October 20, 2020
DEPARTMENT OF FINANCIAL SERVICES FILES STATEMENT OF CHARGES AGAINST THE ALIERA COMPANIES AND TRINITY HEALTHSHARE
DFS Charges Violations of The New York Financial Services Law And New York Insurance Law for Entities Operating as Sham Insurers
The New York State Department of Financial Services (DFS) today filed a statement of charges against the Aliera Companies (Aliera) and Trinity Healthshare (Trinity). DFS alleges that, for years, Aliera and Trinity deceived consumers while operating an illegal health insurance business in the State of New York, leaving consumers who believed that they had purchased legitimate coverage responsible for legitimate medical expenses.
“New Yorkers should not have to worry whether a trip to a medical professional could lead them to bankruptcy, a factor that has been compounded by this unprecedented global health crisis,” said Superintendent Lacewell. “DFS is committed to protecting consumers and the integrity of New York’s healthcare marketplace, ensuring New Yorkers receive the care they expect and may need.”
According to the DFS statement of charges, Aliera and Trinity conducted an illegal insurance business in New York by selling health insurance to New York consumers, while overstating the coverage offered and, at times, committing outright fraud while pocketing consumers' premiums.
Aliera and Trinity aggressively marketed these products in the health insurance marketplace, preying on uninsured New Yorkers. A substantial portion of customer premiums were diverted to so-called administrative costs, rather than retained for reimbursement of members’ medical claims. As a result, New York consumers were short-changed when requesting reimbursement for valid medical expenses.
Examples of harmed New Yorkers include the following:
- Aliera refused to pay Consumer A for leukemia treatments, including thousands of dollars for an emergency hospital admission in 2019. When Consumer A attempted to resolve the claims, she was erroneously told by Aliera, with no further information, that her claim was denied due to a “pre-existing condition.” Consumer A never received any further details from Aliera despite repeated requests for clarification. The claim remains outstanding.
- During the summer of 2019, Consumer C was denied coverage for surgery for nerve damage in his hand. When the consumer contacted Aliera regarding his coverage, Aliera stalled, delayed, and refused to respond, frustrating the consumer’s efforts to resolve the issue. Consumer C has since cancelled his policy with Aliera. To date, he has not had surgery for the issue with his hand.
- During the fall of 2019, Consumer B reported that when enrolling with Aliera, the consumer was provided with information stating that his current doctor was “in network.” Following a visit to his doctor, Aliera subsequently refused to reimburse Consumer B for a visit to the doctor.
The hearing will be held at the office of the New York State Department of Financial Services, One State Street, New York, New York, beginning on February 2, 2021.
Consumers who believe that they have been the victim of Aliera, Trinity, or health care sharing ministries that may be operating unlawfully in the State of New York can contact the DFS Consumer Assistance Unit at the Consumer Complaint Portal.