Before signing upl, I got a brochure stating what they do not cover, and ophthalmology was not listed. Paid all premiums on time. Three months later I needed to see an ophthalmologist. Aliera said I first needed a referral from my PCP, but they still helped me find in-network ophthalmologists. My PCP diagnosed me with Graves disease and referred me to an endocrinologist and an ophthalmologist, but Aliera now tells me that ophthalmology is not a specialty that’s covered. I need orbital decompression eye surgery, and Aliera won’t pay. There is nothing Christian about this company; they are scam artists who belong in jail.
i signed up with Aliera Care or Aliera Health Care in October of 2017 thru a recommendation from Covered California and The ACA. The information in their online and offline brochures grossly misrepresents what they cover and do not cover. There are huge gapping holes in what they do not cover.
I was perplexed that I had never seen these giant limitations of coverage and about 10 major areas of normal health care that they refuse to cover. That is fine, I thought I must have missed the fine print or something.
I returned to their website to read the marketing materials and details on their website you're supposed to read upon signing up. It is completely hiding the huge areas of medical care they do not cover and is just an extremely bare bones plan for the same price you would pay for a regular insurance policy that covers everything under ther "Affordable Care Act."
I was told that my ER visit would not be covered because the diagnosis was not ‘life threatening‘ even though massive panic attacks can masquerade as a heart attack.
Now I am left to pay THOUSANDS of dollars to the hospital and the ambulance company.
I cancelled with them today. I am a little worried because other consumer complained about not being able to cancel.
Below is a quote from another consumer about their issues:
‘I would like to warn prospective customers of Aliera Care or Aliera Health Care of all the major medical conditions and situations you'll be shocked to find Aliera Care will not pay for, even after you've been paying $400-$700 per month for years.
How can you have a health care plan and can't cancel it while they debit your bank account or credit card month after month???
This company and it's employees are criminals and should be locked up.
That's another unethical lie of Aliera Care. On the same website at alierahealthcare.com they say "you can easily cancel by phone or email" and it will be processed immediately.”
This company is a complete rip off and scam. They try to steal your money and masquerade as some type of religious group of people shearing healthcare expenses with all their members but then hide the fact that they cover little or nothing including most major medical emergencies that would wipe out your average family.
I called Aliera on the phone to get them to help me find a femal doctor that was close to where I live and they told me where one was and that she was in their net work and would accept Aliera Health care. My husband and I both made appointments with her and when we got there the clinic had never heard of Aliera and the clinic called to find out if it was accepted and was told that clinic was not in their net work. I called Aliera and they said that clinics are now changing their networks inclussions so if you make an appointment with a doctor today that is in Aliera's net work today by the time you get to that dotor's appointment that doctor may not still be in that net work. In the mean time we are paying 500 bucks a month in insurance premiums automatically out of our credit card each month because thats the only way they accept payment. Automatic.
They got over 5 thousand bucks out of us before we finally got around to actually going to the doctor and finding out that this health care plan is useless. We demanded they cancle our subscription but of course we are out the 5 grand they got out of us. They never paid for a single health care need of eithe of us and now we are back to having no health care coverage at all because we are told our income is over the amount to qulify for a Obama care tax credit so we have to pay full price for any insurance plan we get. The cheapest for my husband me was $1,500 bucks a month for one that did not even cover hardly any thing! So not only can we not afford to pay the $1,500 full price for a health care plan but we will be punished with a tax penalty because we don't have a plan. This Aliera so called "health care sharing" was the only thing that was affordable for us so we took it, hook, line, and sinker.
Part of it was our own fault for not going to the doctor as soon as we signed up then we would have seen sooner that it all just a big ripp off and we would have been out a few hundred bucks instead of thousands of dollars. If you are looking for health care plan stay away from Aliera and all other forms of any so called "health care sharing" plans. They are nothing but promisses dreams and fantasies. In the end they don't have enough doctors that work with them and seem to be loosing more and more of them because one day the doctor is in the net work and the next day he is not. And you won't find that out till you get to the doctor or worse..... until you get the bill.
I have been with Aliera Health Care for some time. My Dr. office said every time they send something to Aliera care, it is returned, as "incorrect address." This is the address on their documents they provide to members as well as participants like doctors, labs and hospitals in their network or plan. Apparently, due to their completely incompetent and disorganized management and employees who do not do their job i.e. "update their address for billing purposes as working health care organziation." Finally, I had to waste hours to solve this problem that went around in circles. First calling Aliera Care talking to people in customer service who were not trained nor had the resources or ability to do anything, but talk to you on the phone i.e. "maybe this or maybe that." They didn't know what to do. They didn't even have the basic information to provide me the lastest PO Box Aliera Care of Atlanta, GA is using to receive member bills and process them.
Finally, I had to give my doctor's office Aliera Care's phone number and they called them. The Dr office called me back and was told by Aliera they had changed p/o. Box's 2 times this year. Why would a business do this? Needless to say after the bills went many months late. No one at Aliera Care could be contacted except for the "call center people" who don't even know how Aliera Care works, how to troubleshoot and solve such a problem nor provide the contact information of someone I can contact to resolve this mess.
Finally, I had to pay a $537 doctors bill, plus $1,238 lab bill because the providers in their network had never been provided a working address for bill processing and I nor the doctor's office could ever be put through to a responsibile party or manager who could help.
Completely worthless after paying hundreds of dollars per months for 2 years or about $13,000 of my income over 2 years by a family who is just getting by and has a family to feed.
Everything their is so backwards and poorly run, I have to wonder if they're doing this on purpose in their quest to cut cuts and pay outs they have make for members health care bills.
Aliera Care should be shut down by the government.
I signed up with Aliera Care or Aliera Health Care in December of 2017. The information in their online and offline brochures grossly misrepresents what they cover and do not cover. There a huge gapping holes in what they do not cover.
I was perplexed that I had never seen these giant limitations of coverage and about 10 major areas of normal health care that they refuse to cover. That is fine, I thought I must have missed the fine print or something.
I returned to their website to read the marketing materials and details on their website you're supposed to read upon signing up. It is completely hiding the huge areas of medical care they do not cover and is just an extremely bare bones plan for the same price you would pay for a regular insurance policy that covers everything under ther "Affordable Care Act."
I even called to talk to a rep at their company acting as if I was a new customer seeking info before signing up. I was told to go to their "website all the details of what is covered and not is there" I was told. Knowing this is not true, I asked the person on the phone to tell me where and on what page of their online brochure and or marketing materials these extremely important details can be found. He was flustered and said, he never read the brochure and doesn't have any idea about what Aliera Care is or what is covered. He said works for any answering service and is neither sales, customer service or anything else.
He took down my information and told me "someone will call me back" who can provide these materials in writing for specifically what is covered and is not. I'm not referrring to the "maximum pay-outs or caps" on costs. Yes, that is there.
I would like to warn prospective customers of Aliera Care or Aliera Health Care of all the major medical conditions and situations you'll be shocked to find Aliera Care will not pay for, even after you've been paying $400-$700 per month for years.
I even called back again and tried to see if this was some scam again, thinking I must have just talked to some moron who was new to the company or something. I couldn't believe they hire a 3rd party answering service and never call anyone back.
Then again, I called and was told "all the details are in the website" which it is not.
