The Widdershins

Despicable health insurance companies

Posted on: February 13, 2014

keep calm kick blue cross


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.

Maginnis went further and said:

“As an anti-fraud measure, Blue Cross and Blue Shield of Louisiana has implemented a policy, across our individual health insurance market, of not accepting premium payments from any third parties who are not related” to the subscriber…”

Now, Blue Cross and Blue Shield of Louisiana can cite “anti-fraud” all they want and it’s a load of crap and they know it.  As this article from Reuters points out:

Before Obamacare, the 1990 Ryan White Act offered people with HIV/AIDS federal financial help in paying for AIDS drugs and health insurance premiums, especially in state-run, high-risk pools.

And Lucy Cordts of the New Orleans NO/Aids Task Force said:

Starting on October 1, AIDS advocates and others in Louisiana “were enrolling anyone and everyone we could” through the Obamacare exchange.  [Not exactly what I’m sure La Blue wanted to hear!]

However, the truth of the matter, as if we really didn’t know it before, came out as Tom Aswell points out in this article from his blog, Louisiana Voice:

Jessica Stone, a member of U.S. Sen. Mary Landrieu’s staff, in an email to health care advocates, wrote, “BCBS LA told me their decision was not due to the CMS guidance or any confusion (as we thought before) but was in fact due to adverse selection concerns” in an effort by insurers to keep AIDS patients from enrolling in their plans.

As Tom says: “Adverse selection refers to the situation where an insurer attracts patients with chronic conditions and expensive care.”  Nope, La Blue definitely wouldn’t want that to affect their bottom line!

CMS had previously sent out a clarification in December  after their November notice that stated that yes, Ryan White Act funds could be used for premium payments.  That apparently wasn’t enough for La. Blue.  So, in light of this latest brouhaha, CMS has sent out another statement.

In an email sent to WAFB on Monday, a CMS spokesperson stated:

“Federal rules do not prevent the use of Ryan White funds to pay for health care plans.  In fact, CMS issued guidance last week making this clear and encouraging issuers and Marketplaces to accept such payments.  Given the importance of access to care for people with HIV/AIDS, CMS is considering amending those the rules to require issuers to accept these payments.” [Bolding, etc. mine]

Blue Cross Blue Shield of Louisiana (LA Blue) is not an organization made up of stupid people.  I’m sure they employ actuaries, statisticians and other like folk.  They voluntarily chose to offer their insurance products on the federal exchange, knowing that there are over 10,000 PLWH  in the state.  Likewise, CMS employs a lot of smart people.  And further, they control or manage the purse strings of federal health care.  Indeed, they are the big kid on the block when it comes to health care.  LA Blue would be wise not to cross them.

11 Responses to "Despicable health insurance companies"

Tangential, but imagine the kind of mind you have to have to be the lawyer who’s smart enough to tie together (officially third party) Ryan White funds and HIV+ enrollees and realize this was a way to deny them medical care. I’m seeing an earwig with 1400cc of brain.

quixote@1: It’s the same ones who came up with what a friend found out about his BCBS-AL bronze plan. He found out he has diabetes right after he had signed up for the bronze plan. At that time, he thought his health was pretty good so the limits with the bronze plan didn’t bother him. Looking at the brochure for his plan I saw that they would cover his diabetes test strips and lancets if they were filled at one time for his $20 copay. He went to his doctor before the plan became effective and got a script for those items. After his coverage went into effect he went to the pharmacy to get the lancets and strips, they processed it and told him the price was like $300 +. 😯 So, he called Blue Cross to ask about it and they told him that yes he has a $20 copay but that’s for generic drugs and since he has a Bayer Contour test machine, that makes the strips and lancets brand name so the $20 thing does not apply. That cost would be applied toward his deductible of $6350! 👿

Round and round we go.

Oh wow…I’m amazed at the typos and other things I found in here now that I’m looking at it in broad daylight. It’s what I get for trying to write a post and watch the weather plus keep looking out the window at the snow coming down. LOL!

Oh my. It looks like the ole miserymap for flight delays is lit up for the east coast.

This whole mess is just begging for a nice little class action suit. If someone steps forward to take this on, I bet BCBS-LA would quickly find the time to reconsider their actions.

How do these people sleep at night? What is so hard about doing the right thing?

Wow. That test strips story is just jaw-dropping. And yet I’ll bet it’s normal now, in the sense of being the likeliest outcome to expect. 3x 👿 !

Prolix@5: I believe Lambda Legal is looking into some type of legal action and I say go for it!

quixote: I almost had to sit down and laugh because right in the 50-something page booklet it stated that if you used one prescription for both lancets and strips at the same time you would pay one copay. Yet as far as I could tell, there are no such things as generic test strips. There are a ton of testing devices out there by Bayer, Ascensia, OneTouch, Accuchek, etc. Each one requires its own strips to be used with that device. The rep at BCBS-AL did tell my friend that they only covered 3 brands, but then you go back to the brand/generic thing so it was a perfect catch-22.

The strips cost anywhere from a dollar to $1.25 or so for each strip and when you are recently diagnosed as my friend was, you will test frequently. I got the address for the state insurance commission and suggested my friend write them a letter explaining that BCBS was basically lying in their brochures but I don’t think he ever followed through. One good thing was that he was able to find the strips for his device at amazon for about fifty cents a strip. Of course he has to pay that out of his pocket. SMH

Quixote @1 – LOL! What an image, just perfect.

Just thought I’d let you guys know that Nancy Pelosi just came out against Fast Track!!! Thanks to everyone who signed that petition for DFA. I think about 180,000 people ended up doing the same!

mb@9: I got an email about that with Pelosi. Let’s hope they are able to put a stop to this mess.

Boom…boom…boom, another one bites the dust! 🙂

Oh hell..and another one in Ky!

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