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Archive for February 13th, 2014

keep calm kick blue cross

NOTE:  I’M FILLING IN FOR CHAT TODAY.  BECAUSE OF THAT
I WON’T BE DOING A SATURDAY LIGHT FARE POST

Blue Cross and Blue Shield of Louisiana agreed to participate in the health exchange for the A.C.A.  While La. did not create a state exchange, their policies were available on the federal exchange.  Now at this point I’m pretty sure that we all know that one of the things with the A.C.A. is that insurance companies cannot discriminate against anyone that has a pre-existing condition.  So, if you are an insurance company and you see that people with HIV/AIDS are starting to enroll in your healthcare plans you need to find a way to, shall we say, “discourage” them from doing so, since we know that treating PLWH (People Living with HIV/AIDS) can cost some serious money.  With plans purchased on the healthcare exchange, the most an individual can be responsible for in a calendar year is $6350 for the individual.  Anything after that, again in a calendar year, is picked up by the insurance company.  Now, $6350 is a goodly chunk of change for an individual to be responsible for, but for an HIV+ individual, I’m guessing that number can be reached rather quickly.  So what to do with those damned HIV+ folks if you are an insurance company who can’t deny them coverage based solely on their health condition?  You are going to look for any and every way you can to try to stop covering them and BCBS-LA found a way in a directive sent out by CMS, the Centers for Medicare and Medicaid Services, a part of DHH.

Back in November of last year, CMS sent out a directive concerning third-party payments because of the possibility of fraud.

The November 2013 directive warned “hospitals, other health care providers and other commercial entities” not to accept third-party payments because of fraud risks, just months after the agency told insurers that they could accept Ryan White funds “to cover the costs of private health insurance premiums, deductibles and co-payments”

Soon, I’m sure heads were bent towards each other in Baton Rouge as BCBS-LA folks said “this is sooo great because now we have an excuse to kick those PLWH folks off our rolls”.  You see, some PWLH are able to get part or all (I’m not sure) of their health insurance premiums paid by Ryan White Act funds.  Part of the monies from the Act are given as grants to the states and the states in turn can give the grants to local organizations and those local organizations can, in turn, use the money to help pay for insurance premiums for folks.

Part B grants fund core medical services and support services. Core medical services include outpatient and ambulatory health services, ADAP, AIDS pharmaceutical assistance, oral health care, early intervention services, health insurance premium and cost-sharing assistance, home health care, medical nutrition therapy, hospice care, home and community-based health services, mental health, outpatient substance abuse care, medical case management, and treatment adherence services.

So, the “thinking heads” at Blue Cross said “aha, we have our out!” and issued this statement:

“In no event will coverage be provided to any subscribers, as of March 1, 2014, unless the premiums are paid by the subscriber (or a relative) unless otherwise required by law,” Blue Cross Blue Shield of Louisiana spokesman John Maginnis told Reuters.

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