ORLANDO, Fla. — Families who rely on the Affordable Care Act marketplace said rogue insurance agents are adding, changing and even canceling their health coverage without them knowing.
Many didn’t know it happened until they went to a pharmacy or doctor and suddenly had no coverage.
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“When I got to the pharmacy, you can imagine my shock when they told us it was $1096,” Lorie Delaney said.
Delaney said that’s the moment she realized there was something wrong with her and her husband’s insurance.
His diabetes medication that typically cost $25 a month is now 40 times that.
“We literally were on the phone for hours getting everything situated,” Delaney said.
She found they no longer had the health plan she signed up for.
A broker had switched them to a different insurance plan without telling them.
“I was just like; how can all these people touch our case? How can they touch it and not have permission?” Delaney said.
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9 Investigates found the Delaney’s aren’t alone.
“It’s stressful and scary,” said Tiesha Foreman.
Foreman said the first sign of trouble for her was when her daughter’s pediatrician thought the family had no insurance.
“It’s embarrassing because you have them looking back at you like, you know ‘why are you giving us this card saying that you’re covered and you’re not… Again?” Foreman said.
Then, the Georgia mom got a tax form, essentially a $1,700 tax bill for insurance she never signed up for.
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“For three months, I kept trying to call on the phone, trying to talk to the Marketplace to get them to understand I wasn’t doing these applications. I didn’t know who this agent was,” Foreman said.
This class action lawsuit alleges families who rely on the Affordable Care Act Marketplace are victims of a multimillion-dollar scheme.
“I believe this is the largest health insurance fraud case ever,” said attorney Jason Soss. Soss said rogue insurance agents exploited a provision added during the pandemic so low-income families could switch their health coverage any time, not just during open enrollment.
“The problem is, what if the bad guy owns the enrollment platform, they have the keys to the castle,” Doss said.
Insurance agents get paid a monthly commission of about $20 per Affordable Care Act policy. If they switch you, they make money.
It took less information to switch victims’ health coverage than what you’d need to change your phone plan!
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“All they need is a first name, last name, date of birth and state,” said insurance agent Callie Navrides. She says she noticed dozens of her clients’ policies getting switched, and she was no longer listed as their broker. And, she had no idea who was doing it.
“Instead of taking on new clients, helping them enroll into insurance, my job became fighting fraud and getting on the phone with the marketplace, my client, multiple times a day, all week long,” Navrides said.
The lawsuit says the companies behind the scheme, include True Coverage and Enhance Health. 9 Investigates found several of their call centers were based here in Florida.
The suit says they used pop-up ads like these to get customers’ information by promising free money for rent or groceries.
The federal government says between January and August, nearly 275,000 people complained they were changed from or enrolled in plans without their consent.
Each switch meant potential gaps in their health insurance coverage.
“It’s just like somebody is in there just messing with your life every day,” Delaney said.
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The federal agency that runs the marketplace says at least 850 agents and brokers have been suspended for “reasonable suspicion of fraudulent or abusive conduct” related to unauthorized enrollments or plan switches.
True Coverage was blocked from the Marketplace entirely.
In court filings, all the companies named in the lawsuit have denied the allegations, calling them quote “baseless”.
True Coverage also sent 9 Investigates a written statement:
“True Coverage 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 True Coverage 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.”
It’s hard to protect yourself, so take all the usual precautions:
- Be suspicious of high-pressure calls and emails, especially those promising free money.
- Guard your personal information.
- If you’re on Medicare, remember you don’t need the ACA marketplace.
- When you get a doctor’s bill or prescription, look at the paperwork. Make sure you recognize the insurance they used. Akra said that would have helped in her case.
Report Marketplace Fraud to 800-318-2596.
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