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The new rules will help people get upfront cost estimates for about 500 so-called “shoppable” services, meaning medical care they can schedule ahead of time. DNY59/Getty Images hide caption toggle caption DNY59/Getty Images The new rules will help people get upfront cost estimates for about …
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A Google search for Obamacare plans can direct consumers to a series of “lead-generating” websites: nongovernmental webpages that connect insurance brokers to consumers.
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A Google search for Obamacare plans can direct consumers to a series of “lead-generating” websites: nongovernmental webpages that connect insurance brokers to consumers.
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Tina Passione needed health insurance in a hurry in December. The newly retired 63-year-old was relocating to suburban Atlanta with her husband to be closer to grandchildren. Their house in Pittsburgh flew off the market, and they had six weeks to move out 40 years of memories.
Passione said she went online to search for the federal health insurance marketplace, clicked on a link and entered her information. She promptly got multiple calls from insurance brokers and bought a plan for $384 a month. Later, though, when she went to a pharmacy and doctors’ offices in Georgia, she was told she did not have insurance.
In fact, it said it right on her card: “THIS IS NOT INSURANCE.”
Passione is one of 10 consumers who told KHN that they thought they were buying insurance but learned later that they had been sold a membership to a Houston-based health care sharing ministry called Jericho Share. The ministry formed in 2021 when House of Prayer and Life Inc., a half-century-old Christian congregation, assumed the name Jericho Share, according to Texas business filings.
Health care sharing ministries are faith-based organizations whose members agree to share medical expenses. The ministries grew in popularity before the Affordable Care Act’s mandate for having insurance coverage was repealed, because they offered a cheaper alternative to insurance, and the law exempted people in ministries from having to pay a tax penalty for not having insurance. But they are not insurance, are largely not regulated as such and don’t necessarily cover members’ medical bills. Massachusetts is the lone state that requires ministries to regularly report data, and only about half of claims submitted to ministries there were deemed eligible for payment. This spring, the Colorado legislature passed similar requirements that await the governor’s signature.
The Better Business Bureau gives Jericho Share an F rating, its lowest, and its website shows more than 100 complaints filed in less than a year. Texas Department of Insurance documents show two complaints, from February and March, about Jericho Share. The department responded to both by saying it regulates insurance, which ministries are not, and forwarding them to the state attorney general’s office. The attorney general’s office did not respond to KHN’s questions about the status of the complaints.
John Oxendine, a lawyer who was elected four times as Georgia’s insurance commissioner, responded to KHN’s inquiries made to Jericho Share. He is facing federal charges of conspiracy to commit health care fraud that he said are unrelated to Jericho Share. He denied any wrongdoing. If Jericho Share memberships are being sold to consumers in misleading ways, “that’s a good way for a broker to get fired,” he said.
“Jericho Share does not tolerate any type of misrepresentation or unethical conduct on the part of its programs,” according to a statement sent through Oxendine. “Whenever we become aware of inappropriate conduct, we take appropriate action to remedy the situation.”
Consumers can always cancel their Jericho Share plans, Oxendine said. Many consumers who spoke to KHN did cancel their plans and receive refunds, but several said the process to do so was frustrating. Some were left to sort out payment for bills they incurred while they thought they were insured. At least seven of the people KHN spoke with said they ended up with Jericho Share after beginning their health insurance searches on Google.
Encountering such issues while shopping for health insurance is not uncommon, said JoAnn Volk, co-director of Georgetown University’s Center on Health Insurance Reforms. She co-authored a 2021 report that found “misleading marketing practices” were directing consumers to alternative health plans, like ministries, that can cost more than marketplace plans and offer fewer protections.
“It’s especially unfortunate because people have set out to buy comprehensive coverage,” Volk said.
Susan Fauman, 47, a metalsmith from Germantown, N.Y., relied on her spouse’s insurance coverage but wanted her own insurance policy before submitting her divorce paperwork last fall. Fauman said her Google search landed her on a series of what the advertising industry calls “lead-generating” websites: nongovernmental webpages that connect insurance brokers to consumers.
Susan Fauman thought she was buying health insurance but learned later that she had bought a membership to Jericho Share, a Houston-based health care sharing ministry.
Susan Fauman
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Susan Fauman
Susan Fauman thought she was buying health insurance but learned later that she had bought a membership to Jericho Share, a Houston-based health care sharing ministry.
Susan Fauman
None of the consumers KHN spoke with could say with certainty which site ultimately connected them to the brokers who sold them Jericho Share memberships. ObamacarePlans.com and AffordableHealthPlans.org are among the lead-generating websites that show up on Google when someone searches with terms such as “Obamacare insurance” or “healthcare marketplace.” Those site listings are actually advertisements that resemble ordinary Google search results but are labeled with the word “Ad” and are placed above the most relevant search result: the federal government’s official health insurance marketplace, healthcare.gov.
