Washington regulators target faith-based health care firm that Spokane Valley woman says scammed her

Jun. 9--Faced with a rapidly looming deadline to attain affordable health insurance in late 2017, Spokane Valley resident Sheryl Manchester thought she'd found an unbelievable deal through a broker.

"I have health issues. I needed to have a good insurance policy," said Manchester, who takes medication for asthma and requires imaging for her hips and other injuries. "I was thrilled to buy it. I was very thankful for it."

But Manchester hadn't bought insurance. She'd bought a membership into what's known as a health care sharing ministry, a faith-based cost-sharing program that operates outside the regulatory structure of traditional health insurance with coverage from state laws. Monthly payments are often lower than the premiums of plans on public health exchanges, but the companies -- which offer coverage for close to 1 million Americans, according to an industry trade group -- can require their members to make certain health pledges, like abstaining from drugs and alcohol, and aren't legally required to cover any portion of medical costs.

Manchester said she didn't know any of that, or what a health care sharing ministry was, when she agreed to pay $419 monthly "shares" into a plan administered by a company called Aliera in early 2018, a significant reduction from the $750 monthly premium she'd been paying previously. Aliera, now the target of regulatory action by insurance investigators in both Washington and Texas, says their brokers are instructed to inform potential customers what they're selling isn't insurance, and that fact is featured prominently in its promotional materials.

Aleira responded to questions for this story with a statement through a spokesman, defending the training of their brokers and pledging to fight what they called "false claims" about the company from regulators.

"We know navigating health care can be a complex process, so we have an entire division of trained 'Member Concierge' staff to guide consumers through plan options and details to help them make informed choices to best meet their needs," the statement read. "All third-party brokers and agents are required to undergo this training as well, and if we find they've failed to meet their contractual obligations or misrepresented the products we market to consumers, they will be terminated."

Aliera also said it had no record of the broker who sold Manchester her membership when contacted for comment last week. A message left on the phone number Manchester provided for her insurance broker was not returned Friday.

Aliera plans to appeal a cease-and-desist order to stop selling plans in Washington state that was handed down last month, arguing it fits both the state and federal definitions of a faith-based health care cost-sharing company distinct from insurance. Aliera markets and administers plans for a corporation called Trinity Healthshare, which claims roots in the Baptist tradition in tax filings with the IRS.

"More than one million Americans choose Health Care Sharing Ministries to meet their health care needs because they want an alternative to traditional health insurance that is more affordable, flexible, and compatible with their religious beliefs, and that's a choice government at all levels should respect," the company continued in its statement through a spokesman. "We will vigorously defend against the false claims directed at our company, and we are confident we will prevail when these questions are ultimately determined by impartial judicial review."

Ministries ask members to make monthly "shares" into a pooled escrow account, or match up members directly to pay for each other's approved health care costs. The four largest in the United States claim ties to the Christian faith, and payments often also include prayer messages from other members.

The difference between traditional insurance and what she'd purchased became apparent quickly for Manchester. She'd been told she'd have $20 copays for office visits and for MRIs. While the deductible for the plan was high ($5,000), she didn't believe her routine doctor consults would count toward it. Also, she was promised a 60/40 cost share with Aliera for her prescriptions.

But when she tried to schedule an appointment after switching coverage, she found the physicians she needed to see either hadn't heard of Aliera, or wouldn't do business with the company.

"It took me nine months, from January, to get an appointment on the north side with my OBGYN," Manchester said. The other promises, including low co-pays and prescription drug cost-sharing, also turned out to be bogus, she said.

Aliera directs its customers, in the case of any medical event, to contact its firm first and go through a telemedicine provider or to work with its employees for a list of physicians who would work with the company. After calling several of them, including spending a day at the Splashdown water park with her grandchildren talking to customer service representatives instead of enjoying the sun, she'd decided she had enough. She later fired off a complaint to the Washington Office of the Insurance Commissioner.

"I racked up over $1,000 in prescriptions, over $4,000 in medical bills -- what a joke -- yes I got completely scammed," Manchester wrote in her complaint, dated the first of this year after she'd received new, state-backed coverage through Molina Healthcare.

Manchester's was one of more than two dozen such complaints received by the office of Mike Kreidler, the Washington Insurance commissioner. That office reports more than 27,000 Washington residents had purchased memberships in health care sharing ministries, which are protected from regulation under a state law passed in 2011. Lawmakers approved that protection after Kriedler had previously sent a cease-and-desist order to another firm, Samaritan Ministries.

Thirty states have passed such laws to protect similar companies from regulation. Many members have praised the arrangements as being a low-cost alternative to traditional insurance, especially after the Affordable Care Act required companies to provide certain coverage and the now-repealed tax penalty for lacking insurance.

In a statement announcing the latest cease-and-desist order, Kriedler called Trinity a "sham" ministry, noting that the company had incorporated well after the Dec. 31, 1999, cutoff date to be grandfathered into protection from regulation under federal law. Kriedler's office also contends the firm, based in Georgia but incorporated in Delaware, offers misleading information to sales agents working with consumers and doesn't accurately portray the statements of faith that are required of members of Trinity.

"Legitimate health care sharing ministries offer a valuable service to their members," said Kreidler in a statement announcing the action. "Unfortunately, we're seeing players out there trying to use the exemptions enjoyed by legitimate ministries to skirt insurance regulation and mislead trusting consumers."

Aliera is facing similar charges out of Texas. That state's Department of Insurance published an investigative report showing that Aliera had earned $180 million in revenue in 2018, and that its practices amounted to selling insurance with the intent of avoiding important safeguards for consumers.

Aliera is fighting those charges, arguing that while the company may have been formed in 2018, the acts of charity behind it date to the 16th century Protestant traditions of the Baptist church. Ending the sale of its products would amount to the loss of coverage for its roughly 100,000 customers nationwide, it contends, including 3,000 in Washington state that rely on the ministry for financial assistance.

The company won a procedural victory earlier this month when the courts in Texas prevented the Department of Insurance from moving forward with a cease-and-desist order pending the outcome of a hearing Thursday.

Manchester hopes Washington and Texas prove victorious in their efforts against Aliera. Even after leaving the company's membership at the end of last year, her credit card continued to be charged by the ministry once the calendar turned. She also received a $2,000 bill in the mail for an MRI performed after her insurance had switched to Molina.

The religious oath, "hallelujah," spills from her lips when she reflects on moving on from the ministry she didn't know she was a part of.

"They're really not insurance programs, it's not insurance," Manchester said. "Good luck getting stuff covered. Find somebody that's a real insurance company."

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