Third, after calling and calling Aliera Care to their "benefits department" I ask about specific medical conditions and situations. Finally, after they "verify I'm already a paying member" tell me they don't cover much of anything. That I should use "Telemedicine" which I had tried.
The Telemedicine is nothing more than help if you have a running nose or a cold. The doctor cannot prescribe anything or help in any other way. Hey Aliera Care, I have never even physically went to the doctor for a runny nose or a cold. So the Telemedicine that you market is supposed to save me so much money in your slimmy and scam marketing practices is a complete waste of time.
Finally, after a year of use I called Aliera Care or Aliera Health Care. Guess what, still same answering service. They told me, "someone will call me back about cancelling." I called 2 more times over a week and was promised the same thing. No one ever called me back.
How can you have a health care plan and can't cancel it while they debit your bank account or credit card month after month???
This company and it's employees are criminals and should be locked up. Finally, I started emailing all the emails on thier website pleading for some help. After over a week, I got someone who said they would cancel it after I filled out a form.
That's another unethical lie of Aliera Care. On the same website at www.alierahealthcare.com they say "you can easily cancel by phone or email" and it will be processed immediately.
This company is a complete rip off and scam. They try to steal your money and mascarade as some type of religious people then hide the fact they cover little or nothing including major medical crisis that would wipe out an average family who even have a good income.
This is hands down the most corrupt company that I have ever delt with!!!! Everything that has been said about them on here is true! I cant even get a return phone call or email from them regarding my bills. They disconnet you, put you on hold or switch you to another person's( Director of Claims - Terry Moore) voicemail... but he wont answer or call back either. Now I have email documentation that they dont respond to either. They dont fall uder the Department of Insurance regulations, so you have no recourse, except in their arbitration/court system in Atlanta!!! Good Luck with that. They also claim that the benefits which you bought your plan under do not exsist, lol, which I have in writing and have provided to them!!!
DO NOT PARTICIPATE IN THIS PLAN.... unless you never paln to use it!!!!
NOW COMPLAINING TO THE BBB... WILL SEE IF IT GOES ANYWHERE
This company is a fraud. Horrible experience. They claim you have the benefit coverage yet refuse to pay the claims. Nothing good about them.
Total fraud and already are being sued by state of Texas and soon will be in trouble all over the country. I am starting a suit against them in atlanta!
Force to cancel my healthcare plan due to court order
I was with Aliera for two years. Last week, I received a notification forced me to cancel my healthcare otherwise it will be automatically canceled on Nov 18, 2019. I am waiting for my refund
That means there will be a gap on my healthcare plan from 11/18/19 until a new plan will be picked up on 12/01/19. What am I going to do if there's something happen to my family in that gap? Who will get the responsibility to my family? I am starting to lose Faith to any organizations which using Christian name on it.
Aliera Healthcare is a total SCAM. They don't even deserve 1 star. You are paying a company who claim will share your healthcare costs but in reality you have no coverage and get incorrect information from Aliera that will alternatively cost you. My family has used Aliera 3x and all 3 claims have been denied (reasons below). I am surprised there is no class action lawsuit against them. I have submitted an appeals letter for 2 denied claims and will soon appeal the 3rd denied claim for an ER visit - just waiting to get the bill before I can appeal. My appeals are currently being reviewed by Aliera (They received my appeal on 3/28/19 by certified mail). If my pending medical bills are not adjusted by Aliera I will be seeking legal consult.
Reason for Appeals: One of my considerations to switch to Aliera Healthcare was based on the condition that my daughter’s pediatrician was within network. Both myself and my Insurance Broker found the Pediatrician's Name and Foundation on Aliera's Portal prior to registration. My Broker called Aliera to confirm participating provider and I called Sutter to confirm eligibility. Sutter and Aliera accepted my insurance/provider choice. I scheduled an annual wellness checkup for my daughter (4 years old) which, should be covered 100% per my Premium Plan. Approx. 30 days later I get a bill stating provider is out of Network and bill is patients full responsibility. End of 2018 I contact Aliera Concierge and ask them to send me a list of providers so I can establish a new Pediatrician. Aliera Concierge emails me a list of provider and again my daughters Pediatrician that I was billed for as out of network was on the provider list. I called Aliera and Customer Service advised me to call the Alliera Appointment Center for confirmation. I call the appointment center, explain my past experience, and she pulled up my daughters pediatrician info and confirmed she was an accepted provider under my plan and that I should go see her and she will make the proper notes to claims to avoid reoccurance. Early in 2019 my daughter has her annual wellness check and approx. 30 days later I get a bill stating out of network and full payment is patients responsibility. Furious, I call Aliera Claims Dept. and get hung up on, placed on hold for over an hour at a time and after several consecutive days of trying to reach someone I speak to a manager who confirmed she sees the pediatrician on their portal but the bill was coded incorrectly. I asked why this is my issue and why claims isn't addressing this wth Sutter and the only response I received was that I had to appeal. It's now April 2019 and I'm still trying to get this resolved - pending results from my appeals. I, my Broker, Aliera Website, Aliera Concierge and Aliera Appointment Center and Dr. office all confirmed my daughters Pediatrician was a participating provider. If I can't use these resources to determine my healthcare what am I supposed to use?? I've exhausted all tools available to me by Aliera. I lose sleep thinking what if something medically serious happened to my family. I also worry about others that have Aliera and experience a true health complication or emergency.
My ER pending bill is approx. $3,600. I was billed $300 at the ER for my deductible per my medical card. However, apparently this is also not covered because it wasn't life threatening. I asked Aliera Claims who determines if a claim is life threatening and apparently its a private panel that represents Aliera. Well, if their child wakes up at 12:00am and has a fever of 104 degrees and is complaining they're unable to breathe well and is swollen and pale in the face I hope they wouldn't wait until normal business hours to take their child in. To me that's life threatening enough to not chance negligence by not taking her in. Test results confirmed she had severe case of Influenza which according to the CDC as of January 2019 California alone has reported 42 deaths linked to influenza. I'd say that's life threatening!
PLEASE SPEND MORE MONEY ON REAL INSURANCE. PROTECT YOURSELF, YOUR FAMILY IN THE EVENT SOMEONE DOES GET SICK OR INJURED.
Aliera got over 5 grand in monthly premiums out of my husband and me before we went to the primary care doctor that Aliera promised was in their net work only to find out the doctor was not in the net work.
Seems the way it works is the doctor you make an appointment with might be in the network today but by the time you go in for your appointment that doctor no longer is and unless you make sure of that before you go in you might not find out until you receive the huge doctor and lab bill that Aliera does not pay. I called Aliera to cancel our enrollment and they promised to send me a verification that we canceled to my email address but that never came. I had to just block them from automatically taking any more premiums out of our credit card.
It says right on the "insurance" verification card they give you that "this is NOT health insurance". Well they sure did not lie about that. DO NOT GIVE ONE DIME OF YOUR MONEY TO THIS SCAMMING COMPANY. Now we are back to where we were before. With out any health care coverage at all.
Because of what happened with Aliera my husband refuses to give any more money to any other health insurance alternative company and since the regular companies like Kiser and Blue Cross are way to expensive, and we don't qualify for the Obama care tax credit to help pay the primiums, health coverage continues to be out of our reach and we are forced to pray we don't get sick and just try to make it to the age of medicare. And on top of that we are forced to pay a penalty on our taxes for not having coverage because we don't qualify for the tax credit for the premiums. Worse off than before Obama care. Still with out but now punished for being with out.