Google spokesperson Christa Muldoon said companies that advertise on searches related to the Affordable Care Act must prove they are licensed to sell insurance via the federal or state marketplaces.
Those marketplaces let consumers shop for comprehensive health insurance, tell them whether they qualify for financial assistance and connect consumers with enrollment assistance, if needed. By contrast, lead-generating websites typically just sell the personal information provided by consumers to insurance brokers and agents who can sell other types of plans.
Fauman said she unwittingly put her information into what turned out to be several lead-generating websites. She was soon inundated with phone calls from insurance brokers, she recalled.
Eager to get insurance, Fauman said, she bought a plan for about $330 a month, plus a $99 sign-up fee. She said the broker — who, she later realized, never named the plan — said she’d have basically no copays and no restrictions on where to get care. But he did not tell her that it was a health care sharing ministry, she said, or that it wasn’t insurance — something she didn’t know to ask about. When she received her Jericho Share card with its disclaimer, she thought, “What the hell did I sign up for?”
Ministries and aggressive insurance marketing practices have raised eyebrows before, and the Washington state attorney general issued a consumer alert last year about “ads and websites posing as the official health insurance marketplace.” But Georgetown University’s Volk said large-scale crackdowns would likely require cooperation by multiple state regulators because states are the default enforcers of insurance rules. The Federal Trade Commission did bring a case against a Florida-based operation in 2018, alleging it collected over $195 million by enrolling consumers in “worthless plans.” The case is ongoing.
And it’s not always clear who can and should be protecting consumers in this complicated space that covers public and private insurance, interstate commerce, websites and health care sharing ministries.
The Centers for Medicare & Medicaid Services manages the healthcare.gov website. “When CMS sees an ad we think is misrepresenting HealthCare.gov, we share it immediately with the search engines,” Deputy Administrator Ellen Montz said in a statement.
Louise Rasho, a spokesperson for MediaAlpha, which operates ObamacarePlans.com, said in an email that the company’s code of conduct does not allow brokers who buy customer leads to mislead consumers. It periodically monitors calls to ensure compliance. She also noted that the site has disclaimers saying that it is not a government website.
Craig Sturgill of Excel Impact, which owns AffordableHealthPlans.org, said that if the company learns a broker has broken the law or used questionable tactics, it terminates contracts and takes “further action” as necessary. “As a digital marketing company, we aren’t necessarily in the business of deeply educating consumers from beginning-to-end about all of their available options,” Sturgill said in an email. “Our role is to connect consumers to advisors who can and should effectively educate consumers.”
The broker callback number that consumer Hemani Hughes said she used to correct the spelling of her name on her Jericho Share plan — before she realized it was a ministry — is listed on the websites of the Better Business Bureau and the Utah Insurance Department as belonging to Florida-based Prosperity Health. In an email, Prosperity Health’s registered business agent, Ahmed Shokry, said it had “never sold Health Shares.”
Hughes, a 49-year-old communications strategist in Kansas, said she was sold a Jericho Share plan in February after specifically telling a broker she did not want a health care sharing ministry plan. Hughes said she realized after her call that the broker never mentioned the plan by name, saying only that she was signing up for a “national PPO” and walking her through the copays.
When Hughes realized it was a health care sharing ministry, she said, she called to cancel her plan. She was met with what she described as “a pretty manipulating and very belligerent gantlet of customer service reps and hold times” over multiple calls.
At one point, Hughes said, the people she was speaking with told her it was irresponsible to go without insurance — even though Jericho Share itself is not insurance.
Hughes outlined her story in a complaint she filed with the Better Business Bureau. Jericho Share responded to the consumer watchdog that it was contacting Hughes directly to protect her private health information and said, “We are working very diligently to investigate this complaint thoroughly.” Hughes ultimately received a refund.
When Tina Passione was searching for health insurance online, she entered her information into what she thought was a government website for Affordable Care Act plans.
Tina Passione
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Tina Passione
When Tina Passione was searching for health insurance online, she entered her information into what she thought was a government website for Affordable Care Act plans.
Tina Passione
Passione, in Georgia, said she filed her complaint with the Better Business Bureau after she couldn’t get a straight answer about payment for her doctor appointments and prescriptions. In March, Passione canceled her Jericho Share plan and signed up for COBRA coverage through her former employer for $782 a month.
“A bit expensive, but at least I know what I am getting,” Passione said.
She said she was reimbursed by Jericho Share for one month’s payment and is waiting to hear whether her credit card company can recoup payments she made in January and February.
Fauman, who also filed a complaint, received a refund too, but spent two months uninsured and avoided calling her doctor while she sorted out the situation.
“I was afraid of what it was going to cost me,” Fauman said.
