Greene Co family battles insurance company

A Georgia family is stuck with a $325,000 medical bill they say their health plan provider, Aliera, refuses to pay.

Lola Grae Segars, 10, is healthy, just four months after brain surgery.

On Sept. 11, she was rushed from the local ER in Green County by ambulance to Children’s Healthcare Scottish Rite, where doctors removed a softball-sized brain tumor.

“It was just amazing, the care,” said her father, Wesley Segars.

But last week, came the bill from their health plan, Aliera Companies.

Aliera said the hospital is out of network, and they won’t pay the $325,000 in hospital bills. “We had a life-threatening emergency. They failed us, and her,” said Lola Grae’s mother, Ashley Segars.

“We can chip away at it, but we would take that debt to the grave,” Wesley Segars said.

In a Channel 2 Action News investigation in November, we told you how the FBI is investigating Aliera.

Aliera administers the payouts for faith-based nonprofit Trinity HealthShare.

Members pay monthly and are supposed to share each other’s medical expenses, but our investigation found many members stuck with big bills.

Multiple states have ordered Aliera to stop doing business.

Washington state Insurance Commissioner Mike Kreidler said for every dollar paid in by members, Aliera paid out only 16 cents in claims. The norm is 80 cents. “What we saw, and what we’re aware of at this time, it’s clearly a scam,” Kriedler sad.

We reached out to Aliera about the Segars’ case. They would only refer us to an earlier statement saying they’ve paid out $165 million in claims over the years. The statement reads, “member complaints represent less than one half of one percent of the ministries’ total overall membership that Aliera markets.”

The Segars say Aliera even rejected Lola Grae’s original emergency room bill. It was serious headaches that sent her to the ER, and led doctors to find the tumor. Aliera told the Segars that headaches are not an emergency.

“This is a high-level criminal organization, as far as I’m concerned,” Wesley Segars said.

The Segars were told by Aliera they could file an appeal of their bill.

We’ve confirmed the New York State Department of Financial Services is investigating Aliera.

Aliera has also started selling health care coverage through another name, Ensurian.