Family thought they bought insurance to cover son’s birth, gets bill for more than $150K
ST. LOUIS (KMOV) — A local family just welcomed a baby boy into their family. But the birth came with a hefty price tag, one that they thought their health plan would at least partially cover.
Now Ali and Elijah Middlesworth are sharing their story because they don’t want anyone else to fall victim to the company that has them facing $150,000 debt.
Ali Middlesworth said her son Declan’s birth in October wasn’t easy.
“Went to the hospital with severe pre-eclampsia,” Ali said.
For her safety and the baby’s, days later doctors at Mercy Hospital decided to induce labor five weeks before her due date.
“He came out and he was unresponsive, 10 minutes go by [and] they call in a crash cart, and they finally revive him and take him straight down to the NICU,” Ali said.
It was days before Ali and Elijah could hold Declan for the first time, and two weeks before they could bring him home.
“He’s perfectly healthy, he’s three months old now,” Ali said.
The joys of having a healthy baby have been watered down by mounting medical bills
“My responsibility is $47,481.61,” Ali said. But that’s just from one medical statement. “It’s close to totaling $150,000.”
Ali said her health plan company has refused to pay a dime.
“I feel scammed.”
Her job doesn’t supply her with insurance coverage. So, she signed up for Aliera Health.
“The plan in the book shows it’s a really good plan, you know 80/20 co-insurance, $1000 deductible, $500 for maternity coverage isn’t bad. Throughout the entire pregnancy, they covered everything, doctors’ visits; just like regular insurance,” she explained.
It wasn’t until later they realized the coverage isn’t what they thought they were paying for.
“They even sold it to us as insurance on the phone. Then when labor and delivery hit, they covered nothing.”
Aliera is part of what’s called a health care sharing ministry. They aren’t required to follow the same rules as traditional insurers, including paying claims.
“It’s not even insurance, but they don’t tell you that before you sign up and make your first payment,” Middlesworth said.
Aliera says “member contributions are received by the health care sharing ministry and are then used to pay eligible share requests to the ministry’s members.”
So what Ali thought was a monthly-premium is actually called a “contribution” or “gift” which ends up in a money pot and is shared amongst Aliera’s members.
She learned that even has a limit.
“Medical expenses for newborn arising from complications at the time, including but not limited to premature birth, are treated as a separate incident and limited to $50,000 of eligible share.”
A quick Google search of Aliera Healthcare shows how confusing it can be.
Once you get past the ads, the first website is called Aliera Companies, which doesn’t even look like a healthcare webpage.
And on Ali’s paperwork it calls her “the insured.” But Aliera says “health care sharing ministries, by law, are not a contract and are not insurance.”
“It’s partially probably our fault for not reading the fine print, but it’s very deceiving,” Ali said.
When she added Declan to their plan she was sent new cards with a new company name.
“It was a different company. It went from Aliera to Trinity. And at the bottom, in all caps it said ‘This is not insurance’ and it didn’t say that before,” Ali said.
Trinity Healthshare is an Aliera client.
Ali said when they started taking Declan to the doctor staff wouldn’t take the cards because they say “this is not insurance.”
Then the bills started coming in and that’s when she started reading.
“Monthly contributions are voluntary contributions or gifts that are non-refundable. As a non-insurance membership neither Trinity share, nor the membership are liable for any part of an individual’s medical need all contributors are responsible for their medical need. That just makes my heart drop, it says basically they’re not responsible for any bills, but we pay almost $500 a month,” Middlesworth said.
Aliera sent News 4 a statement, it reads in part:
“We are proud of the work we do to help ministries provide a more flexible method for securing affordable high-quality health care, and we will continue to vigorously defend against false claims about our company.”
As it stands, Ali and Elijah are $150,000 in medical debt.
“We’re gonna be paying it the rest of our lives,” Ali said.
Ali said their case is hanging between Mercy hospital and Aliera/Trinity Healthcare.
“[Mercy] keeps telling me the insurance company has declined the bills and so I call Aliera and they say they haven’t declined them, they’re just waiting on medical records, and Mercy says they’ve sent the medical records and have proof that Aliera has declined them,” Ali said.
Mercy hospital sent News 4 this in response to the family’s medical bills:
“In instances where a family does not have insurance, Mercy works with families to see if they would qualify for Medicaid and then otherwise work to provide financial assistance, if they can’t.”
“Mercy has been nothing but the best to us, and they’ve worked with us so much,” Ali said.
While they’re stuck in the middle, Ali and Elijah say Declan is worth every cent.
“We got him out of it and he’s all that matters to us, as long as we have him that’s all that matters,” Mom said.
Aliera told News 4 families can file an appeal.
The Middlesworths said Aliera told them it’s reviewing $41,000 of their debt but no money has been paid.
According to the Better Business Bureau, the company is facing more than 100 complaints and a suspended accreditation. Colorado, Texas, and Washington have sent cease and desists letters to stop Aliera from operating.
We reached out to the Missouri Department of Commerce and Insurance. They told us they couldn’t speak on any possible open investigations, because their files are closed.