She eventually got marketplace insurance with the help of a “navigator,” someone trained to help consumers enroll in coverage without earning a commission. After subsidies, Fauman’s premium is around $95 a month, costing her about $2,800 less a year than what she said her Jericho Share plan would have — and her new plan is actually insurance.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. It is an editorially independent operating program of KFF (Kaiser Family Foundation).
Linda Munson’s youngest grandson, Daniel Gomez, 2, tries on an Oculus headset in her yard in Berlin, Conn. Playing different virtual reality games has become her family’s regular Sunday activity, Munson said. Yehyun Kim for NPR hide caption toggle caption Yehyun Kim for NPR Linda …
Jon Miller sits in his bedroom with his dog, Carlos, whom he received as a present for successfully completing cancer treatment a decade ago. Miller sustained severe brain damage, and requires the help of home health aides to continue living in his home. Natalie Krebs/Side …
Claudia and Jesús Fierro of Yuma, Ariz., review their medical bills. They pay $1,000 a month for health insurance yet still owed more than $7,000 after two episodes of care at the local hospital.
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Claudia and Jesús Fierro of Yuma, Ariz., review their medical bills. They pay $1,000 a month for health insurance yet still owed more than $7,000 after two episodes of care at the local hospital.
Lisa Hornak for Kaiser Health News
The Fierro family of Yuma, Ariz., had a string of bad medical luck that started in December 2020.
That’s when Jesús Fierro Sr. was admitted to the hospital with a serious case of COVID-19. He spent 18 days at Yuma Regional Medical Center, where he lost 60 pounds. He came home weak and dependent on an oxygen tank.
Then, in June 2021, his wife, Claudia Fierro, fainted while waiting for a table at the local Olive Garden restaurant. She felt dizzy one minute and was in an ambulance on her way to the same medical center the next. She was told her magnesium levels were low and was sent home within 24 hours.
The family has health insurance through Jesús Sr.’s job, but it didn’t protect the Fierros from owing thousands of dollars. So when their son Jesús Fierro Jr. dislocated his shoulder, the Fierros — who hadn’t yet paid the bills for their own care — opted out of U.S. health care and headed south to the U.S.-Mexico border.
And no other bills came for at least one member of the family.
The patients: Jesús Fierro Sr., 48; Claudia Fierro, 51; and Jesús Fierro Jr., 17. The family has Blue Cross and Blue Shield of Texas health insurance through Jesús Sr.’s employment with NOV, formerly National Oilwell Varco, an American multinational oil company based in Houston.
Medical services: For Jesús Sr., 18 days of inpatient care for a severe case of COVID-19. For Claudia, fewer than 24 hours of emergency care after fainting. For Jesús Jr., a walk-in appointment for a dislocated shoulder.
Total bills: Jesús Sr. was charged $3,894.86. The total bill was $107,905.80 for COVID-19 treatment. Claudia was charged $3,252.74, including $202.36 for treatment from an out-of-network physician. The total bill was $13,429.50 for less than one day of treatment. Jesús Jr. was charged $5 (70 pesos) for an outpatient visit that the family paid in cash.
Service providers: Yuma Regional Medical Center, a 406-bed nonprofit hospital in Yuma, Ariz. It’s in the Fierros’ insurance network. And a private doctor’s office in Mexicali, Mexico, which is not.
What gives: The Fierros were trapped in a situation in which more and more Americans find themselves. They are what some experts term “functionally uninsured.” They have insurance — in this case, through Jesús Sr.’s job, which pays $72,000 a year. But their health plan is expensive, and they don’t have the liquid savings to pay their share of the bill. The Fierros’ plan says their out-of-pocket maximum is $8,500 a year for the family. And in a country where even a short stay in an emergency room is billed at a staggering sum, that means minor encounters with the medical system can take virtually all the family’s disposable savings, year after year. And that’s why the Fierros opted out of U.S. health care for their son.
According to the terms of the insurance plan, which has a $2,000 family deductible and 20{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} coinsurance, Jesús Sr. owed $3,894.86 out of a total bill of nearly $110,000 for his COVID-19 care in late 2020.
The Fierros are paying off that bill — $140 a month — and still owe more than $2,500. In 2020, most insurers agreed to waive cost-sharing payments for COVID-19 treatment after the passage of federal coronavirus relief packages that provided emergency funding to hospitals. But waiving treatment costs was optional under the law. And although Blue Cross and Blue Shield of Texas has a posted policy saying it would waive cost-sharing through the end of 2020, the insurer didn’t do that for Jesús Sr.’s bill. Carrie Kraft, a spokesperson for the insurer, wouldn’t discuss why his bill was not waived.
(More than two years into the coronavirus pandemic and with vaccines now widely available to reduce the risk of hospitalization and death, most insurers again charge patients their cost-sharing portion.)
