Medicare & Medicaid Services and necessary to meet specific criteria. Consumers who enrolled were shielded from the Affordable Care Act's individual mandate that required they show proof of insurance or pay an excellent.

But CMS no more certifies HCSMs and, since Congress zeroed out the mandate's penalty in 2021, a brand new crop of companies, including Aliera, has popped up. That worries some of the traditional ministries.

“HCSMs must operate with integrity, transparency, full compliance with the law, and enforcement of the law,” officials with Medi-Share, which has 415,000 members nationwide, said in a statement. “Anything beyond that violates the true spirit of the HCSM community.”

Washington investigators found that Aliera's ads rarely mention religious or ethical motivations, plus they don't meet government requirements.

Many of these entities mimic the marketing, structure and language of ACA-compliant health insurance plans – but offer none of the protections, said JoAnn Volk and Justin Giovannelli, researchers in the Georgetown University Focus on Health Insurance Reforms, who wrote concerning the issue last summer.

“The way they advertise and the services they're providing, it sounds a heck of a lot like medical health insurance,” Giovannelli said. “They're letting folks believe they have a product that includes a promise to pay for.”

Sheri Lewis teaches a body-rolling class at Balance Physical Therapy in Issaquah, Wash. Lewis, who was enrolled in a health care sharing ministry, found out that the hip transplant she much needed wasn't covered. She got the process in Tijuana, Mexico, with the help of a GoFundMe account.(Dan DeLong for KHN)

That's precisely what Lewis thought.

“It looked like Aliera was health insurance in my experience,” she said.

When Aliera denied her surgery, she'd to turn to a GoFundMe site organized by friends to raise nearly $13,000 and then travel to Tijuana, Mexico, to obtain a hip transplant she can afford.

Fuller, who was diagnosed with throat cancer, said he was tied to $81,000 in bills for his first month of treatment.

“They started checking my insurance also it didn't cover nothing,” said the retired commercial electrician.

Fuller, his voice still raspy after radiation, said he had insurance through his union for years, however when the premiums spiked, he went online to find another thing.

The person he talked to from Aliera said he might get insurance, not a problem, Fuller said. The premium would be $350 per month, as opposed to the $1,300 fee for a gold plan on their state insurance exchange. “And which was with dental, too,” he added.

Low premiums also attracted Bruzas, who left her well-paid government job in Tacoma, and the insurance it provided, after her husband died in 2021. She moved to a small town in southeastern Washington to care for her parents and went online to find medical health insurance.

“I just sat down and Googled 'Obamacare,'” she said. “I had a call back from the lady who said she could help me find coverage.” Bruzas was charged $219 for the first month.

Four days later, she was at the local emergency room with massive rectal bleeding. As she was discharged, hospital officials said they'd “never heard about Aliera Healthcare,” she said.

The $10,000 bill was not covered. Bruzas, who works part-time at a home improvement store, declared charity care and the debt was reduced to $6,500. She is repaying it slowly, $50 every month.

The Washington patients recalled mentions of “sharing” and vague references to spirituality. But none realized they were signing up for a religious cost-sharing ministry, i was told that.

“I would have stuck the phone if she'd have said, 'We're a group, and we'll review your records and pray for you,'” Bruzas said.

Aliera officials said they make the character of their products clear.

“Aliera disagrees that Trinity's inclusive and specific statement of beliefs misleads consumers or violates the applicable regulations governing healthcare sharing ministries,” the statement said.

It's not clear how states can curb the new sharing ministries. If Aliera ignores his order, Kreidler said, he'll seek a court injunction to force the particular groups to cease operations. But several states contacted by KHN said that since the ministries are not health insurance, state insurance officials don't review or regulate them.

Some users of sharing ministries say the lower-priced products ought to be readily available for consumers who understand and accept the potential risks involved.

But consumers have to pay close focus on details once they sign up for any health plans, said Colorado Insurance Commissioner Michael Conway, who's investigating sharing ministries operating in the state.

“Ask if it's actually insurance,” he advised. “Ask if there's a guarantee of coverage. Enter into the policy documents. Read the contract they're receiving.”