CHEROKEE COUNTY, Ga. — A local hospital is now refusing to accept a Christian-based medical plan that covered more than 200 patients in the past year.
One of those patients told consumer investigator Jim Strickland she got the news in the middle of her cancer treatment. The hospital told her she needed to pay cash before she left the doctor’s office.
Laura Alley, a 39-year-old runner, discovered a lump on her neck months after giving birth to her fifth child.
“You know, first thing I start to think about is, ‘What am I going do without my wife?’” Laura’s husband, Nick Alley, said.
He said paying for her treatment was not on his mind because they thought they were covered. Then came a phone call from the finance office in the middle of chemotherapy treatment.
“I'm sitting there, with a needle in my arm, receiving chemotherapy in my arm, and they are telling us that we are not going to be able to leave, until we pay them $41,000,” Laura said.
The Alleys have Medi-Share, a medical co-op which satisfies the Obamacare mandate for health coverage. Members pay in and share each other’s medical expenses. It's not insurance, but does use an insurance network called Private Healthcare Systems to negotiate rates. The Alleys said they made sure Medi-Share was accepted before Laura began treatment at Georgia Cancer Specialists, run by Northside Hospital.
“I sat in front of them, in front of their computers, and handed them my card three or four times, and no problems whatsoever,” Laura said.
A spokesperson for Northside Hospital told Channel 2 by email, in part:
“We have a contract with PHCS. We have never had a contract with Medi-Share. Because we thought Mrs. Alley was part of the PHCS plan (PHCS did not tell us otherwise), we billed PHCS for her care. PHCS gave her bills to Medi-Share, who underpaid on our contracted rates with PHCS.
“When we contacted PHCS about the underpayment, they alerted us that the patient did not have insurance with PHCS, but rather was a Medi-Share member.
“We have never said that we accept Medi-Share. Our contract was with PHCS. Once we realized this confusion, we corrected Mrs. Alley’s account. Because she does not have insurance, she is considered a self-pay patient. We have provided her with multiple options to reduce and satisfy the remaining balance on her account.
“We did not tell the patient that she was “pre-certified.” When our staff called PHCS to ask if pre-authorization was needed, they told us that it was not.”
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Strickland asked Laura Alley about the statement: “’We have never said that we accept Medi-Share,’ true or false?”
“That's false,” Laura replied. “It's about money. But even then, it doesn't make sense, because they're getting paid.”
While the email stated that, even at discounted insurance company rates, Medi-Share underpaid the Alley's bills, we reviewed bills from Northside Hospital and each one had a zero balance. More than $98,000 had been paid, or discounted like traditional in-network insurance, before the hospital quit accepting Medi-Share.
Health insurance broker Beau Miller, with Your Insurance Advocates, reviewed the Alleys' bills, and said it appeared Medi-Share did pay the bills like a regular insurance company. Miller said he does not recommend co-op insurance like Medi-Share to his clients.
“It's hope and pray they pay insurance,” Miller said. “I say that in jest, but it's the truth.”
Miller said he's seen co-ops like Medi-Share grow in popularity because of their low rates, but cautions they offer less legal protection.
“Because it is not true insurance and there is no legal contract for them to pay their bills.” Miller said. “Not to say they don't pay their bills, there's just no legal contract.”
Miller said if Laura Alley had true insurance and Northside had quit accepting that, the hospital most likely would have a contractual obligation to continue her treatment.
Laura has reason to trust Medi-Share because Medi-Share paid the bill to Wellstar North Fulton after she'd had a baby just before the cancer hit. Wellstar told Strickland by email, “Medi-Share patients are considered in-network when seeing Wellstar Health System providers.”
The Alleys are no longer under threat of losing Laura’s cancer care. Their current bill also shows a zero balance because Medi-Share paid it in advance at self-pay rates.
“They wired the money,” Nick told Strickland. “I mean, wired the money. what kind of health insurance company would do that, you know?”
Laura told Strickland despite the billing dispute, the hospital staff at Northside provided outstanding care during her cancer treatment.
Northside, Medi-Share and Wellstar each declined to go on camera. Medi-Share says it's working with Northside to find a solution.
On Wednesday, Northside sent another statement saying, “In the time since WSB-TV first contacted Northside for this story, the patient has continued her medical treatments with no delays, interruptions or cancellations. Her care has been our top priority from the beginning of her treatment. We consistently worked with the patient on her billing status, and all billing issues have been resolved.”