- Associated Press - Wednesday, February 19, 2014

BATON ROUGE, La. (AP) - People in Louisiana with HIV or AIDS are facing roadblocks in getting health insurance through the online marketplace created under the federal health law.

Most companies offering insurance plans for Louisiana residents through the marketplace say they won’t accept payment from a federal program that helps low- and moderate-income HIV and AIDS patients cover their health costs.

Estimates are that up to 3,000 people in Louisiana could be affected by the policy.

The decision started with the largest insurer offering coverage to Louisianians through the federal marketplace: Blue Cross and Blue Shield of Louisiana.


Blue Cross spokesman John Maginnis said the company on March 1 will stop accepting payments from unrelated third parties for an individual, because of fraud concerns. The Louisiana Health Cooperative followed suit. Vantage Health Plan says if those companies continue that policy, it will be forced to follow their lead.

Only one other company offers insurance plans in Louisiana through the marketplace - and only in one parish.

People living with HIV and AIDS accuse the companies of discrimination, saying it appears designed to keep costly patients from insurance programs and to get around language in federal law that prohibits insurers from denying coverage based on pre-existing conditions.

“It’s a smoke screen so that they will not accept individuals with high rates of medical costs. We have to stop this,” John G. Simms, a New Orleans resident with HIV, told the Louisiana Commission on HIV, AIDS and Hepatitis C this week.

Lambda Legal, an organization that advocates for people with HIV and AIDS, has filed complaints with federal officials about the insurance companies’ policy.

Earlier this month, Blue Cross announced that only the policyholder, an immediate relative or a legal guardian can pay an individual’s insurance premium, beginning in March.

That decision prohibits payments for insurance coverage from the Ryan White HIV/AIDS program, which advocate groups say is the largest source of public funds available to help pay for health coverage for people with HIV.

Guidance recently issued by the federal Centers for Medicare and Medicaid Services encouraged health plans to accept the Ryan White program payments, but insurance companies say the law doesn’t require it.

In a statement, Maginnis said the prohibition is designed to ensure that people aren’t being steered by a third-party payer to a specific product or health provider, to combat attempts to defraud the system.

“We are applying this policy across the board to all individual members, regardless of their health status, type of plan purchased or previous method of paying for their health care coverage,” he said.

But Moriba Karamoko, director of the Louisiana Consumer Healthcare Coalition, said people with Ryan White funds are the largest population that uses third-party payments to cover insurance premium costs.

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