Jill Goodridge was shopping for affordable health insurance when a friend told her about O'NA HealthCare, a low-cost alternative to commercial insurance.
The self-described "health care cooperative" promised a shield against catastrophic claims. 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 company promises 24/7 telemedicine and holistic dental care on its website. It says it provides more nontraditional options than "any other health care plan," including coverage for essential oils, energy medicine and naturopathic care. All of that and conventional care, too.
It struck Goodridge as innovative. She signed up for a high-deductible plan, paying more than $9,000 in premiums and fees over 13 months, she said. Yet she could not get O'NA to cover her family's medical bills. For example, O'NA applied only a small portion of more than $6,000 in hospital-related bills against her $10,000 deductible.
"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.
A yearlong investigation by the state insurance agency prompted by her complaint concluded she was right, uncovering a business scheme operating in the gray areas of insurance regulation and tribal law to appeal to patients looking to save money on health care.
Hers is a cautionary tale for anyone looking for cut-rate coverage at a time when the cost of commercial insurance is rising and a wide range of alternatives are on offer.
Tempting low premiums may mean skimpy coverage with huge out-of-pocket expenses.
"Health insurance is getting so expensive people are looking for other options," Maine insurance Superintendent Eric A. Cioppa said. "We tell everybody that if you do business over the internet to call us first and make sure it's licensed."
O'NA stood out, with a polished website featuring its story of holistic health and sun-dappled photographs. The sales pitch: "We're here to guide you to a new way for your mind, body, and soul."
Goodridge felt led astray.
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 of state or federal law. 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.
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.
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."
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. That tribe is not one of the three federally recognized Cherokee tribes.
But the troubles with O'NA went deeper than that, Cioppa and his team discovered during a year-long investigation. 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.
"The more we found out," Cioppa said, "the more we wanted to keep digging."
