Buyer Beware Answering Those Health Insurance Spam Calls

“Hello, this is Stanley Mayers, I’m with USHEALTH,” the voicemail begins. “I’m just responding to your recent request for health coverage, just trying to reach out to you and see how we can help you today.”

While this might be helpful for someone who actually asked for health coverage information, I hadn’t.

Spam calls, robocalls, and aggressive telemarketers are common fixtures of my missed calls list, but Stanley Mayers' call, and dozens of other calls and texts about health insurance, signaled an escalation.

Despite me having this number for more than five years, these calls are not actually meant for me. They’re directed to the person who owned my number before me, who seems to be targeted by payday lenders, loan adjusters and insurers alike.

Because she — and I — get so many calls about health insurance, I tried to figure out what was being sold. I learned figuring that out can be very difficult…and we all should be very careful.

“It’s upsetting, because they shouldn’t be putting pressure on folks with those repetitive phone calls,” says Stephanie Snakovsky, an Individual Benefits Advisor with Vantage Financial Group in Cleveland. “That’s not what insurance is about: to harass folks to purchase a plan. It’s important to educate folks so that they’re making a decision that’s important based on their budget and their family needs.” 

Stephanie Snakovsky of Vantage Financial Group. [Tony Ganzer / ideastream]

Snakovsky says even with Affordable Care Act plans, agents could get pretty aggressive with the phone calls, but there’s also a riskier world of non-ACA compliant plans. These plans don’t have to follow rules set by the law because many are not comprehensive coverage.

“A client came in, they were in between coverages, they were coming off an employer plan, had done some research on the internet,” she says. “They found this plan, the premium was right for them. [The company is] presenting it as health insurance, but there’s no network. And when you look at the benefits that they provided it was a flat dollar amount. So once you reach say, $2,000, then that’s all they’re going to pay.”

For many people, the ins and outs of insurance are hard to grasp, but you might wonder how plans like this can exist after the ACA. Part of it has to do with the on-going, often partisan political fight over health care.

“The Trump administration relaxed some rules around certain types of plans that don’t have to meet all of the ACA requirements,” says Jennifer Tolbert, Director of State Health Reform at the Kaiser Family Foundation.

“So now they are more available which I think is, in part, leading to some of these intense marketing efforts on the part of companies that are selling some of these policies, as well as the brokers that may be getting commissions for selling some of these policies,” she says.

Take one example: a short-term plan, set up to fill the gap in coverage if you get a new job. They’re meant for healthier people, and often cost much less than employer plans. The Obama Administration allowed these gap plans for up to 3 months, but the rules change now allows them for 364 days, and they’re renewable for 3 years, at the discretion of the companies. States deal with these plans very differently — you can’t even get them in California anymore for example.

These plans are put forward as affordable, Tolbert says, but while they do cost less, you also get less coverage, and more risk. 

“Insurance companies are prohibited from rescinding coverage in the middle of the policy term, but what they can do is choose not to renew the coverage if someone experiences a health care crisis or need while they have the coverage,” she says.

This means if a customer has a serious illness, and is being treated for it, but the plan lapses, the company could choose to walk away from that client.

These and similar plans not being subject to the ACA also means they aren’t held to what’s known as an MLR, medical loss ratio, of 80 percent. Essentially it means, under the ACA, 80 percent of premiums need to go toward medical claims.

If companies are not held to that, it can mean more profits.

But to really find out what the dozens of calls and text messages were trying to sell me, I called a few of them back, including Abel Ernstberger, an insurance agent with USHEALTH Advisors in Indiana.

He had sent me a text message about health insurance.

“We don’t offer short-term plans,” Ernstberger said in a telephone interview. “We do offer ancillary products that could be considered supplemental plans. But our flagship product it’s a long-term health insurance product. It is not ACA-compliant, or approved according to ACA standards, but that just means we don’t have any sort of connection or no-strings-attached to government, or government-subsidized plans. But, yes, it is still long-term full coverage insurance.”

Ernstberger cut our conversation short, but did say he thought my being bombarded with inquiries gave agents like him a bad name.

But many of the calls came from Ernstberger’s colleagues with USHEALTH, from numbers tied to Michigan, Connecticut, and Florida, the site of a recent lawsuit against another company which customers claim misled them about the kind of plan they bought.

“You see the thing is it’s not our company only that texts you, it’s at least 30 other companies, and that’s at least,” says Dinu Golban, a former USHEALTH employee in Las Vegas who sent me three text messages about health insurance. His first message included the line, “I’m not going to overwhelm you with calls.”