Terrible company. They claimed my daughter's doctor was in our network, we went and then the doctor said they were not in network. It has taken 12 months for Aliera Health Care claims department to process this claim and it is still not settled. They also made us call Aliera to make doctor appointments instead of calling the doctor ourselves and then Aliera never called back. This company should be out of business. I feel like they just take your premiums and then do not deliver any service. I canceled as soon as possible.
We had to pay the doctor’s bills, expensive tests like MRIs and bloodwork or be sent to collections and have our family’s good credit ruined. I could never get a hold or anyone by phone. Apparently the people who keep failing to process and pay their share of the member costs are too important to ever be contacted by your doctor, your hospital or by patients like myself who has been paying over $600 per month for my family for years.
Aliera Care suggests before you make any doctor’s appointment or do any type of basic medical service (that your medical doctor and/or specialist recommends) that you call and verify eligibility. Well, I called and verified eligibility, my doctor’s office called and verified eligibility and the lab company called and verified eligibility.
I feel like they reduced me to some sort of welfare recipient trying to get free benefits or something. I work full time, overtime, have a family with kids, etc. Yet, they expect me to be on the phone trying to get the Aliera Care employees in billing to do their jobs. They expect me to remind Aliera Health Care of Atlanta, Georgia that they created a legal contract to pay their part of the medical expenses.
It seems they under staff, do not hire or train employees and purposefully disorganized their offices in an effort not to pay or dramatically reduce the amount of member health share costs they must pay out.
I have no doubt it works. Eventually, the member has to pay or be sent to a collection agency and get their credit ruined. Poor credit doesn’t only prevent you from getting a mortgage, it increases the cost of your insurance premiums on a home, car insurance, increases the cost financing things like an auto loan and employers often check your credit for getting a job.
Aliera Health Care should be ashamed of themselves, especially since part of their deceptive and misleading sales and marketing scheme. I see nothing moral about taking money from hardworking families and providing such a poorly run office bills are always paid months late and sometimes not at all!
I’ll note this is 100% true because it happened to me one more than 2 occasions and many other Aliera Health Care members too. Aliera of Atlanta GA is certainly the “a false sense of security.”
Imagine if you had a real medical emergency like your child in a car accident or you get cancer and have to deal with these goons! --- I think the games and resistance to paying their agreed “shared” part of the medical bills would grow dramatically. If they take months to pay a simple doctor bill or not pay at all, you can imagine you’d have to hire an attorney to get your coverage you paid into. Then Aliera Care could say, “We do not promise or guarantee we will pay any of your medical costs.”
Joke is on you if you this “joke of a health care plan” which amounts to NOTHING, but a fake plan you have to waste dozens of hours each year doing the job of the Aliera employees and manager who sit and do nothing all day, but waste time shuffling papers around, but nothing to help paid customers.
We live in n.y. l.i. a friend gave us this number heard they were cheaper then the 1,300 we were paying for the 2 of us ,my husband called and spoke withKevin Dicutti @561-367-2445 he told my husband his Daughter even had this plan so we bought it .
We put it on auto pay ,Iwent to my doctors for my meds i take every month 3 times in all visits my husband went for a cold 1 time ,we were getting calls from the doctors office stateing they never received payment .
I called Aliera and they said they were reviewing it this went on for months here we are now a year later and nothing was payed ,we are in collection.
Intentionally falsifying their PHCS provider directory network to deceive me and the public at large into signing up for their healthcare coverage.
Overview:
Aliera is listing providers in their PHCS provider directory that have never been a provider. Providers listed have never had an agreement or contract with Aliera Healthcare to provide services to enrollees (Members) of Aliera. Even after repeated communications of this fact, they continue to list these same providers. They also have a scheme of listing Providers Names (i.e. Jackson Hospital and Clinic) as in- network but with a wrong NPI#. I believe this is intentional. In my case, this allowed them to list a major hospital in their provider directory to attract new members. All is well until it comes time to apply for a prior-authorization or seek reimbursement of claims. Then they then claim the wrong NPI# was assigned to Jackson Hospital and Clinic in their PHCS directory and therefore coverage is denied. They will point to the disclaimers on the PHCS provider network. However, their disclaimers are intentionally misleading as will be outlined below.
I encountered multiple problems with Aliera Healthcare in approving Jackson Hospital and Clinic for a simple biopsy. At first, they approved verbally to me over the phone on 7/15/19. Then, when Jackson Hospital called them on 7/16 to confirm coverage, several days after Leslie at Jackson faxed the prior authorization form, Derik at Aliera read back an incorrect NPI# than what Leslie put on the prior authorization form she faxed to Aliera. Since that NPI # was for Montgomery Anesthesia and not Jackson Hospital and Clinic, it was finally confirmed that Jackson was NOT in network.
Once Leslie at Jackson confirmed with Derik at Aliera that Jackson Hospital and Clinic was NOT a in- network provider, Aliera never even contacted me to let me know. They didn’t even call me, a Member and tell me the prior authorization they gave me was now not valid.
After realizing their PHCS provider directory was unreliable, I asked Kathleen, Compliance Manager for Aliera Healthcare to email me a list of approved Drs.’s in Montgomery that treat breast cancer. She didn’t send me the list the next day as I was promised. Two days later we received the biopsy results of mammary carcinoma. I now had no time to waste. I contacted her alerting her to the diagnosis and told her I needed a list from her with in-network providers.
Soon thereafter on 7/19/19 I received the attached list of Radiology Oncologist Kathleen sent me as all approved by Aliera Healthcare as in-network for the Montgomery, AL area. (See attached “Aliera sent this list of Radiology Oncologist”) I contacted all the Radiology Oncologist on the list. I spoke with the insurance and billing specialist who actually file the insurance claims with all the providers.
NOT A SINGLE ONE has heard of Aliera Healthcare or Trinity HealthShare. Not a single one.
None have filed an insurance claim with Aliera Healthcare or Trinity HealthShare. Not a single one.
So, the list that Kathleen told me she personally called to verify was not accurate. This list she sent to me never heard of Aliera Healthcare or Trinity Healthshare and had never sent them a claim or received a payment from them. They even checked their own internal records of all providers of insurance and they were not even listed in their directory.
Just out of curiosity, this morning 8/2/19, I checked their MultiPlan PHCS provider directory to see if Jackson Hospital and Clinic was still listed as a provider and even checked the NPI#. You guessed it. Jackson Surgery Center is still listed as a provider as of this morning, 2 1⁄2 weeks since they told me Jackson Hospital and Clinic in NOT in-network! (See attached screen shot “Jackson still showing in Aliera MultiPlan PPO network 5”)
I even checked the NPI# Aliera has on their PHCS provider directory. The correct NPI# for Jackson Hospital and Clinic is NPI# 1043262488. The NPI# Aliera has listed in their directory for Jackson is NPI# 1043281553. That NPI # belongs to Montgomery Anesthesia Associates. (See attached screen shot
“Montgomery Anesthesia Associates NPI”).
Timeline of communications;
1. 7/12/19 – Leslie at Jackson Hospital faxes Prior-Authorization form to Aliera Healthcare.
2. 7/15/19 - Aliera (Demetric with the Prior-Authorization Dept) approved the procedure verbally over the phone to me.
