This article was reprinted from Kaiser Health News.
It took Kelly Macauley almost a year to realize that the health insurance plan she purchased when buying insurance last October wasn’t really insurance. Sure, red flags popped up along the way, but when she called to complain, she was met with an explanation that sounded reasonable enough that she kept paying the $700 monthly premium, she said. Told.
She said she was told she hadn’t paid for her medical bills because the hospital had submitted them incorrectly. was her underwriter, not the actual insurance company. She had not received her packet of policy welcomes because the company was saving paper and passing those savings on to her customers.
And this summer, a 62-year-old retired teacher who recently moved to South Carolina from the Philadelphia area learned that last year’s hip replacement bill was only paid for $120 and had a balance of over $40,000. I was. She said that when she was purchasing her insurance, she was confident that the surgery would be covered, but the plan she purchased wasn’t insurance, it was called a health care sharing ministry. turned out to be part of the
A healthcare sharing ministry is an alternative to health insurance where members agree to share medical costs. They are often faith-based and can be less expensive than traditional insurance, but they don’t necessarily cover medical expenses for members. Federal Fund Report.
“That was never said to me,” McCauley said. “Honestly, I believed I was buying legitimate medical insurance.”
Starting November 1, millions of Americans will purchase health insurance for 2023 during a period called “open enrollment.”through federal government When state insurance marketconsumers can purchase affordable healthcare law-compliant health insurance plans and find out if they qualify for financial assistance.
But the influx of coverage purchases, experts say, is also often cheaper than comprehensive coverage, but much more for those who sell alternative products, such as short-term health insurance and health care sharing. It warns that it offers an opportunity to offer less protection. While these alternatives are legal in themselves, experts warn: misleading marketing Consumers can be tempted to shop for comprehensive coverage, like buying health insurance that excludes protection against pre-existing conditions and leaves patients vulnerable to large medical bills. .
“It’s a great opportunity to go find consumers looking to buy insurance and lead them down the wrong path,” he said. Joanne Volkco-director of the Center for Health Insurance Reform at Georgetown University.
Volk has identified clear signs of that wrong path: when the person selling the plan starts asking about your health history, or refuses to send any information about the plan outright, or refuses to pay. You agree to provide that information only after you have done so. information.according to 2021 Secret Shopper Report In a misleading marketing practice co-authored by Volk, one broker incorrectly cited HIPAA, a law protecting patient privacy, as a reason not to share information about medical plans.
“It’s just fiction,” Volk said. “When you’re committing fraud, there are no boundaries.”
In a statement to KHN, Jericho Share spokesperson Mark Hubbard said the organization could not discuss Macquarie’s case without her prior written approval, but that misrepresentation in any part of its program would not be permitted. and unethical behavior will not be tolerated.
Nationally, legislators and regulators are looking at how health care plans are marketed.Chairman of the Senate Finance Committee Ron WydenOregon Democrat, We are investigating your complaint Marketing of Medicare Advantage Plans.and in May, Centers for Medicare & Medicaid Services pointed out the complaint Medicare Advantage and Medicare Prescription Drug Benefit Plan marketing practices increased from 15,497 in 2020 to at least 39,617 in 2021.
The Delaware Insurance Commissioner said, “Healthcare-related fraud is growing exponentially.” Trinidad Navarroalso chairs the National Association of Insurance Commissioners’ Anti-Fraud Task Force.
Multiple factors are driving the increase, Navarro said. Rising healthcare costs can drive up the cost of regulated healthcare plans, such as those complying with the Affordable Care Act. Higher costs will lead more Americans to look for cheaper alternatives. Doesn’t provide as much coverage It can confuse consumers.such a plan surged under President Donald Trumpsaid Navarro.
Elected Democrat Navarro said, “I don’t want to sound political.” related to these plans. ”
Finally, states are the primary regulators of insurance, so quelling healthcare fraud can be like playing a game of whack-a-mole, Navarro said.
To combat this tactic, Navarro said, insurance regulators across the country have created what he describes as “confluence pages” to share information about bad actors with each other. For consumers, the regulator is discussing creating a public search tool to search for complaints against health insurance brokers, he said. BrokerCheck tool Created by financial industry regulators to monitor brokerage firms.
For now he proposes to work together healthcare navigatorhelping consumers enroll in plans through official health insurance marketplaces, healthcare.govRegulators are also taking legal action against misleading sales tactics. In August, the Federal Trade Commission won a refund of $100 million For consumers, they say they were “cheated” by fake health insurance plans.Last year, the Massachusetts Attorney General won $515,000 in consumer relief From insurance companies accused of fraudulent selling practices.
According to an October court filing, the California Attorney General is investigating Jericho Shea, the Department of Health Care Sharing, which Kelly McCauley said had unknowingly purchased the plan, to file a lawsuit against the Department of Health Care Sharing. Checking for compliance with state requirements.
Hubbard, a Jericho Share spokesperson, said the organization was “appropriately responding” to the Attorney General’s investigation.
Macauley contacted KHN after reading the book. Survey in June Of consumers who said they thought they were buying insurance but later learned that their membership had been sold to the Ministry of Health Sharing.
Hubbard said that since that article was published, Jericho Share has automatically refunded new consumers within 72 hours if they request a refund within 30 days of signing up, and that “the It said it did not allow “outsourced marketing” and added a member guide and popup to that page. His website showing Jericho Share is a health care sharing ministry.
The company responded to Macauley’s bad reviews online. Better Business Bureau I am requesting more information about her case on your website. She said she provided the information but she didn’t hear back.
After Macaulay tried unsuccessfully to cancel the Jericho Shares plan directly with the company, she called her credit card company to stop them from authorizing any further charges by the company. The credit card clerk told her, “This is a scam,” and offered her a full refund of the insurance premium.
Even if those efforts were successful, Macaulay would be left with tens of thousands of dollars in medical bills because he unknowingly had no insurance.
She’s on the health insurance market again and plans to pick a company she’s heard about before.
“Whatever it costs,” said McCauley.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. KHN is one of his three major operational programs in the United States, along with policy analysis and polling KFFMore (Kaiser Family Foundation). KFF is a donated non-profit organization that provides information on health issues to the public.