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Lambda Legal sues to force La. insurers to accept premiums for HIV patients

Friday, February 21, 2014
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NEW ORLEANS — Lambda Legal said in a lawsuit Thursday that an insurance company is violating the Affordable Care Act by refusing to take premium payments from a federal program that helps HIV and AIDS patients pay for care.

The legal advocacy group, which represents LGBT people and those with HIV or AIDS, filed the suit in a Baton Rouge federal court.

medical-treatmentLambda Legal earlier filed complaints with federal agencies after Blue Cross and Blue Shield of Louisiana said it would stop taking payments March 1 from unrelated third parties such as the White program.

The Louisiana Health Cooperative said it also would stop taking such payments and a third company, Vantage Health Plan, says it’s considering doing so. All three are named as defendants.

More than 2,400 people in Louisiana were getting help from the federal Ryan White HIV/AIDS program as of Jan. 7, said Olivia Watkins, spokeswoman for the state Department of Health and Hospitals.

Blue Cross and Blue Shield of Louisiana spokesman John Maginnis said the company had not seen the lawsuit Thursday. In a prepared statement, he said the company was concerned about fraud and that the policy change is meant to ensure that third-party payers don’t steer people to a specific product or health provider.

The U.S. Department Of Health and Human Services said in November that insurers should reject third-party payments from businesses such as hospitals or healthcare providers. But that does not apply to state and federal programs such as the Ryan White HIV/AIDS program, or to qualified health plans for people enrolled through Indian tribes or urban Indian organizations, officials said in a Feb. 7 clarification.

“Even after CMS repudiated BCBS’s sole justification for refusing these payments, BCBS did not acknowledge its misinterpretation – or mischaracterization – of the earlier guidance and did not resume its longstanding policy to accept Ryan White HIV/AIDS Program payments,” a draft of the lawsuit said.

Lambda Legal said it filed the suit in an effort to keep the three companies with the widest reach among those in Louisiana’s insurance exchange from following through on an announced policy change scheduled to take effect March 1.

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It violates Affordable Care Act provisions against denying insurance to people with pre-existing conditions, said Lambda Legal attorney Scott Schoettes

“The situation is dire. That’s why we’re asking for emergency relief,” said Schoettes. “These people need consistent care and uninterrupted access to their medicines.”

The Ryan White program is the largest third-party plan. “We’re not aware of any other third-party payer that is focused on a particular population with a disability, and where we’re looking at federal funds that have been earmarked for decades now to make insurance affordable,” said Lambda Legal attorney Susan Sommer.

Nearly 19,400 people in Louisiana were living with HIV or AIDS at the end of 2013, Louisiana’s Department of Health and Hospitals estimates.

Associated Press contributed to this report.

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