![]() Under federal law, most insurers spend 80% or more on benefits for subscribers. ![]() It turned out, that was not uncommon for a company that describes its services as “low cost, high value.” According to a state inspection of O’NA’s unaudited books in fall 2019, the plan spent an “unusually low” amount of the $2.5 million it collected in premiums to cover customers’ medical bills-just 13% or less. Stranger still, investigators found that O’NA required physicians to pay $485 a year to join its network. ![]() Goodridge also paid a family premium of $751 a month for 13 months before canceling, according to her testimony before the Maine Bureau of Insurance. In addition to traditional medicine, O’NA said, its members could seek care at “Native American Tribal Healing Centers” nationwide, though it did not identify the centers or their locations. She paid a tribal membership fee of $165, which the company said was a tax-deductible contribution to an unspecified Native American tribe. There was much about Goodridge’s new coverage that seemed unorthodox to the investigators. “The more we found out,” Cioppa said, “the more we wanted to keep digging.” For patients, a tempting offer with red flags Along with serious doubts that anyone involved with O’NA had valid indigenous roots, there were financial irregularities, allegations of embezzlement and phony professional credentials. That tribe is not one of the three federally recognized Cherokee tribes.īut the troubles with O’NA went deeper than that, Cioppa and his team discovered during a yearlong investigation. It sent its customers a “tribal membership ID & benefits card.” And it said it derived its status from an affiliation with the United Cherokee Nation–Aniyvwiya. The company advertised it was “comfortably nestled under a Native American tribal corporate umbrella” and “protected by the many rights and privileges that Native American Indians enjoy today.” O’NA HealthCare appears to be the first insurer to claim that Native American status exempted it from oversight, according to the National Association of Insurance Commissioners. O’NA claimed it did not have to adhere to federal insurance requirements, such as guaranteeing standard coverage or maintaining a designated level of funds in reserve to pay claims. The company claimed Native American ties that would exempt it from state insurance regulations because of tribal sovereignty, which gives federally recognized tribes the authority to self-govern outside state or federal law. “It almost seemed like we were just spending the premium money every month for really not much,” said Goodridge, whose family runs a Rockland, Maine, restaurant that is temporarily shuttered because of the coronavirus pandemic. For example, O’NA applied only a small portion of more than $6,000 in hospital-related bills against her $10,000 deductible. Yet she could not get O’NA to cover her family’s medical bills. She signed up for a high-deductible plan, paying more than $9,000 in premiums and fees over 13 months, she said. It says it provides more nontraditional options than “any other health care plan,” including coverage for essential oils, energy medicine, and naturopathic care. ![]() The company promises 24/7 telemedicine and holistic dental care on its website. Its name suggested an affiliation with a Native American tribe-a theme that carried through on its website, where a feather floats from section to section. The self-described “health care cooperative” promised a shield against catastrophic claims.
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