3. 7/16/19 Leslie, who handles pre-authorizations with Jackson Surgery, called Aliera Healthcare to follow up since she hadn't received a confirmation back. She spoke with Derik. He gave her a verbal approval but with a different NPI #. Turns out that NPI # is for "Montgomery Anesthesia Associates" who works IN THE Jackson Hospital and Clinic, Inc. but are not PART OF Jackson Hospital. She told them they read back a different NPI # than was on the fax she sent them. So, they had Jacksonville Hospital and Clinic, Inc. listed using Montgomery Anesthesia Associates NPI #. So, Jackson Hospital and Clinic, Inc. is NOT in- network and the procedure WILL NOT be covered! He even told her to just go ahead and use the NPI# for Montgomery Anesthesia Associates! She refused!
Aliera Healthcare DID NOT contact me at all to let me know that they reversed their decision and refused Jackson Hospital and Clinic as a provider. They DID NOT offer an alternative provider for the surgery once they learned they had the wrong NPI# in their system. That was their claim why Jackson Hospital was listed as an in-network provider.
Leslie, pre-authorization administrator at Jackson Hospital, in order to assist me in finding an in-network provider, asked Derik with Aliera Healthcare what other facilities in the area are in-network. She stated he said, "they don't know what other facilities are in the area that do the test we are looking for".
What? In their Member Guide "under PPO Network it states "With a growing nationwide PPO network of more than 1,000,000 healthcare professionals and more than 6,000 facilities. Multiplan PHCS network offers Plan Members a range of quality choices to help them stay healthy".
4. 7/17/19 – Talked with Jen in Claims Department. Told her about the issue I had with getting a prior authorization and the fact Jackson Hospital and Clinic is listed as in-network but actually turned out not to be an approved provider. I asked her who is actually approved in Montgomery or near Montgomery for breast surgery, radiation and chemotherapy. That is what I needed.
Keep in mind, Aliera doesn’t have out of network coverage so if we go to a provider listed on their network and later discover that the provider is not in-network (even if it is Aliera’s fault) Aliera will not pay the claims! She said when she did a search that Jackson Hospital and Clinic is approved. I told her someone at Aliera needs to get on this quick and fix the directory now. I along with other Members and Aliera Member Services is using the PHCS provider network as the basis of in-network providers and it was just confirmed that Jackson Hospital and Clinic is not an approved in-network provider. All claims submitted for services at Jackson will not be approved.
5. 7/17/19 - I was contacted by Kathleen, Compliance Manager for Aliera Healthcare because she saw my reviews on Yelp.com. I told her Jackson Hospital and Clinic was still showing on their provider network. I told her this should immediately be removed as this is very misleading. People searching for Healthshare as an alternative would see Jackson Hospital and Clinic and purchase their coverage not knowing, until they needed hospitalization, that Jackson Hospital and Clinic were not ever an approved in network provider. Keeping this hospital listed is very deceptive.
I asked her a very simple question. Who is in your network? I needed to know in the event my wife’s biopsy that was scheduled for the next day at Jackson Hospital and Clinic turned out to be malignant. She couldn’t give me the list of approved providers during that call. That was very disturbing. She said she would research and email me a list by the close of business the next day.
6. 7/19/19 – Jackson Hospital called to tell us the biopsy determined the mass was mammary carcinoma. I called Kathleen as now I had to move fast. It had now been two days and I didn’t get the list of in-network providers by COB 7/18/19 for Montgomery, Al as she promised. She told me she would be personally calling all the in-network providers in the Montgomery area to make sure they are accepting Aliera and are in-network. During that call I reminded her of the error in listing Jackson Hospital and Clinic on their provider network. She told me she would pass that along to have the PHCS Directory updated. Soon thereafter on 7/19/19 I received the attached list of Radiology Oncologist Kathleen sent me as all approved by Aliera Healthcare as in-network for the Montgomery, AL area.
7. 7/22/19 - I called and talked with Astrid with Member services. I told her that Jackson Hospital and Clinic is still showing as in-network and we had already established that this hospital in not in-network.
During that call, I had this exchange with Astrid. I told her about the list Katherine sent me of Dr.’s in Montgomery on 7/19/19. I specifically stated, “but you guys would have a contract with them obviously if they are in your network”. She said “yes, we do have a contract with them but a lot of times its where they can be in network last month and then decide this month today that they don’t want to be in network. And we don’t have anything to do with that. So, the only thing we can do is call them, confirm that they are in network, and if they are you just make an appointment. If not, you just go down the list and find the one that is in network and make an
appointment. But the ones were giving you they are saying they have signed a contract with PHCS telling us and PHCS that they are in network”.
So today, 8/2/19, it’s 2 1⁄2 weeks and Jackson Surgery Center and Jackson Hospital and Clinic is still listed on their provider directory and are NOT an in-network provider. (See attached screen shot “Jackson still showing in Aliera MultiPlan PPO network 5”)
I started coverage with Aliera Healthcare effective 12/1/18. That decision was based on a belief this company was not fraudulent in their representations made on their PHCS provider directory. That decision was based on the claims made in their Member Guide under PPO Network it states
“With a growing nationwide PPO network of more than 1,000,000 healthcare professionals and more than 6,000 facilities. Multiplan PHCS network offers Plan Members a range of quality choices to help them stay healthy".
This claim is blatantly false. This is fraud and Aliera Healthcare has used this to attract new Members in a Ponzi type scheme. If it was only a scam to bilk Members out of their monthly premiums that wouldn’t be as bad. The worst part is when Members need Aliera for the services we contracted for, that’s when we discover the scam and it’s too late. It’s too late to sign up for a legitimate healthshare ministry because they all have pre-existing condition clauses. Yes, this is the most unethical fraud ever perpetrated on the public.
In this case, the PHCS Providers they claim are not in network. In my case, they don’t have anyone in network in Montgomery. No one!
Imagine all the people who right now may be searching for a health share provider in central Alabama and have no idea Jackson Hospital and Clinic and Jackson Surgery Center is not an approved in- network provider yet find them on the Directory. What about people all over the US who did not conduct due diligence on Aliera Healthcare and discover the reviews on the Better Business Bureau. These people, like myself, signed up for their plans not realizing their directory network is full of providers that not only don’t have a contract, never had a contract and never even heard of Aliera Healthcare.
Aliera Healthcare will argue “but there are two pop-up messages alerting everyone with these messages”.
1. “We work hard to ensure our data is accurate, but provider information changes frequently”. (See attached screen shot “Alier Healthcare Jackson Hospital page 1 provider listing”)
2. “Provider information contained in this Directory was last updated earlier today and therefore may have changed”. (See attached screen shots “Alier Healthcare Jackson Hospital page 2 provider listing”)
Yes, however, I believe it will be proven at some point down the line in a civil or criminal trial that Aliera Healthcare never had a contract to provide in-network services with most of these providers listed. So, the ruse is, consumers look at this directory during their sign-up process if at all.
Everyone understands the in-network/out of network issue can change. But Aliera Healthcare is making the claim that they actually had a contract with them at one point.
