As the cost of healthcare rises for many people, some have turned to cost-sharing ministries (non-insurance entities in which members share a common set of ethical or religious beliefs and share medical expenses among members) and The Doctors examine whether they can help lower someone's medical bills or run the risk of increasing them.
Members pay monthly dues in hopes that the group will cover medicals bills, but these groups do not guarantee coverage of all types of healthcare expenses, and because these groups are not insurance companies, the normal insurance laws do not apply.
One example of a member who had a negative experience with a cost-sharing ministry is Keith, who was paying over $500 dollars a month to a group which he says was led to believe it was like a traditional health insurance. But when he needed complex back surgery, Keith checked with the cost-sharing ministry to make sure he would be covered, and he was told they would cover the cost of the surgery. Unfortunately, after his surgery, the ministry refused to pay and denied his claim.
He tells The Doctors he was informed he would be responsible for approximately $215,000 dollars for the surgery and hospital stay. He says he is now having to consider declaring bankruptcy because there is no way he could pay a bill this large.
Washington state Insurance Commissioner Mike Kreidler and consumer protection attorney Peter Holland join the conversation to shed more light on this complex issue. Mike explains that an insurance company is required to pay 80 cents of every dollar for a person's medical bill, compared to cost-sharing ministries, which he says are only paying approximately 16 cents of every dollar for someone's bills. He tells The Doctors, "They are not offering any real coverage, it's fairly limited." He warns that some of these programs are "bottom feeders that are taking advantage of consumers." He adds, "They are in this business to make money, they are for-profit." He also notes these fraudulent examples differ from the original idea behind a true cost-sharing ministry, which was created with the intention of helping members of a church or a particular group. He goes on to recommend people have a backup plan if they choose to use this type of program.
Is there legal recourse for people who been treated this way by a cost-sharing ministry?
Our consumer protection attorney Peter says this will vary from state to state, but yes, consumers should be protected in some way by unfair trade practices like what Keith endured. He says these types of practices could be considered fraud, deception, and breach of contract, both at the state and federal level. He urges Keith to meet with a consumer rights attorney to determine what can be done to help him and he offers to discuss the matter further with him.
In order to avoid an issue like Keith's, Mike urges consumers to contact your state's insurance commissioner to ask about cost-sharing ministries before you sign up. "Let the buyer beware. If it sounds too good to be true, it probably has a problem."
In order to help Keith with his health, Portsmouth Physical Therapy in New Hampshire is offering Keith 24 sessions of physical therapy at no cost.