More than 100 Oklahomans are struggling to find health coverage after learning an insurance company was taking their premiums with no intention of paying claims. Bob Harper was days away from getting a pacemaker when he learned his insurance was fake. Joe Smith’s wife, Christy, was undergoing chemotherapy for cancer when he found out the $10,000-per-week treatment would not be covered. Harper, 62, of Yukon, and Smith, 38, of Sperry, were contacted by the state Insurance Department in November and told their health insurance provider was a fraud — a comingling of at least a dozen companies investigators say are working together as a part of a sham. Insurance Commissioner Kim Holland said the main company, American Trade Association, sold fake health insurance plans to 116 Oklahoma customers and continually has changed its name and provided fictitious contact information to avoid paying claims. Investigators say the company sold plans to individuals in at least 20 states. About $14 million in premiums has been paid to the company. This total only represents individuals who’ve alerted authorities that they were scammed, Holland said. "This is just infuriating,” Holland said. "There are folks trying to do the right thing, and they are being taken advantage of at a vulnerable time,” she said. Holland said she thinks the company still is operating under different names and taking more money from unsuspecting people looking for health coverage. But for Harper and Smith, it isn’t just about the lost money. It’s about taking care of their health and their families. "This hurts. There is no cure for this,” Harper said. "These scams are rampant everywhere, but this hits close.” Harper isn’t yet eligible for Medicare. Because he has pre-existing conditions, the insurance companies he’s contacted either won’t cover him or won’t cover the pre-existing conditions. And he doesn’t understand how he was duped. Harper said he recently got out of the real estate business and was looking for temporary coverage when a fax came through. The American Trade Association offer was low and looked like a good deal. So he called. "I asked all the right questions,” he said. "They told me they were licensed; they gave me a list of doctors who were covered.” When the packet came in the mail, it included discount cards for services and a prescription coverage card, along with the insurance card. All appeared legitimate. His doctors didn’t even blink when he gave them the insurance card. The prescription card mailed to him was legitimate and covered his prescription expenses. Holland said her agency still is investigating that connection. What wasn’t covered was more than $1,000 in medical visits. Doctors have offered to cut the price of his bills. "If some insurance company would cover me, if there is one with a heart, that would be the greatest thing that could possibly happen,” he said. Smith said he, too, received a fax from the company. He called, listened to the pitch and then compared rates. He wanted to ensure that his family was fully covered since he’s suffered financially from medical problems in the past. His wife, Christy, has cancer of the thymus, a small gland that is part of the lymph system. Her doctors are going to continue treating her, but Smith knows he’ll likely be responsible for the thousands of dollars in unpaid claims. "We’re just stuck,” he said.Comments
How they got caughtState Insurance Department officials learned of the company after a licensed insurance professional called the agency about the company and questioned its legitimacy. The query later was turned over to the department’s anti-fraud unit. "Investigators have gone to track the companies down, and they’ve found store fronts with no one there,” Holland said. Nearly 30 individuals and companies are listed on a cease-and-desist order issued by the department in November, she said. Companies are located all across the country, and one has ties to Pakistan. Calls to American Trade Association’s telephone number listed on its Web site result in a prerecorded voicemail message.