“When you put your information online, this information gets rerouted to almost all insurance companies, independent agents, everyone,” Golban says. “So they call you exactly at the same time, so this is why it gives you the illusion that everyone’s bombarding you, but in reality just most of these guys they don’t know who you’re calling.”

Golban says USHEALTH Advisors was a pretty good place, with bosses who spoke about the ethics of their business, and how to go about selling their insurance products, but it just didn’t work for him financially to stay.

He says he can’t talk about specifics of the plans offered, but they were not short-term insurance, and were not ACA-compliant.

“These plans were flexible. You could always structure them.  And here it was about the ethics of each agent, like in our office they told us about it. Because there were different types of plans. This is why it was a kind of a hybrid insurance plan, I can’t remember the exact name of it, basically you could set a lower deductible, lower the premium, but the coverage would also be lower,” Golban says.

Golban’s experience notwithstanding, USHEALTH has its critics.

“It’s based out of Texas where the insurance rules are a lot more lax than they are in Ohio,” says James Harmon, Managing Principal of Quality Benefits Agency in Cleveland.

“They would sell short-term health insurance products prior to Obamacare, or ACA, and then afterwards, and what their pitch was: look, here’s a great plan—it’s six months prior to the change from the Trump administration—where we’ll give you a high-deductible plan, we’ll cover everything, so it was really designed as a catastrophic policy,” Harmon says. “The problem that occurred, as in all things, is they started having claims, and they started denying coverage and/or not renewing policies.”

USHEALTH defends its products and business operation firmly.

The company’s Senior Vice President of Marketing Bill Shelton sent me an 11-page statement answering a number of my questions about what the company does and doesn’t do.

Here are just a few takeaways:

Shelton in the statement emphasizes many times that the company’s products are fully lawful under state and federal law, including having the products and rates filed with and approved by the Ohio Department of Insurance. He also says the company doesn’t sell stand-alone short-term insurance in Ohio.

The statement also says USHEALTH products are sold by independently contracted agents, but it does have processes to ensure customer understanding. These include, the statement says, rigorous training of agents, detailed brochures and automated documentation sent to applicants, and a 30 day trial period during which a customer can return coverage for a full refund if they’re not satisfied for any reason.

Up until a couple days ago, the Better Business Bureau, listed USHEALTH Advisors as having lost its BBB accreditation in June of last year in part for not adhering to standards of advertising and selling. There are a number of complaints on the BBB website referring to multiple calls, text messages, and voicemails, even when a person says they didn’t request any health information—similar to what I experienced.

"I have been getting repeated calls, texts and voicemails on a daily basis for the past 3 months from different sales agents stating they are calling from US Health Advisors, LLC [sic] about health information that I was requesting," one comment reads. "To set the record straight, I HAVE NEVER REQUESTED ANY SERVICE/RESPONSE FROM US HEALTH ADIVSORS, LLC!!"

In its statement, USHEALTH’s Bill Shelton says the company’s BBB account was transferred from the consumer watchdog's office in Fort Worth, TX, where the insurer is located, to Austin. The BBB office there began processing nationwide complaints against the company, and noticed some agents, who were also customers, were also leaving positive reviews. USHEALTH says it took action to stop the agent reviews, but the BBB still said it found a pattern of consumer misunderstanding of coverage benefits, among other things.

USHEALTH defended itself against the claims, along a number of lines, but still lost its accreditation. The notice of revocation remained on the website until June 29, 2019, one year from the original revocation.

If you go to the BBB site now, it just says USHEALTH Advisors is not accredited.

“The thing that people need to understand about health care is that if there is a dollar to be made, people will try figure out a way to make it,” says Loren Anthes, Public Policy Fellow in the Medicaid Policy Center of the non-partisan Center for Community Solutions, in Cleveland.

“My ultimate hope would be that the State of Ohio does its job in ensuring that if there are consumers that are negatively affected by the opening of this regulation that they step in and protect those consumers,” Anthes says. “And I have no reason to think that they aren’t doing that, or wouldn’t do that.”

Healthcare is plagued by asymmetric information, Anthes says, meaning companies know a lot about the field, and consumers don’t know much at all. And this may be why experts say getting more information is key to protecting yourself from a bad or ill-fitting plan.

“I think it’s education,” Snakovsky says, emphasizing the point. “I think it’s definitely a matter of finding the right team to educate them on the benefits.”

Experts also advise you to complain about questionable policies, or non-stop phone calls—tell politicians and regulators what’s going on. That way they might pay closer attention to problems in the market.

And then the public might pay closer attention the next time the phone rings.