Blog

A family in Georgia faces a hefty healthcare bill after their insurance provider refused to pay for their daughter’s brain surgery. The cost they now shoulder?

$325,000.

On September 11 of last year, Ashley and Wesley Segars became alarmed when their daughter, Lola Grae, 10, suffered from extreme headaches. Following her repeated complaints, they took her to the local emergency room in Green County. Then, an ambulance rushed her from the local ER to Children’s Healthcare Scottish Rite. There, the doctors discovered the true severity of her condition.

Lola suffered headaches as a result of a softball-sized brain tumor.

Doctor’s successfully removed the tumor, abating further damage to the child’s brain. “It was just amazing, the care,” commented her father, Wesley.

However, a week ago, they received the bill from their insurance provider, a nonprofit company by the name of Aliera. Aliera monitors the payouts for faith-based organization Trinity HealthShare.

Healthcare Provider Under Investigation

Their members pay monthly and share the cost of each other’s medical expenses. Unfortunately, it hasn’t worked that way for many. An investigation conducted by WSB-TV2 Atlanta uncovered a number of families saddled with large medical bills.

In Lola’s case, Aliera claimed she received her treatment at an out-of-network hospital. Therefore, their policy won’t cover the cost.

Aliera’s business practices garnered the attention of several states, who subsequently ordered the company to stop doing business there. Mike Kreidler, Washington state’s Insurance Commissioner, said Aliera paid out only 16 percent of the money it took in. In comparison, the norm for similar companies is 80 percent. “It’s clearly a scam,” Kreidler said.

In response, Aliera directs people to a statement explaining complaints account for less than half of a percent of overall membership. It also states they’ve paid out $165 million in claims over the years.

Aliera presently faces an investigation from the New York State Department of Financial Services.

They also sell coverage through a second name, Ensurian.