Aliera Healthcare Reviews
Before signing upl, I got a brochure stating what they do not cover, and ophthalmology was not listed. Paid all premiums on time. Three months later I needed to see an ophthalmologist. Aliera said I first needed a referral from my PCP, but they still helped me find in-network ophthalmologists. My PCP diagnosed me with Graves disease and referred me to an endocrinologist and an ophthalmologist, but Aliera now tells me that ophthalmology is not a specialty that’s covered. I need orbital decompression eye surgery, and Aliera won’t pay. There is nothing Christian about this company; they are scam artists who belong in jail.
i signed up with Aliera Care or Aliera Health Care in October of 2017 thru a recommendation from Covered California and The ACA. The information in their online and offline brochures grossly misrepresents what they cover and do not cover. There are huge gapping holes in what they do not cover.
I was perplexed that I had never seen these giant limitations of coverage and about 10 major areas of normal health care that they refuse to cover. That is fine, I thought I must have missed the fine print or something.
I returned to their website to read the marketing materials and details on their website you're supposed to read upon signing up. It is completely hiding the huge areas of medical care they do not cover and is just an extremely bare bones plan for the same price you would pay for a regular insurance policy that covers everything under ther "Affordable Care Act."
I was told that my ER visit would not be covered because the diagnosis was not ‘life threatening‘ even though massive panic attacks can masquerade as a heart attack.
Now I am left to pay THOUSANDS of dollars to the hospital and the ambulance company.
I cancelled with them today. I am a little worried because other consumer complained about not being able to cancel.
Below is a quote from another consumer about their issues:
‘I would like to warn prospective customers of Aliera Care or Aliera Health Care of all the major medical conditions and situations you'll be shocked to find Aliera Care will not pay for, even after you've been paying $400-$700 per month for years.
How can you have a health care plan and can't cancel it while they debit your bank account or credit card month after month???
This company and it's employees are criminals and should be locked up.
That's another unethical lie of Aliera Care. On the same website at alierahealthcare.com they say "you can easily cancel by phone or email" and it will be processed immediately.”
This company is a complete rip off and scam. They try to steal your money and masquerade as some type of religious group of people shearing healthcare expenses with all their members but then hide the fact that they cover little or nothing including most major medical emergencies that would wipe out your average family.
This is a shameful organization!
I called Aliera on the phone to get them to help me find a femal doctor that was close to where I live and they told me where one was and that she was in their net work and would accept Aliera Health care. My husband and I both made appointments with her and when we got there the clinic had never heard of Aliera and the clinic called to find out if it was accepted and was told that clinic was not in their net work. I called Aliera and they said that clinics are now changing their networks inclussions so if you make an appointment with a doctor today that is in Aliera's net work today by the time you get to that dotor's appointment that doctor may not still be in that net work. In the mean time we are paying 500 bucks a month in insurance premiums automatically out of our credit card each month because thats the only way they accept payment. Automatic.
They got over 5 thousand bucks out of us before we finally got around to actually going to the doctor and finding out that this health care plan is useless. We demanded they cancle our subscription but of course we are out the 5 grand they got out of us. They never paid for a single health care need of eithe of us and now we are back to having no health care coverage at all because we are told our income is over the amount to qulify for a Obama care tax credit so we have to pay full price for any insurance plan we get. The cheapest for my husband me was $1,500 bucks a month for one that did not even cover hardly any thing! So not only can we not afford to pay the $1,500 full price for a health care plan but we will be punished with a tax penalty because we don't have a plan. This Aliera so called "health care sharing" was the only thing that was affordable for us so we took it, hook, line, and sinker.
Part of it was our own fault for not going to the doctor as soon as we signed up then we would have seen sooner that it all just a big ripp off and we would have been out a few hundred bucks instead of thousands of dollars. If you are looking for health care plan stay away from Aliera and all other forms of any so called "health care sharing" plans. They are nothing but promisses dreams and fantasies. In the end they don't have enough doctors that work with them and seem to be loosing more and more of them because one day the doctor is in the net work and the next day he is not. And you won't find that out till you get to the doctor or worse..... until you get the bill.
I have been with Aliera Health Care for some time. My Dr. office said every time they send something to Aliera care, it is returned, as "incorrect address." This is the address on their documents they provide to members as well as participants like doctors, labs and hospitals in their network or plan. Apparently, due to their completely incompetent and disorganized management and employees who do not do their job i.e. "update their address for billing purposes as working health care organziation." Finally, I had to waste hours to solve this problem that went around in circles. First calling Aliera Care talking to people in customer service who were not trained nor had the resources or ability to do anything, but talk to you on the phone i.e. "maybe this or maybe that." They didn't know what to do. They didn't even have the basic information to provide me the lastest PO Box Aliera Care of Atlanta, GA is using to receive member bills and process them.
Finally, I had to give my doctor's office Aliera Care's phone number and they called them. The Dr office called me back and was told by Aliera they had changed p/o. Box's 2 times this year. Why would a business do this? Needless to say after the bills went many months late. No one at Aliera Care could be contacted except for the "call center people" who don't even know how Aliera Care works, how to troubleshoot and solve such a problem nor provide the contact information of someone I can contact to resolve this mess.
Finally, I had to pay a $537 doctors bill, plus $1,238 lab bill because the providers in their network had never been provided a working address for bill processing and I nor the doctor's office could ever be put through to a responsibile party or manager who could help.
Completely worthless after paying hundreds of dollars per months for 2 years or about $13,000 of my income over 2 years by a family who is just getting by and has a family to feed.
Everything their is so backwards and poorly run, I have to wonder if they're doing this on purpose in their quest to cut cuts and pay outs they have make for members health care bills.
Aliera Care should be shut down by the government.
I signed up with Aliera Care or Aliera Health Care in December of 2017. The information in their online and offline brochures grossly misrepresents what they cover and do not cover. There a huge gapping holes in what they do not cover.
I was perplexed that I had never seen these giant limitations of coverage and about 10 major areas of normal health care that they refuse to cover. That is fine, I thought I must have missed the fine print or something.
I returned to their website to read the marketing materials and details on their website you're supposed to read upon signing up. It is completely hiding the huge areas of medical care they do not cover and is just an extremely bare bones plan for the same price you would pay for a regular insurance policy that covers everything under ther "Affordable Care Act."
I even called to talk to a rep at their company acting as if I was a new customer seeking info before signing up. I was told to go to their "website all the details of what is covered and not is there" I was told. Knowing this is not true, I asked the person on the phone to tell me where and on what page of their online brochure and or marketing materials these extremely important details can be found. He was flustered and said, he never read the brochure and doesn't have any idea about what Aliera Care is or what is covered. He said works for any answering service and is neither sales, customer service or anything else.
He took down my information and told me "someone will call me back" who can provide these materials in writing for specifically what is covered and is not. I'm not referrring to the "maximum pay-outs or caps" on costs. Yes, that is there.
I would like to warn prospective customers of Aliera Care or Aliera Health Care of all the major medical conditions and situations you'll be shocked to find Aliera Care will not pay for, even after you've been paying $400-$700 per month for years.
I even called back again and tried to see if this was some scam again, thinking I must have just talked to some moron who was new to the company or something. I couldn't believe they hire a 3rd party answering service and never call anyone back.
Then again, I called and was told "all the details are in the website" which it is not.
Third, after calling and calling Aliera Care to their "benefits department" I ask about specific medical conditions and situations. Finally, after they "verify I'm already a paying member" tell me they don't cover much of anything. That I should use "Telemedicine" which I had tried.
