A Facebook friend commented on one of our posts that Aliera Healthcare, one of the healthcare sharing ministries, had denied a claim, saying that while the doctor was in-network, the billing entity was not. It seemed wacky, so I asked for more detail. Here is his story. We’re not using his name because that’s not central to understanding the amount of time and energy he put into trying to get what he thought he had paid for. The claim was ultimately paid. Aliera has been in the news a lot recently — officials in several states and the F.B.I. have been investigating charges that Aliera failed to pay claims. See this Houston Chronicle article for details.
We had chosen Alieracare when we decided to travel the U.S. full time for a couple of years and I no longer had employer-based health insurance. At the time we lived north of San Diego, CA, and one of the reasons we picked Alieracare was that my existing primary care provider was in network and they seemed to have a pretty broad provider network throughout the U.S.
During our travels there were no problems and my annual PCP visits at my local provider were covered. At the end of our travels we decided to settle in Missoula, MT and we also checked if Alieracare has in-network providers here, which seemed to be the case. I set up an appointment with a provider (Jennier Culp of Providence Missoula Family Medical) that was listed in Alieracare’s directory and had the provider confirm before my first annual wellness visit on 5/1/2019 that they are indeed contracted with Alieracare (they are contracted with PHCS, which is what Alieracare uses for their network).
After the visit I thought all had gone well until I received a bill for $367 from the provider on 5/29/19 stating that Alieracare had rejected the claim and that I had to pay the whole balance. Below are my phone call notes on this topic. Note that apparently all billing for any provider within the Providence system is done centrally by Providence Health and Services in Washington state. The numbers in square brackets are for the phone system menu options.
Doctor is in network, but billing facility is not
5/29/2019 11:36 AM Called Alieracare claims hotline 833 552 5246 – 5/29/2019 12:04 PM spoke to Derek – he said he will check if they are in network, it may also depend how the provider bills it. He confirmed that Jennifer Culp is in network, but the BILLLING facility is not in network. He initially said I am responsible for the bill. I asked how I should have figured out that the billing facility is not in network – he said I should have called them directly but it turns out most of the representatives would not have caught the billing facility problem either. He then said he can send this particular claim back for reprocessing because the comment in their system stated as the reason that the membership was terminated (in error, due to Alieracare having switched the plan having from Unity Health Sharing to Trinity in mid-May).
This reprocessing could take up to 60…90 business days to complete. He asked to wait for this claim to process to see if it is covered. I asked how I could find out right away that the facility is in network – I should call 844 457 7726 for that. He said repeat billing by the provider will automatically be rejected. I asked if I could get some email trail for this – he said he cannot provide that to me. Claim transaction number is 629194.
5/29/2019 12:25 PM called Providence billing facility to avoid going into collection over this 1-866-747-2455 – [3] spoke to Vraulio – guarantor ID XXXXXXX from bill. I told him about the situation – he will push the statement out as far as he can – which is 45 days. I should contact the insurance beforehand to see if it is processed by then. If not processed then I need to call billing again, can reference Vraulio’s name.
I would have 2 more notices ‘time’ before the account would be in danger anyways.
Back to Aliera, then the doctor
5/29/2019 12:34 PM called eligibility department at Alieracare to find out about Jennifer Culp – spoke to Devin – he said if the provider bill under the doctor’s name then it is in network but if they bill under Providence Health and Services then it is not in network. I stated that I find this ridiculous and he said that’s the way it is.
5/29/2019 12:43 PM called Doctor’s office at 406-728-3111 [4] – spoke to Brianna, she said they don’t do any billing in the office. She wanted to transfer me to the Providence billing department. I explained the situation to her and she will talk to the practice manager and have her get back to me.
5/30/2019 4:38 PM called 844 457 7726 again to follow up [4] – spoke to Sharon, asked for office manager – office manager is currently not in there (Brianna was just a float yesterday) – Sharon will find out if the message got to the manager and get back with me tomorrow.
