Keith Meehan is on the hook for more than $230,000 in medical bills after his insurer denied his claims from back surgery earlier this year.

After going without medical coverage for two years, the 49-year-old Rochester man signed up for a health care sharing ministry, an arrangement in which people with common ethical or religious beliefs share medical expenses, according to the federal government.

Meehan thought the procedure, done in March in hopes of reducing his debilitating pain, was covered. But his providers, Aliera Healthcare and Trinity HealthShare, denied claims for the surgery and post-op treatments. The reason? A preexisting condition.

Although the 2010 Affordable Care Act passed by Congress prohibits qualified health plans from denying coverage or services because of preexisting conditions, health care sharing ministries are exempt.

The denial of benefits to Meehan and dozens of other Granite State residents by Aliera and Trinity has prompted New Hampshire officials to order the company to halt operations. Other states, including Georgia and Texas, have taken similar actions.

“I would not have had the surgery if I had known the way this was going to turn out,” Meehan said.

Last month, Insurance Commissioner John Elias ordered Atlanta-based Aliera Companies and Trinity HealthShare to immediately stop selling or renewing “illegal health insurance” in New Hampshire, where about 1,400 state residents are covered by the plans. The agency took action after receiving dozens of complaints.

Many thought they were signing up for health insurance, only to find their claims were denied because of preexisting conditions or because the claims were deemed inappropriate for a “Christian lifestyle,” according to the department.

Aliera, which is not licensed in New Hampshire, has been administering and marketing health coverage on behalf of Trinity HealthShare, according to the department. Aliera also markets products under the company name Ensurian. Trinity HealthShare operates as a health care sharing ministry, in which members pay premiums and voluntarily agree to share their medical expenses in accordance with their Christian beliefs, according to its website.

Aliera says it will challenge the cease-and-desist order in court.

“New Hampshire has some of the highest health insurance premium rates in the country, so it’s deeply disappointing to see state regulators working to deny residents access to a more affordable alternative offered by our health share ministry partner,” the company wrote in a statement.

“We’re confident the HCSMs (health care sharing ministries) we support will defend the right of their members to exercise their religious convictions in making health care choices,” the statement read. “HCSMs provide members with a flexible method for securing high-quality health care at an affordable price, something that is becoming more important than ever with skyrocketing costs for traditional health insurance.”

Health care sharing ministries are not insurance companies, according to Cathryn Donaldson, director of communications and public affairs for America’s Health Insurance Plans, a national association whose members provide coverage for health care and related services.

“These types of arrangements could leave patients vulnerable and without access to critical services or prescription drugs,” she wrote in an email.

More than 100 ministries serve just under a million people across the nation, according to the Alliance of Health Care Sharing Ministries website.

“There are legitimate health care sharing ministries that offer coverage for their members, but Aliera and Trinity are not one of them,” Elias said in a statement. “Unfortunately, we are seeing entities in the marketplace that are misleading consumers and finding ways to try to avoid insurance regulation. It is important for consumers to be cautious when they purchase health coverage and to reach out to the department when they have questions or concerns.”

Elias said an investigation found Aliera and Trinity fail to meet key federal and state standards, including a requirement that they be formed before Dec. 31, 1999. Trinity was formed on June 27, 2018, with no members.

‘It’s like a bad dream’

After landing a new job, Meehan sought to buy insurance through a broker. Because he was outside the open enrollment period for most insurance companies, his options were limited.

He said the Aliera/Trinity plan was represented to him as similar to traditional health insurance, except he needed to be a member of a religious group and sign a waiver that he was opposed to abortion. Meehan is Catholic.

Once the plan kicked in, Meehan saw a doctor for the first time in two years. The physician agreed he should see an orthopedic doctor for his back and leg pain.

“They expedited me getting in there because of the pain I was experiencing,” Meehan said.

A case manager agreed with the doctors’ decision that Meehan have an MRI and eventually two-level back spinal surgery on March 4. The surgery took 6½ hours and required months of recovery.

Meehan said he didn’t discover payment for the surgery had been denied until his fifth physical therapy session. The company considered it a preexisting condition because the pain started before the plan kicked in or any official diagnosis or recommendation for surgery was made, he said.

“It’s like a bad dream,” he said.

Joanne Morganti, 64, of Derry was denied a $66,000 claim for surgery at Concord Hospital for a broken arm.

Like Meehan’s, her claim was considered the result of a preexisting condition.

“I’m like, ‘How can a broken arm be a preexisting condition?’ ” she said. “I had the insurance effective Oct. 1 and I broke my arm Oct. 5. It’s not like I broke my arm Sept. 28.”

As a Catholic, she signed up for Aliera/Trinity to fill a gap before she qualified for Medicare at 65. The cost was $468 a month compared to more than $800 through the Affordable Care Act.

“I should have been buyer beware,” she said.

She has worked the bills down to $26,477.

“There is nothing I can do except pay all these bills down,” she said.

Aliera stands by its methods.

“We sympathize with their frustration, with an unfortunate example of the need to understand health plan details, especially what is eligible for cost sharing and what is not — such as preexisting conditions,” the company said in response to Meehan’s and Morganti’s situations.

What’s next

Morganti is working a part-time job at Market Basket and making monthly $300 payments to Concord Hospital. She now pays more than $900 a month for health insurance through Ambetter Insurance.

She thinks more needs to be done to end this practice.

“I would like to see them totally shut down,” she said.

Meehan filed an appeal to Trinity, but the company is standing by its decision.

The Insurance Department likely won’t be able to help, either, he said.

“There is no way at 49 years old I am going to get out from under $230,000 of medical bills,” he said. “That is kind of taking a toll in another way, emotionally and mentally. I have a daughter who is getting ready to go off to college.”

Once again he is without insurance and considering bankruptcy. He hasn’t made any payments toward the surgery.

“I’m kind of hoping a miracle will happen and this thing finds a way to work itself out,” he said. “I’m in limbo. I don’t know what to do.”

Monday, December 09, 2019
Sunday, December 08, 2019