The Telemedicine is nothing more than help if you have a running nose or a cold. The doctor cannot prescribe anything or help in any other way. Hey Aliera Care, I have never even physically went to the doctor for a runny nose or a cold. So the Telemedicine that you market is supposed to save me so much money in your slimmy and scam marketing practices is a complete waste of time.
Finally, after a year of use I called Aliera Care or Aliera Health Care. Guess what, still same answering service. They told me, "someone will call me back about cancelling." I called 2 more times over a week and was promised the same thing. No one ever called me back.
How can you have a health care plan and can't cancel it while they debit your bank account or credit card month after month???
This company and it's employees are criminals and should be locked up. Finally, I started emailing all the emails on thier website pleading for some help. After over a week, I got someone who said they would cancel it after I filled out a form.
That's another unethical lie of Aliera Care. On the same website at www.alierahealthcare.com they say "you can easily cancel by phone or email" and it will be processed immediately.
This company is a complete rip off and scam. They try to steal your money and mascarade as some type of religious people then hide the fact they cover little or nothing including major medical crisis that would wipe out an average family who even have a good income.
This is hands down the most corrupt company that I have ever delt with!!!! Everything that has been said about them on here is true! I cant even get a return phone call or email from them regarding my bills. They disconnet you, put you on hold or switch you to another person's( Director of Claims - Terry Moore) voicemail... but he wont answer or call back either. Now I have email documentation that they dont respond to either. They dont fall uder the Department of Insurance regulations, so you have no recourse, except in their arbitration/court system in Atlanta!!! Good Luck with that. They also claim that the benefits which you bought your plan under do not exsist, lol, which I have in writing and have provided to them!!!
DO NOT PARTICIPATE IN THIS PLAN.... unless you never paln to use it!!!!
NOW COMPLAINING TO THE BBB... WILL SEE IF IT GOES ANYWHERE
This company is a fraud. Horrible experience. They claim you have the benefit coverage yet refuse to pay the claims. Nothing good about them.
Total fraud and already are being sued by state of Texas and soon will be in trouble all over the country. I am starting a suit against them in atlanta!
Force to cancel my healthcare plan due to court order
I was with Aliera for two years. Last week, I received a notification forced me to cancel my healthcare otherwise it will be automatically canceled on Nov 18, 2019. I am waiting for my refund
That means there will be a gap on my healthcare plan from 11/18/19 until a new plan will be picked up on 12/01/19. What am I going to do if there's something happen to my family in that gap? Who will get the responsibility to my family? I am starting to lose Faith to any organizations which using Christian name on it.
Aliera is a SCAM - Please Read!!
I KNOW THIS IS LONG BUT PLEASE READ!!!
Aliera Healthcare is a total SCAM. They don't even deserve 1 star. You are paying a company who claim will share your healthcare costs but in reality you have no coverage and get incorrect information from Aliera that will alternatively cost you. My family has used Aliera 3x and all 3 claims have been denied (reasons below). I am surprised there is no class action lawsuit against them. I have submitted an appeals letter for 2 denied claims and will soon appeal the 3rd denied claim for an ER visit - just waiting to get the bill before I can appeal. My appeals are currently being reviewed by Aliera (They received my appeal on 3/28/19 by certified mail). If my pending medical bills are not adjusted by Aliera I will be seeking legal consult.
Reason for Appeals: One of my considerations to switch to Aliera Healthcare was based on the condition that my daughter’s pediatrician was within network. Both myself and my Insurance Broker found the Pediatrician's Name and Foundation on Aliera's Portal prior to registration. My Broker called Aliera to confirm participating provider and I called Sutter to confirm eligibility. Sutter and Aliera accepted my insurance/provider choice. I scheduled an annual wellness checkup for my daughter (4 years old) which, should be covered 100% per my Premium Plan. Approx. 30 days later I get a bill stating provider is out of Network and bill is patients full responsibility. End of 2018 I contact Aliera Concierge and ask them to send me a list of providers so I can establish a new Pediatrician. Aliera Concierge emails me a list of provider and again my daughters Pediatrician that I was billed for as out of network was on the provider list. I called Aliera and Customer Service advised me to call the Alliera Appointment Center for confirmation. I call the appointment center, explain my past experience, and she pulled up my daughters pediatrician info and confirmed she was an accepted provider under my plan and that I should go see her and she will make the proper notes to claims to avoid reoccurance. Early in 2019 my daughter has her annual wellness check and approx. 30 days later I get a bill stating out of network and full payment is patients responsibility. Furious, I call Aliera Claims Dept. and get hung up on, placed on hold for over an hour at a time and after several consecutive days of trying to reach someone I speak to a manager who confirmed she sees the pediatrician on their portal but the bill was coded incorrectly. I asked why this is my issue and why claims isn't addressing this wth Sutter and the only response I received was that I had to appeal. It's now April 2019 and I'm still trying to get this resolved - pending results from my appeals. I, my Broker, Aliera Website, Aliera Concierge and Aliera Appointment Center and Dr. office all confirmed my daughters Pediatrician was a participating provider. If I can't use these resources to determine my healthcare what am I supposed to use?? I've exhausted all tools available to me by Aliera. I lose sleep thinking what if something medically serious happened to my family. I also worry about others that have Aliera and experience a true health complication or emergency.
My ER pending bill is approx. $3,600. I was billed $300 at the ER for my deductible per my medical card. However, apparently this is also not covered because it wasn't life threatening. I asked Aliera Claims who determines if a claim is life threatening and apparently its a private panel that represents Aliera. Well, if their child wakes up at 12:00am and has a fever of 104 degrees and is complaining they're unable to breathe well and is swollen and pale in the face I hope they wouldn't wait until normal business hours to take their child in. To me that's life threatening enough to not chance negligence by not taking her in. Test results confirmed she had severe case of Influenza which according to the CDC as of January 2019 California alone has reported 42 deaths linked to influenza. I'd say that's life threatening!
PLEASE SPEND MORE MONEY ON REAL INSURANCE. PROTECT YOURSELF, YOUR FAMILY IN THE EVENT SOMEONE DOES GET SICK OR INJURED.
DO NOT BUY ALIERA AS INSURANCE!!!
Very simple, DO NOT EVER GET ANY TYPE OF COVERAGE FROM THIS COMPANY! THIS IS A SCAM PLAIN AND SIMPLE!
Aliera is a scam
Aliera got over 5 grand in monthly premiums out of my husband and me before we went to the primary care doctor that Aliera promised was in their net work only to find out the doctor was not in the net work.
Seems the way it works is the doctor you make an appointment with might be in the network today but by the time you go in for your appointment that doctor no longer is and unless you make sure of that before you go in you might not find out until you receive the huge doctor and lab bill that Aliera does not pay. I called Aliera to cancel our enrollment and they promised to send me a verification that we canceled to my email address but that never came. I had to just block them from automatically taking any more premiums out of our credit card.
It says right on the "insurance" verification card they give you that "this is NOT health insurance". Well they sure did not lie about that. DO NOT GIVE ONE DIME OF YOUR MONEY TO THIS SCAMMING COMPANY. Now we are back to where we were before. With out any health care coverage at all.
Because of what happened with Aliera my husband refuses to give any more money to any other health insurance alternative company and since the regular companies like Kiser and Blue Cross are way to expensive, and we don't qualify for the Obama care tax credit to help pay the primiums, health coverage continues to be out of our reach and we are forced to pray we don't get sick and just try to make it to the age of medicare. And on top of that we are forced to pay a penalty on our taxes for not having coverage because we don't qualify for the tax credit for the premiums. Worse off than before Obama care. Still with out but now punished for being with out.