Given the developments surrounding the billing issues I started to get concerned that I might not have any hospital coverage in Missoula either…
Hospital or medical group? It’s a mystery
5/30/2019 4:43 PM called Alieracare eligibility hotline 844 457 7726 – spoke to Nimmie – asked about Providence St. Patrick hospital in zip 59802. He sees Providence Medical Group, but only their inpatient rehab for Providence Medical Group in 59808, St. Patrick Hospital 500 W. Broadway is also showing as in network. I asked to speak with the manager – 5/30/2019 4:59 PM spoke to Brianna (a different Brianna from the doctor’s office) – explained the situation, she said the providers call and verify eligibility and who it is being billed through – Alieracare is not at fault if the doctor’s office provides incorrect information to Alieracare. She found my file and it was going to be resubmitted. If the provider continues to bill under this provider “Providence Health and Services” then I need to find a new one. Alternatively, the billing facility would need to contact PHCS and request to be added to the network – they would have to agree to accept billing for all services under the contracted rate (not my problem). She will forward this to a manager for processing and have the person give me a call tomorrow. I said that this should be paid by Alieracare as an in-network provider.
5/31/19 received call from Sharon at the Doctor’s office, she spoke to the office manager and they will get this resolved, will get in contact with the insurance and figure out how to ensure these bills get paid in the future.
6/6/2019 11:06 AM called Alieracare eligibility hotline again 844 457 7726 checked again explicitly for St. Patrick Hospital 500 W Broadway St and their billing – spoke to Phillip, gave him zip 59802. He shows that the hospital is in network, but I should still check about the specific physician. He confirmed that the billing facility needs to be in network too – I can find that out from the medical facility. Called St. Pat’s emergency room 406 329 5635 – [4] – asked Tim – he did not know, he txfrd me to registration (Amanda) – she was not sure, transferred me to Admission financial counselor Deb, also updated our address in the system, she confirmed that they use Providence Health and Services for all billing. She said I should talk to the financial people as well – she knows they have done other health-sharing ministries. She transferred me to finance people – Christina Hill – left message with phone number.
Aliera, again
6/13/2019 2:43 PM called Alieracare eligibility hotline again 844 457 7726, spoke to Alexandria – she only shows St. Patrick Hospital within 20 miles of 59801. She said they also have plans that offer out of network benefits that I could consider. The next tier (Bronze/Silver/Gold) offer out of network care, but that was not acceptable to me financially. Mind you, she would have told me the hospital is in network and would not have caught the billing facility issue…
6/13/2019 3:12 PM called the Hospital again 406 543 7271- asked for Christina Hill, left message again. Try 1 866 747 2455 – Providence Business Office – [0] – spoke to Stephanie (Guarantor ID – XXXXXX) – she does not know someone who can help me there. She said all claims are only paid based on a tax ID number and that needs to match. She said Alieracare would need to contact them to be added for credentialing. She said this credentialing would take quite a while (not this year), she can send a message so that the situation with the insurance is confirmed. Worst case I can always pay for it myself, I asked if she can see that my bill was pushed out until 7/13 – she confirmed that.
Given these issues I canceled my Alieracare membership on 6/20/19 and switched to Liberty Health Share instead.
Now it’s a ‘technical issue’
7/8/2019 9:25 AM Called Alieracare claims hotline 833 552 5246 providence bill number XXXXXXXXXX, guarantor ID XXXXXXXX. Spoke to Nick, asked about the claim status – they are having a technical issue – he cannot verify the claim. He will have to call me back. I told them 2PM Mountain time would be a good time. I gave him background on the initial claim being rejected based on the supposed (but incorrect) lapse in coverage.
7/10/2019 11:06 AM had not received callback from Nick as promised. Called Alieracare claims hotline 833 552 5246, spoke to Carrington, told him I had not received a call back. He sees the claim from service date 5/1/19, the status is processed and paid on 6/21/19, there is no outstanding member responsibility.
I ended up making a lot of phone calls and I always take very detailed notes, including times of calls, who I spoke to, etc. In the end I am not sure whether they would pay future claims from that provider, but given the other problems with no local hospital or urgent care coverage due to the billing issue I am glad I got out of Alieracare.
I hope this is helpful for you. Please let me know if you have any other questions.
