AJC IN-DEPTH: Georgia-based health insurance alternative faces probes

Channel 2 investigative reporter Jim Strickland tracked down the company's CEO and spoke with clients.

When Michael Greer shopped for his family’s 2018 insurance plan, he joined the thousands of Georgians on the individual market seeking something more affordable. His trusted broker had a suggestion: cost-sharing coverage called health share or health care sharing ministries.

“He said, ‘It’s not traditional insurance,’” Greer remembers the broker saying about the coverage he bought through a company then called Aliera, now known as Ensurian. “‘But they’re going to cover what they say they’re going to cover.”

But they haven’t, Greer maintains, leaving him with more than $70,000 in bills. And it’s not insurance at all.

As open enrollment closes Sunday for plans sold on Affordable Care Act exchanges, most people will be able to get premiums that are subsidized and affordable, or even cost nothing at all. But those who face the brutal full cost of premiums are looking for alternatives. One of them is health sharing.

Health shares started as communal sharing of health care bills by religious communities. The groups have been around since long before the Affordable Care Act, and they won an exception carved out in the law: In general, the ACA mandates that every American have insurance. But people don’t have to have insurance if they have a health share instead.

They, however, come with risks. And reporting by The Atlanta Journal-Constitution and Channel 2 Action News found that health shares marketed by Georgia-based Aliera, the company through which Greer bought his plan, exemplify those risks, with the company under investigation or ordered to stop selling plans by regulators in at least four states.

The company said in a statement that it can’t discuss Greer’s case or others because of health privacy law. But it says it makes it clear to all customers that the products it offers aren’t actually insurance and that claims don’t have to be paid. In addition, it said, the complaints against it are false.

“It’s deeply disappointing to see state regulators working to deny access to more affordable alternatives offered by health care sharing ministries,” the statement said.

In June, in the midst of the scrutiny, Aliera Healthcare changed its name to Ensurian, according to Georgia secretary of state records. Now Ensurian is a brokerage company of the Aliera Cos. The company says putting forth Ensurian was among the changes the company enacted to make it clearer that the product is not insurance.

The health commissioner of Washington state, Mike Kreidler, told Channel 2 that he hadn’t heard the complaints about other health shares that he’s received about Aliera. “What we saw, and what we’re aware of at this time, it’s clearly a scam,” Kreidler said.

Health shares look at first glance like insurance. People pay a set monthly amount into the plan, and then the plan helps pay their medical bills. But there the similarities end.

Unlike isurance, health shares don’t have to pay claims if they don’t want to. And sometimes they don’t.

Aliera is part of a group of companies that are closely in business together. To be clear, Aliera itself is not the health share. Trinity Healthshare and Unity Healthshare are nonprofits whose health share products have been sold by Aliera.

Aliera emphasizes this separation. Health share executives can’t take profits, but Aliera and Ensurian are not health shares. The health shares attract the customers, and Aliera and Ensurian can make money administering them and brokering sales.

Regulators have investigated or suspended Aliera and companies it works with in Washington, Colorado, New Hampshire and Texas. New Hampshire’s regulators ordered Aliera and Trinity to stop selling their plans in that state and have scheduled a hearing on the matter next week.

Georgia regulators issued a warning earlier this year to customers to be careful about shopping for health shares, and Georgia Health News confirmed the warning was prompted by Aliera.

In a sort of Catch-22, the problem, some states said, is that they can’t investigate Aliera because they only investigate insurance. And Aliera doesn’t sell insurance. The regulators that have taken up the complaints mostly did so under the theory that Aliera was pretending to sell insurance. Aliera denied that assertion.

Aliera said it’s always been clear it doesn’t deal in insurance, and it instituted many changes to make that clearer, including making customers state their agreement by phone that the plan is a health care sharing ministry. The company also stopped calling its different plans by “bronze,” “silver” and “gold,” the categories used by ACA insurance plans.

Greer says his plan left him with more than $70,000 in unpaid medical bills for his wife’s emergency surgery and his daughter’s broken arm. He said he’s heard different reasons over the past year why the claim hasn’t been paid yet.

“I thought I was buying health care coverage,” Greer said. “Because that’s what they’re selling, right?”

He’s a successful businessman and lucky to be able to afford the bills. But he says he shouldn’t have to and wants others to be aware.

“This would ruin most other people,” Greer said. “That’s what really irks me.”

Stacey Pogue said she watched in Texas as health shares lobbied successfully to get the law changed so they explicitly wouldn’t be regulated. However, “agents working on behalf of (Aliera) are using insurance terminology to explain their product,” Pogue said, citing the “bronze, silver and gold plans” terminology that the company said it now has dropped. “There’s a reason you think you have insurance.”

Experts say no one should read ill intent into every health share. But everyone should know they might not pay.

“There are absolutely ministries that stay focused on their original intent,” said Emily Curran, a research fellow at Georgetown University who has studied health shares. However, she said, “One of the concerns was that ministries that were originally founded on the idea of sharing … over the years they’ve come to really mimic insurance as we know it.”

Some advertise during ACA open enrollment, Curran’s team found, which has nothing to do with them except if they want to compete.

“There’s growing concern of course that consumers will be confused by that,” she said.

Agreeing is Will Pollock, an Atlantan with a new baby who believes the health share he bought through Aliera owes him thousands of dollars for prescriptions.

“The fact is that these people are working in the health insurance space,” he said.

ExploreCLICK TO SEE CHANNEL 2 ACTION NEWS’ REPORT: Nov. 1, 2019

HEALTH SHARE: WHAT TO KNOW

  • Health sharing plans, also called health care sharing ministries, sound like insurance but they're not. A like-minded group, for example a religious group, agrees to pay in monthly and then to share medical expenses. But unlike insurance, they do not have to pay. That's why they can be less expensive than insurance for higher-income people.
  • They're attractive because they have an exception in the Affordable Care Act: a person with health share does not have to have insurance.
  • People only have until Sunday, Dec. 15, to sign up or switch ACA insurance plans. If you grow dissatisfied with your health share plan after Dec. 15, you cannot sign up for real insurance again until open enrollment begins Nov. 1, 2020.