Terrible company. They claimed my daughter's doctor was in our network, we went and then the doctor said they were not in network. It has taken 12 months for Aliera Health Care claims department to process this claim and it is still not settled. They also made us call Aliera to make doctor appointments instead of calling the doctor ourselves and then Aliera never called back. This company should be out of business. I feel like they just take your premiums and then do not deliver any service. I canceled as soon as possible.
We had to pay the doctor’s bills, expensive tests like MRIs and bloodwork or be sent to collections and have our family’s good credit ruined. I could never get a hold or anyone by phone. Apparently the people who keep failing to process and pay their share of the member costs are too important to ever be contacted by your doctor, your hospital or by patients like myself who has been paying over $600 per month for my family for years.
Aliera Care suggests before you make any doctor’s appointment or do any type of basic medical service (that your medical doctor and/or specialist recommends) that you call and verify eligibility. Well, I called and verified eligibility, my doctor’s office called and verified eligibility and the lab company called and verified eligibility.
I feel like they reduced me to some sort of welfare recipient trying to get free benefits or something. I work full time, overtime, have a family with kids, etc. Yet, they expect me to be on the phone trying to get the Aliera Care employees in billing to do their jobs. They expect me to remind Aliera Health Care of Atlanta, Georgia that they created a legal contract to pay their part of the medical expenses.
It seems they under staff, do not hire or train employees and purposefully disorganized their offices in an effort not to pay or dramatically reduce the amount of member health share costs they must pay out.
I have no doubt it works. Eventually, the member has to pay or be sent to a collection agency and get their credit ruined. Poor credit doesn’t only prevent you from getting a mortgage, it increases the cost of your insurance premiums on a home, car insurance, increases the cost financing things like an auto loan and employers often check your credit for getting a job.
Aliera Health Care should be ashamed of themselves, especially since part of their deceptive and misleading sales and marketing scheme. I see nothing moral about taking money from hardworking families and providing such a poorly run office bills are always paid months late and sometimes not at all!
I’ll note this is 100% true because it happened to me one more than 2 occasions and many other Aliera Health Care members too. Aliera of Atlanta GA is certainly the “a false sense of security.”
Imagine if you had a real medical emergency like your child in a car accident or you get cancer and have to deal with these goons! --- I think the games and resistance to paying their agreed “shared” part of the medical bills would grow dramatically. If they take months to pay a simple doctor bill or not pay at all, you can imagine you’d have to hire an attorney to get your coverage you paid into. Then Aliera Care could say, “We do not promise or guarantee we will pay any of your medical costs.”
Joke is on you if you this “joke of a health care plan” which amounts to NOTHING, but a fake plan you have to waste dozens of hours each year doing the job of the Aliera employees and manager who sit and do nothing all day, but waste time shuffling papers around, but nothing to help paid customers.
We live in n.y. l.i. a friend gave us this number heard they were cheaper then the 1,300 we were paying for the 2 of us ,my husband called and spoke withKevin Dicutti @561-367-2445 he told my husband his Daughter even had this plan so we bought it .
We put it on auto pay ,Iwent to my doctors for my meds i take every month 3 times in all visits my husband went for a cold 1 time ,we were getting calls from the doctors office stateing they never received payment .
I called Aliera and they said they were reviewing it this went on for months here we are now a year later and nothing was payed ,we are in collection.
Aliera Healthcare & Trinity Healthshare is a SCAM
Aliera Healthcare (aka Aliera Companies, Trinity HealthShare, MultiPlan, FirstCall Telemedicine)
Complaint:
Intentionally falsifying their PHCS provider directory network to deceive me and the public at large into signing up for their healthcare coverage.
Overview:
Aliera is listing providers in their PHCS provider directory that have never been a provider. Providers listed have never had an agreement or contract with Aliera Healthcare to provide services to enrollees (Members) of Aliera. Even after repeated communications of this fact, they continue to list these same providers. They also have a scheme of listing Providers Names (i.e. Jackson Hospital and Clinic) as in- network but with a wrong NPI#. I believe this is intentional. In my case, this allowed them to list a major hospital in their provider directory to attract new members. All is well until it comes time to apply for a prior-authorization or seek reimbursement of claims. Then they then claim the wrong NPI# was assigned to Jackson Hospital and Clinic in their PHCS directory and therefore coverage is denied. They will point to the disclaimers on the PHCS provider network. However, their disclaimers are intentionally misleading as will be outlined below.
I encountered multiple problems with Aliera Healthcare in approving Jackson Hospital and Clinic for a simple biopsy. At first, they approved verbally to me over the phone on 7/15/19. Then, when Jackson Hospital called them on 7/16 to confirm coverage, several days after Leslie at Jackson faxed the prior authorization form, Derik at Aliera read back an incorrect NPI# than what Leslie put on the prior authorization form she faxed to Aliera. Since that NPI # was for Montgomery Anesthesia and not Jackson Hospital and Clinic, it was finally confirmed that Jackson was NOT in network.
Once Leslie at Jackson confirmed with Derik at Aliera that Jackson Hospital and Clinic was NOT a in- network provider, Aliera never even contacted me to let me know. They didn’t even call me, a Member and tell me the prior authorization they gave me was now not valid.
After realizing their PHCS provider directory was unreliable, I asked Kathleen, Compliance Manager for Aliera Healthcare to email me a list of approved Drs.’s in Montgomery that treat breast cancer. She didn’t send me the list the next day as I was promised. Two days later we received the biopsy results of mammary carcinoma. I now had no time to waste. I contacted her alerting her to the diagnosis and told her I needed a list from her with in-network providers.
Soon thereafter on 7/19/19 I received the attached list of Radiology Oncologist Kathleen sent me as all approved by Aliera Healthcare as in-network for the Montgomery, AL area. (See attached “Aliera sent this list of Radiology Oncologist”) I contacted all the Radiology Oncologist on the list. I spoke with the insurance and billing specialist who actually file the insurance claims with all the providers.
NOT A SINGLE ONE has heard of Aliera Healthcare or Trinity HealthShare. Not a single one.
None have filed an insurance claim with Aliera Healthcare or Trinity HealthShare. Not a single one.
So, the list that Kathleen told me she personally called to verify was not accurate. This list she sent to me never heard of Aliera Healthcare or Trinity Healthshare and had never sent them a claim or received a payment from them. They even checked their own internal records of all providers of insurance and they were not even listed in their directory.
Just out of curiosity, this morning 8/2/19, I checked their MultiPlan PHCS provider directory to see if Jackson Hospital and Clinic was still listed as a provider and even checked the NPI#. You guessed it. Jackson Surgery Center is still listed as a provider as of this morning, 2 1⁄2 weeks since they told me Jackson Hospital and Clinic in NOT in-network! (See attached screen shot “Jackson still showing in Aliera MultiPlan PPO network 5”)
I even checked the NPI# Aliera has on their PHCS provider directory. The correct NPI# for Jackson Hospital and Clinic is NPI# 1043262488. The NPI# Aliera has listed in their directory for Jackson is NPI# 1043281553. That NPI # belongs to Montgomery Anesthesia Associates. (See attached screen shot
“Montgomery Anesthesia Associates NPI”).
