Recently, a Colorado woman was badly beaten in an act of domestic violence, her medical bills totaling in the tens of thousands of dollars. But when she asked her health coverage provider to help with the costs, she said the company denied her claim on the grounds that she had engaged in immoral behavior.

She had been drinking before being attacked.

That experience, recounted to state regulators, was one of about a dozen complaints that led the Colorado Division of Insurance last year to shut down a so-called health care sharing ministry operating in the state. Last month, Colorado’s insurance commissioner made the order final as part of a settlement, preventing the ministry, Trinity HealthShare, and the company that administers it, Aliera Healthcare, from marketing sharing ministries in the state for the foreseeable future.

The Colorado Division of Insurance sent cease and desist letters to Aliera Healthcare and Trinity Healthshare in August 2019, accusing them of selling insurance without a license. (John Ingold, The Colorado Sun)

Sharing ministries — many of which are religiously based — look a bit like regular health insurance, pooling members’ money to help pay for everyone’s medical care. In a world of high health insurance premium prices and deductibles, the ministries’ lower costs can be enticing to consumers.

But the plans are exempt from federal insurance requirements and, as a result, provide fewer — if any — guarantees. They can have lifetime or annual caps on benefits, can charge people more based on their health and can deny coverage for any number of reasons — including based on religious belief. Ultimately, and unlike traditional insurance, they have no obligation to pay a member’s claim.

To consumer advocates and, increasingly, state officials across the country, that makes sharing ministries ripe for abuse. In investigating Trinity and Aliera, Colorado authorities also heard about needed surgeries and cancer treatments that wouldn’t be covered.

“They were really devastating,” Kate Harris, the state’s chief deputy insurance commissioner, said of the complaints her office received. “The commonality of all of these was people who thought they had financial protection from this company that they did not have.”

Now, state lawmakers are looking to create more rules for the ministries.

House Bill 1008, which is scheduled for its first committee hearing Tuesday, would require sharing ministries to be more upfront with consumers about how they operate and would explicitly prohibit misleading advertising about the plans. The bill would also give regulators more oversight of sharing ministries.

State Rep. Susan Lontine, a Democrat from Denver who is sponsoring the bill, said she has heard complaints not only from consumers but also from doctors who are frustrated that they have to hound their patients for money when the sharing ministry won’t pay up.

“So there’s harm to the doctor-patient relationship when that happens,” she said.

Rep. Susan Lontine, D-Denver, in the Colorado House on April 30, 2019. (Jesse Paul, The Colorado Sun)

But she’s also heard from plenty of consumers who say the sharing ministries work well for them. Lontine said she hopes, with some tweaks to the bill, that she might even get a number of sharing ministries to support her legislation.

“We don’t outlaw them,” Lontine said. “If they behave and do what they say, they’re still allowed to do business.”

Because sharing ministries don’t currently have to report any numbers to the state, it’s unclear how many are operating in Colorado and how many people are enrolled in them. The Alliance of Health Care Sharing Ministries has said Colorado is one of the top 10 states for enrollment in the programs, with around 53,000 people enrolled as members.

Trinity had about 3,200 members in Colorado. The Division of Insurance has created a special open-enrollment window for those members so they can transition to regulated insurance plans.

Health care sharing ministries have increasingly been in state officials’ crosshairs across the country, with Trinity and Aliera also the subject of regulatory action in at least three other states.

Harris said the problem isn’t with the model — sharing ministries have been around in small religious communities for decades. It’s with sharing ministries that don’t make it clear to potential members that they are not the same as insurance.

“They were acting basically like insurance companies,” Harris said. “They used slightly different language in some cases. But, at the end of the day, they’re making assurances of payment for services. And what we were hearing from consumers was, by and large, that their claims were not being paid.”

Harris said the state has evidence that Trinity and Aliera were spending no more than 20% of what they took in in premium dollars on their members’ medical bills — “shockingly low,” Harris said. By contrast, traditional insurance companies have to pay out 80% to 85% of the premium dollars they take in.

Neither Trinity nor Aliera admit any wrongdoing as part of their settlement agreements with the state. In a statement on its website, Aliera said it intends to continue with other types of health care businesses it operates in the state. The company also runs an insurance brokerage, an information technology company and others.

“While we fully cooperated with the division’s inquiry, it’s disappointing that in Colorado we are unable to provide future (health care sharing ministry) services on behalf of ministries,” Chase Moses, Aliera’s president, said in the statement.

Trinity said it had been ready to fight the state’s shut-down order prior to the state’s offer of settlement negotiations, and it vowed to continue on in other states.

“The vast majority of Trinity’s members, both in Colorado and around the country, are very satisfied with our health care sharing ministry and continue to choose us because it’s a cost-effective medical payment arrangement,” Joe Guarino, Trinity’s president, said in a statement on the organization’s website.

Adam Fox, the director of strategic engagement at the pro-consumer Colorado Consumer Health Initiative, said complaints his organization has received about health care sharing ministries have dropped off since the Division of Insurance shut down Trinity and Aliera.

But Harris said her office is currently in the early stages of investigating other sharing ministries in the state. That process could take months, but she declined to say more.

“I can’t get into too much detail at this point,” she said.

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