AIDS/HIV

Health Insurers Rejecting Checks From AIDS Patients Under Obamacare

AIDS and HIV patients in Louisiana who have insurance under Obamacare are in danger of losing their coverage as Blue Cross Blue Shield of Louisiana begins rejecting checks over fraud concerns.

BCBS of Louisiana says it can’t accept checks from a federal program designed to help HIV/AIDS patients pay for medical care, called the Ryan White CARE Act, Reuters reported.

As BCBS interprets their responsibility for preventing fraud under the Affordable Care Act, the insurance provider says they’re not allowed to accept third party checks from anyone not related to the patient.

The Centers for Medicare and Medicaid Services (CMS) said in September that Ryan White funds could be used to pay Obamacare premiums, but in November it warned that “hospitals, other healthcare providers, and other commercial entities” have “significant concerns” accepting Ryan White payments because of the risk of fraud.

"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, BCBS of Louisiana spokesman John Maginnis told Reuters.

"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,” he said.

A CMS spokeswoman, Tasha Bradley, told Reuters Friday that BCBS is mistaken.

"The third-party payer guidance CMS released (in November) does not apply to" Ryan White programs, Bradley said.

White grantees, "may use funds to pay for premiums on behalf of eligible enrollees in Marketplace plans, when it is cost-effective for the Ryan White program," meaning it could save the government money.

Hundreds of patients are enrolled in the Ryan White program and are not eligible for Medicaid in Louisiana because the state refused to expand the low-income program.

Healthcare advocates worry that the refusal to take Ryan White checks is an effort to keep AIDS patients from enrolling with BCBS.

The insurer says this is untrue.

"We welcome all Louisiana residents who chose Blue Cross and Blue Shield of Louisiana," said Maginnis.

"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," a healthcare expert from Louisiana Sen. Mary Landrieu’s staff told Reuters in an email. "I have also recently learned North Dakota's BCBS plan has implemented the same policy."

Sources: Reuters, New York Times

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