ST. LOUIS – A local family has just welcomed a child into their family. But the birth came with a high price, which 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 is facing them with a $ 150,000 debt.
Ali Middlesworth said that the birth of his son Declan in October was not easy, KMOV reported.
“Went to hospital with severe pre-eclampsia,” said Ali.
For his safety and for the baby, a few days later the doctors at Mercy Hospital decided to induce labor five weeks before his due date.
“He went out and didn’t reply, 10 minutes passed [and] they call a cart and finally revive it and take it directly to the ICU, “said Ali.
Days passed before Ali and Elia could detain Declan for the first time and two weeks before they could bring him home.
“He’s perfectly healthy, he’s three months old now,” said Ali.
The joys of having a healthy baby have been watered down by rising medical bills
“My liability is $ 47,481.61,” said Ali. But that’s only from a medical statement. “It’s close to a total of $ 150,000.”
Ali said his health plan company refused to pay a penny.
“I feel cheated.”
Her job does not provide her with insurance coverage. So, she signed up for Aliera Health.
“The plan in the book shows that it’s a really good plan, you know that 80/20 co-insurance, $ 1000 deductible, $ 500 for maternity coverage isn’t bad. During the whole pregnancy, they covered everything, the doctors’ visits; just like regular insurance, “he explained.
It wasn’t until later that they realized that the coverage wasn’t what they thought they were paying for.
“They even sold it to us as insurance over the phone. So when work and childbirth hit, they didn’t cover anything.
Aliera is part of what is called a health care sharing ministry. They are not required to follow the same rules as traditional insurers, including the payment of claims.
“It’s not even insurance, but they don’t tell you before you register and make your first payment,” said Middlesworth.
Aliera states that “members’ contributions are received by the ministry of health care sharing and are therefore used to pay for eligible participation requests to members of the ministry.”
So what Ali thought was a monthly prize is actually called a “contribution” or “gift” that ends up in a jar of money and is shared among Aliera members.
He learned that he also has a limit.
“Medical costs for infants resulting from complications at the moment, including but not limited to premature birth, are treated as a separate incident and limited to $ 50,000 in eligible allowance.”
A quick Google search by Aliera Healthcare shows how confusing it can be.
Once the ads are passed, the first website is called Aliera Companies, which doesn’t even look like a healthcare web page.
And on Ali’s paperwork he calls her “the insured”. But Aliera says that “the ministries that share health care, by law, are not a contract and are not an insurance”.
“It’s probably partly our fault for not reading the fine print, but it’s very misleading,” said Ali.
When she added Declan to their plan, she was sent new cards with a new company name.
“It was a different company. He went from Aliera to Trinity. And basically, in all capital letters it said “This is not insurance” and has not said it before, “said Ali.
Trinity Healthshare is an Aliera client.
Ali said that when they started taking Declan from the medical staff they wouldn’t take the papers because they said “this isn’t insurance.”
Then the bills started and that’s when he started reading.
“Monthly contributions are voluntary contributions or non-refundable gifts. Since a non-insurance subscription neither Trinity shares nor the subscription are responsible for any part of an individual’s medical needs, all contributors are responsible for their medical needs. This makes me just dropping my heart basically says they are not responsible for the bills, but we pay almost $ 500 a month, “said Middlesworth.
Aliera sent a statement to News 4, which reads in part:
“We are proud of the work we do to help ministries provide a more flexible method of ensuring high quality, affordable health care and will continue to vigorously defend against false claims about our company.”
At present, Ali and Elia have a medical debt of $ 150,000.
“We will pay for the rest of our lives,” said Ali.
Ali said their case is suspended between Mercy hospital and Aliera / Trinity Healthcare.
“[Mercy] he keeps telling me that the insurance company has refused the bills and so I call Aliera and they say they have not refused them, they are just waiting for the medical records and Mercy says he has sent the medical records and to have proof that Aliera has refused them “said Ali.
Mercy Hospital sent News 4 this in response to the family’s medical bills:
“In cases where a family doesn’t have insurance, Mercy works with families to see if they would qualify for Medicaid and if not, they would work to provide financial assistance if they can’t.”
“Mercy was nothing but the best for us and they worked with us so much,” said Ali.
While stuck in the middle, Ali and Elia say that Declan is worth every penny.
“We got it out of this and that’s all that matters to us, as long as we have it, that’s all that matters,” said Mum.
Aliera told News that 4 families can appeal.
The Middlesworth said Aliera said it is 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 credit. Colorado, Texas and Washington have sent terminations and desisted letters to prevent Aliera from operating.
We contacted the Missouri Department of Commerce and Insurance. They told us they couldn’t talk about any possible open investigation because their files were closed.