Louisiana Health Insurers OK Third-Party Payers Through Nov. 15

March 12, 2014

The three major companies in Louisiana offering coverage through the federal insurance exchange have agreed to continue to accept premium payments through Nov. 15 from a program that helps HIV/AIDS patients cover their health care costs.

The Advocate reports the agreement was struck at a hearing during which U.S. District Judge Brian Jackson considered a long-term injunction that would have prevented the insurers from refusing to accept payments from the Ryan White HIV/AIDS Program.

“This will maintain critical health care coverage for lower-income Louisianians living with HIV through the current insurance plan year,” said Scott Schoettes, senior attorney and HIV National Project director at Lambda Legal, a national organization that advocates for the rights of HIV/AIDS victims, gay men, lesbians and transgender people.

The three insurers – Blue Cross and Blue Shield of Louisiana, Vantage Health Plan Inc. of Monroe and Louisiana Health Cooperative of New Orleans – had promised earlier to continue accepting the payments until March 31, which is when open enrollment ends.

The next open enrollment period begins Nov. 15.

“There was a Sword of Damocles hanging over our client and other Louisianians, with these insurers having previously indicated that in just three weeks they would stop accepting the federal Ryan White Program insurance premium subsidies that enabled many people living with HIV to afford life-saving health coverage,” Schoettes said.

John East, represented by Lamda Legal, filed a lawsuit last month against the insurers, alleging the organizations illegally discriminated against people with HIV/AIDS and violated the Affordable Care Act by refusing to accept premium payments from the program.

East, who is insured through Blue Cross and Blue Shield, has a monthly premium of $1,306, which he cannot afford without the federal funds.

Blue Cross announced in February it intended to stop accepting third-party payments, including Ryan White funds, for individual policies in an effort to deter fraud.

A Vantage Health Care spokesman subsequently confirmed the smaller companies would have to follow Blue Cross’s lead, and resource centers for HIV/AIDS reported Louisiana Health Cooperative also stopped accepting the payments.

Before the deal was struck Monday, Jackson expressed skepticism about the insurers’ claims that the policy change was made to protect them from fraud.

“It seems disingenuous, like there may be other motives going on here other than fraud,” he said, noting that he had not seen any evidence of fraud in the Ryan White program. “From a business perspective, you’re concerned about fraud and rightfully so, but where is the fraud in the Ryan White program?”

Anthony Shelley, an attorney representing Blue Cross, told the court that the federal Center for Medicare and Medicaid Services is expected to issue an emergency rule regarding third-party payments this week. He said the rule could either make the case moot, or change the legal arguments surrounding the case.

Shelley, as well as the attorneys representing the other two companies, said the insurers would abide by the law if CMS mandated they accept the payments. But he said it’s also possible the new rule could favor their clients’ current position.

The attorney’s from both sides agreed to meet within 45 days of the issuance of the pending CMS rule to determine if they can come to a consensus.

“We wanted to have a temporary solution to the litigation where all the parties can sort out what CMS says,” Shelley said after the hearing. “This is an amicable way to deal with the situation.”

 

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