On Jan. 1, 2021, the Fierros’ deductible and out-of-pocket maximum reset. So when Claudia fainted — a fairly common occurrence and rarely indicative of a serious problem — she was sent by ambulance to the emergency room, leaving the Fierros with another bill of more than $3,000. That kind of bill is a huge stress on many American families; fewer than half of U.S. adults have enough savings to cover a surprise $1,000 expense. In recent polling by the Kaiser Family Foundation, “unexpected medical bills” ranked second among family budget worries, behind gas prices and other transportation costs.
The new bill for the fainting spell destabilized the Fierros’ household budget. “We thought about taking a second loan on our house,” said Jesús Sr., a Los Angeles native. When he called the hospital to ask for financial assistance, he said, people he spoke with strongly discouraged him from applying. “They told me that I could apply but that it would only lower Claudia’s bill by $100,” he said.
So when Jesús Jr. dislocated his shoulder when boxing with his brother, the family headed south.
Jesús Sr. asked his son, “Can you bear the pain for an hour?” The teen replied, “Yes.”
Father and son took the hourlong trip to Mexicali, Mexico, to Dr. Alfredo Acosta’s office.
The Fierros don’t consider themselves “health tourists.” Jesús Sr. crosses the border into Mexicali every day for his work, and Mexicali is Claudia’s hometown. They’ve been traveling to the neighborhood known as La Chinesca (Chinatown) for years to see Acosta, a general practitioner, who treats the asthma of their youngest son, Fernando, 15. Treatment for Jesús Jr.’s dislocated shoulder was the first time they had sought emergency care from the physician. The price was right, and the treatment effective.
A visit to a U.S. emergency room likely would have involved a facility fee, expensive X-rays and perhaps a specialist’s evaluation — which would have generated thousands of dollars in bills. Acosta adjusted Jesús Jr.’s shoulder so that the bones aligned in the socket and prescribed him ibuprofen for soreness. The family paid cash on the spot.
Although the Centers for Disease Control and Prevention doesn’t endorse traveling to another country for medical care, the Fierros are among millions of Americans each year who do. Many of them are fleeing expensive care in the U.S., even with health insurance.
Acosta, who is from the Mexican state of Sinaloa and is a graduate of the Autonomous University of Sinaloa, moved to Mexicali 20 years ago. He witnessed firsthand the growth of the medical tourism industry.
He sees about 14 patients a day (no appointment necessary), and 30{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} to 40{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} of them are from the United States. He charges $8 for typical visits.
In Mexicali, a mile from La Chinesca, where the family doctors have their modest offices, there are medical facilities that rival those in the United States. The facilities have international certification and are considered expensive, but they are still cheaper than hospitals in the United States.
Resolution: Both Blue Cross and Blue Shield of Texas and Yuma Regional Medical Center declined to discuss the Fierros’ bills with KHN, even though Jesús Sr. and Claudia gave written permission for them to do so.
In a statement, Yuma Regional Medical Center spokesperson Machele Headington said, “Applying for financial support starts with an application — a service we extended, and still extend, to these patients.”
In an email, Kraft, the Blue Cross and Blue Shield of Texas spokesperson, said: “We understand the frustration our members experience when they receive a bill containing COVID-19 charges that they do not understand, or feel may be inappropriate.”
The Fierros are planning to apply to the hospital for financial support for their outstanding debts. But Claudia said never again: “I told Jesús, ‘If I faint again, please drive me home,’ ” rather than call an ambulance.
“We pay $1,000 premium monthly for our employment-based insurance,” added Jesús. “We should not have to live with this stress.”
The takeaway: Be aware that your deductible “meter” starts over every year and that virtually any emergency care can generate a bill in the thousands of dollars and may leave you owing your deductible and most of your out-of-pocket maximum.
Also be aware that even if you seem not to qualify for financial assistance based on a hospital’s policy, you can apply and explain your circumstances. Because of the high cost of care in the U.S., even many middle-income people qualify. And many hospitals give their finance departments leeway to adjust bills. Some patients discover that if they offer to pay cash on the spot, the bill can be reduced dramatically.
All nonprofit hospitals have a legal obligation to help patients: They pay no tax in exchange for providing “community benefit.” Make a case for yourself, and ask for a supervisor if you get an initial no.
For elective procedures, patients can follow the Fierros’ example, becoming savvy health care shoppers. Recently, Claudia needed an endoscopy to evaluate an ulcer. The family called different facilities and discovered a $500 difference in the cost of an endoscopy. They will soon drive to a medical center in Central Valley, California, two hours from home, for the procedure.
The Fierros didn’t even consider going back to their local hospital. “I don’t want to say, ‘Hello’ and receive a $3,000 bill,” joked Jesús Sr.
Stephanie O’Neill contributed the audio portrait with this story.
Bill of the Month is a crowdsourced investigation by KHN and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!
