Kirkland cancer patient, others fighting Aliera Healthcare to get claims paid

VIDEO: Kirkland cancer patient, others fighting Aliera Healthcare to get claims paid

KIRKLAND, Wash. — Patients are left with mountains of medical debt after they thought they signed up for health insurance, but ended up with something that wouldn't pay the claims when they got sick.

The company is called Aliera Healthcare. Washington state ordered the company to stop selling policies in Washington and the state has fined the company more than a million dollars.

But customers across the state are still dealing with the aftermath.

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A cancer patient in Kirkland, Brad Fuller, said he's being forced to max out credit cards to pay for treatment because Aliera is denying his claims.

KIRO7's Deedee Sun investigates the healthcare company the state is calling a "scam."

Fuller is done with chemotherapy, but the impact from throat cancer means he still needs a feeding tube. He said he pours about six bottles of watered-down Ensure into his stomach every day.

"I got my girlish figure back," Fuller said with a laugh. "And I kept my sense of humor."

The fight for his health is only part of his trouble. He's also still battling with Aliera Healthcare.

"They're just like boom, wolves," Fuller said.

He was looking for affordable insurance after retiring last year when he says Aliera found him.

"They called me out of the blue," Fuller said. "This guy was like hey, here's a fresh one. He needs insurance."

He signed up for what he thought was health insurance, paying about $390 per month.

A few months later, he started having health problems - teeth and jaw pain and one night started coughing up blood.

He drove himself to the ER at Evergreen Hospital in Bellevue and said that night, he almost died.

"I had internal bleeding. That's where the blood was coming from," Fuller said.  "He stuck the telescope through my sinus and said, ‘you got cancer.'"

After the diagnosis, Fuller got another blow.

"Then they told me, well your insurance doesn't cover you for cancer," he said.

The bill he got for a week's stay in the hospital was $100,174.99.

The paperwork shows Aliera's payout for the claim was $0.00.

More than 3,000 people in Washington state have signed up for policies with Aliera.

Stories like Fuller's led him and dozens of others across the state to file complaints with Washington Insurance Commissioner, Mike Kreidler.

"We had a bucketful of complaints coming in," Kreidler said.

The commissioner said the company claims it's not an insurance company.

"They were trying to be a health care sharing ministry, which they did not qualify for," Kreidler said.

Legal health care sharing ministries are nonprofits  whose members share ethical or religious beliefs and medical costs. They're also not regulated by the state.

"What they see is a loophole in the law that allows them to break the law, take advantage of people, take in premium dollar, offer very little in the way of service, but take in lots of money," Kreidler said.

In May, the commissioner filed a cease and desist ordering Aliera "to immediately stop selling health insurance illegally and halt deceptive business practices."

"What we saw, and what we're aware of at this time, it's clearly a scam," Kreidler said at the time.

KIRO 7 has since talked with a half dozen people who all thought they were signing up for health insurance with Aliera, only to have their claims denied.

"Deny, deny, deny. And they hope you'll go away," said Sandi Kamuf, who lives in West Seattle. She has been fighting with Aliera to get her husband's trip to the ER paid.

Through a public disclosure request, KIRO7 got ahold of a training video where even the speaker calls their service "health insurance" - before quickly correcting himself.

"We're finally applying health insurance - healthcare - in a market," the speaker said.

The insurance commissioner is still investigating whether there's enough evidence to recommend criminal charges against the company with the state's attorney general.

Other states are also joining Washington in taking legal action. Colorado and New Hampshire have also filed a cease and desist.

Texas has filed a restraining order and injunction against the company.

Meanwhile, Fuller's bills are piling up and some envelopes say "FINAL NOTICE."

"They've already sent me to collections on one bill," Fuller said. "Now that I got my credit cards maxed out, I'm paying more on them. I'm about tapped out pretty soon. I can't do it anymore, because I still got to pay my utility builds, my mortgage, gas bills, all that stuff," he said.

He's dropped Aliera and signed up for legitimate health insurance but has a $1,300 monthly premium and struggles with ongoing medical bills.

Fuller said the one he has no way to tackle is the one from Aliera.

"I'm hoping can someone can sue them for me, because I don't have a pot to pee in," Fuller said.

While investigating the situation, KRIO7 found out law firms in Washington State have filed the first-class action lawsuit against Aliera Healthcare. Seattle firms Sirianni, Youtz, Spoonemore, & Hamburger and the firm Myers & Company are working together on the suit.

Fuller said someone needs to hold the company accountable.

"As far as fraudulent insurance, why are you getting away with it?" Fuller said.

If Aliera Healthcare customers win the class-action lawsuit against the company, you don't have to be named in the suit to get a payout. If a judge assigns an amount for Aliera Healthcare to pay, you can file a claim and get a payout from the fund.

Find out more by reaching out directly to the law firm.

KIRO 7 reached out to Aliera Companies, Inc. by email and phone requesting a response to the state's allegations, and to ask why it denied Fuller's claim.

A spokesperson for Aliera Companies sent the following statement in response:

"As health insurance premiums continue to rise and make traditional insurance too expensive for millions of Americans, it's deeply disappointing to see state regulators working to deny their residents access to more affordable alternatives offered by health care sharing ministries.

"We're 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 the false claims about our company, just as we expect the health care sharing ministries we serve to vigorously defend their members' right to exercise their religious convictions in making health care choices.

"Notwithstanding the Commissioner's long history of hostility towards health care sharing ministries and his latest hyperbolic claims, we remain committed to serving healthcare sharing members in Washington and elsewhere, working with regulators to provide the health care sharing solutions these members need.

"We know health care can be confusing, so we invest heavily in training and compliance for both insurance and non-insurance (ministry plan) product offerings, both internally and to ensure our external sales partners adhere to carefully-crafted scripts and consumer acknowledgements to help avoid consumer confusion."

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