ORLANDO, Fla. — You sign up and pay for health insurance only to find out you don’t have coverage at the doctor or pharmacy.
9 Investigates told you how rogue insurance agents were using false advertising to get your information and then changing-- or even canceling-- your insurance policy without your permission.
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Many of the bad actors accused of the scheme have call centers scattered across South Florida.
Investigative Reporter Ashlyn Webb went to those call centers and spoke exclusively with a former employee that worked at one of them.
He worked for True Coverage. It’s a company listed in this class action lawsuit, and it’s also the same company the feds suspended from the Affordable Care Act Marketplace in August.
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This is after True Coverage was accused of illegal activity including insurance fraud.
The former employee spoke to us about how the scheme worked and what his bosses told him to do.
“I feel like, you know, someone has to from the inside, tell the truth about what happens,” the former employee said.
The whistleblower worked for True Coverage for roughly three months.
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He agreed to talk to us about what he says happened behind the call center doors, but he wanted to remain anonymous.
“We were targeting the poorest of the poor,” he said.
He said he thought he took a job to help sign people up for the best marketplace policy for that person and their family. However, he said he quickly learned that wasn’t True Coverage’s goal.
“It was just trying to churn and churn and convert as many people as possible, no matter what means that we could use,” he said.
He said he would get hundreds of calls a day. Most people wanting money after seeing pop up ads offering thousands of dollars for rent and groceries.
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“No matter what you’re offering, if they think that they’re going to get $6,400 at the end, they’re going to go for it,” he said.
But in reality, there’s no free money.
It’s the federal subsidy for insurance that goes to the insurance company.
But the employee told us the company would still use these ads to lure people to sign up for insurance.
If they already had a plan through the marketplace, they were told to re-enroll them.
In an affidavit, another whistleblower provided an internal True Coverage email from the senior director of quality assurance, who wrote that on the phone they should be vague and cannot give specifics about cash cards despite what ads are promoting.
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“How did you feel when you were on the phone with these callers? Did you feel any guilt, any regret?” Investigative Reporter Ashlyn Webb asked.
“I don’t like the word guilt, but i felt ashamed and I felt embarrassed for the company. And I felt some sort of remorse,” the man said.
The employee said they were encouraged to sign up callers within a seven-minute call.
From there, he said the caller’s information was passed on. Their policy was often changed time and time again, he said.
“So, people just create a funnel of policy churning and recycling that is endless,” he said.
An agent can make about a $20 commission with each change. Each switch could mean potential gaps in health insurance coverage.
“It’s just like somebody is in there just messing with your life every day,” Delaney said.
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We heard from people like the Delaneys and Teisha Foreman who learned their doctors were suddenly out of network, prescriptions no longer covered.
They were faced with hefty bills, forced to choose between paying up or going without doctors’ visits or treatments.
“When you hear these stories, how do you feel?” Webb asked.
“It’s something that is despicable,” the former employee said.
The whistleblower says that’s why he eventually spoke up to his boss.
“I told them that it was against the rules, that I felt it was illegal,” he said. “I frankly believe with all my heart that of all the calls that I took… I would say like I feel like I helped less than 2% of the callers that I got.”
We reached out to True Coverage about the allegations of fraud.
The company called it baseless and without merit.
True Coverage Full Statement:
“TrueCoverage takes these allegations very seriously and is responding appropriately. While we cannot comment on ongoing litigation, we strongly believe that the allegations are baseless and without merit.”
“Compliance is our business. The TrueCoverage team records and reviews every call with a customer, including during Open Enrollment when roughly 500 agents handle nearly 30,000 calls a day. No customer is enrolled into any policy without a formal verbal consent given by the customer. If any customer calls in as a result of misleading content presented by third party marketing vendors, agents are trained to correct such misinformation and action is taken against such third-party vendors.”
— True Coverage
“TrueCoverage takes these allegations very seriously and is responding appropriately. While we cannot comment on ongoing litigation, we strongly believe that the allegations are baseless and without merit.”
“Compliance is our business. The TrueCoverage team records and reviews every call with a customer, including during Open Enrollment when roughly 500 agents handle nearly 30,000 calls a day. No customer is enrolled into any policy without a formal verbal consent given by the customer. If any customer calls in as a result of misleading content presented by third party marketing vendors, agents are trained to correct such misinformation and action is taken against such third-party vendors.”
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