Timeline of communications;
1. 7/12/19 – Leslie at Jackson Hospital faxes Prior-Authorization form to Aliera Healthcare.
2. 7/15/19 - Aliera (Demetric with the Prior-Authorization Dept) approved the procedure verbally over the phone to me.
3. 7/16/19 Leslie, who handles pre-authorizations with Jackson Surgery, called Aliera Healthcare to follow up since she hadn't received a confirmation back. She spoke with Derik. He gave her a verbal approval but with a different NPI #. Turns out that NPI # is for "Montgomery Anesthesia Associates" who works IN THE Jackson Hospital and Clinic, Inc. but are not PART OF Jackson Hospital. She told them they read back a different NPI # than was on the fax she sent them. So, they had Jacksonville Hospital and Clinic, Inc. listed using Montgomery Anesthesia Associates NPI #. So, Jackson Hospital and Clinic, Inc. is NOT in- network and the procedure WILL NOT be covered! He even told her to just go ahead and use the NPI# for Montgomery Anesthesia Associates! She refused!
Aliera Healthcare DID NOT contact me at all to let me know that they reversed their decision and refused Jackson Hospital and Clinic as a provider. They DID NOT offer an alternative provider for the surgery once they learned they had the wrong NPI# in their system. That was their claim why Jackson Hospital was listed as an in-network provider.
Leslie, pre-authorization administrator at Jackson Hospital, in order to assist me in finding an in-network provider, asked Derik with Aliera Healthcare what other facilities in the area are in-network. She stated he said, "they don't know what other facilities are in the area that do the test we are looking for".
What? In their Member Guide "under PPO Network it states "With a growing nationwide PPO network of more than 1,000,000 healthcare professionals and more than 6,000 facilities. Multiplan PHCS network offers Plan Members a range of quality choices to help them stay healthy".
4. 7/17/19 – Talked with Jen in Claims Department. Told her about the issue I had with getting a prior authorization and the fact Jackson Hospital and Clinic is listed as in-network but actually turned out not to be an approved provider. I asked her who is actually approved in Montgomery or near Montgomery for breast surgery, radiation and chemotherapy. That is what I needed.
Keep in mind, Aliera doesn’t have out of network coverage so if we go to a provider listed on their network and later discover that the provider is not in-network (even if it is Aliera’s fault) Aliera will not pay the claims! She said when she did a search that Jackson Hospital and Clinic is approved. I told her someone at Aliera needs to get on this quick and fix the directory now. I along with other Members and Aliera Member Services is using the PHCS provider network as the basis of in-network providers and it was just confirmed that Jackson Hospital and Clinic is not an approved in-network provider. All claims submitted for services at Jackson will not be approved.
5. 7/17/19 - I was contacted by Kathleen, Compliance Manager for Aliera Healthcare because she saw my reviews on Yelp.com. I told her Jackson Hospital and Clinic was still showing on their provider network. I told her this should immediately be removed as this is very misleading. People searching for Healthshare as an alternative would see Jackson Hospital and Clinic and purchase their coverage not knowing, until they needed hospitalization, that Jackson Hospital and Clinic were not ever an approved in network provider. Keeping this hospital listed is very deceptive.
I asked her a very simple question. Who is in your network? I needed to know in the event my wife’s biopsy that was scheduled for the next day at Jackson Hospital and Clinic turned out to be malignant. She couldn’t give me the list of approved providers during that call. That was very disturbing. She said she would research and email me a list by the close of business the next day.
6. 7/19/19 – Jackson Hospital called to tell us the biopsy determined the mass was mammary carcinoma. I called Kathleen as now I had to move fast. It had now been two days and I didn’t get the list of in-network providers by COB 7/18/19 for Montgomery, Al as she promised. She told me she would be personally calling all the in-network providers in the Montgomery area to make sure they are accepting Aliera and are in-network. During that call I reminded her of the error in listing Jackson Hospital and Clinic on their provider network. She told me she would pass that along to have the PHCS Directory updated. Soon thereafter on 7/19/19 I received the attached list of Radiology Oncologist Kathleen sent me as all approved by Aliera Healthcare as in-network for the Montgomery, AL area.
7. 7/22/19 - I called and talked with Astrid with Member services. I told her that Jackson Hospital and Clinic is still showing as in-network and we had already established that this hospital in not in-network.
During that call, I had this exchange with Astrid. I told her about the list Katherine sent me of Dr.’s in Montgomery on 7/19/19. I specifically stated, “but you guys would have a contract with them obviously if they are in your network”. She said “yes, we do have a contract with them but a lot of times its where they can be in network last month and then decide this month today that they don’t want to be in network. And we don’t have anything to do with that. So, the only thing we can do is call them, confirm that they are in network, and if they are you just make an appointment. If not, you just go down the list and find the one that is in network and make an
appointment. But the ones were giving you they are saying they have signed a contract with PHCS telling us and PHCS that they are in network”.
So today, 8/2/19, it’s 2 1⁄2 weeks and Jackson Surgery Center and Jackson Hospital and Clinic is still listed on their provider directory and are NOT an in-network provider. (See attached screen shot “Jackson still showing in Aliera MultiPlan PPO network 5”)
I started coverage with Aliera Healthcare effective 12/1/18. That decision was based on a belief this company was not fraudulent in their representations made on their PHCS provider directory. That decision was based on the claims made in their Member Guide under PPO Network it states
“With a growing nationwide PPO network of more than 1,000,000 healthcare professionals and more than 6,000 facilities. Multiplan PHCS network offers Plan Members a range of quality choices to help them stay healthy".
This claim is blatantly false. This is fraud and Aliera Healthcare has used this to attract new Members in a Ponzi type scheme. If it was only a scam to bilk Members out of their monthly premiums that wouldn’t be as bad. The worst part is when Members need Aliera for the services we contracted for, that’s when we discover the scam and it’s too late. It’s too late to sign up for a legitimate healthshare ministry because they all have pre-existing condition clauses. Yes, this is the most unethical fraud ever perpetrated on the public.
In this case, the PHCS Providers they claim are not in network. In my case, they don’t have anyone in network in Montgomery. No one!
Imagine all the people who right now may be searching for a health share provider in central Alabama and have no idea Jackson Hospital and Clinic and Jackson Surgery Center is not an approved in- network provider yet find them on the Directory. What about people all over the US who did not conduct due diligence on Aliera Healthcare and discover the reviews on the Better Business Bureau. These people, like myself, signed up for their plans not realizing their directory network is full of providers that not only don’t have a contract, never had a contract and never even heard of Aliera Healthcare.
Aliera Healthcare will argue “but there are two pop-up messages alerting everyone with these messages”.
1. “We work hard to ensure our data is accurate, but provider information changes frequently”. (See attached screen shot “Alier Healthcare Jackson Hospital page 1 provider listing”)
2. “Provider information contained in this Directory was last updated earlier today and therefore may have changed”. (See attached screen shots “Alier Healthcare Jackson Hospital page 2 provider listing”)
Yes, however, I believe it will be proven at some point down the line in a civil or criminal trial that Aliera Healthcare never had a contract to provide in-network services with most of these providers listed. So, the ruse is, consumers look at this directory during their sign-up process if at all.
Everyone understands the in-network/out of network issue can change. But Aliera Healthcare is making the claim that they actually had a contract with them at one point.