HIV patient sues La. insurers

Companies refusing federal Ryan White program funds

A New Orleans man has asked a federal court in Baton Rouge to force the state’s largest health insurer and two others to accept federal payments to help people with HIV/AIDS enroll in Obamacare health plans.

In the lawsuit filed Thursday, John East says Blue Cross and Blue Shield of Louisiana, Vantage Health Plan Inc., of Monroe, and Louisiana Health Cooperative, of New Orleans, illegally discriminate against people with HIV/AIDS and violate the Affordable Care Act by refusing to accept payments from the Ryan White HIV/AIDS Program.

The insurance companies are sentencing East and other low-income HIV/AIDS patients like him to death, he said.

“I have no alternative, no other option for health care. ... I’m just devastated at the fact that I may lose my coverage and access to health care and medication, which will lead to me ultimately becoming ill and dying,” East said.

East, 59, said his two HIV medications cost just more than $1,000 a month. But his other medications bring the total cost of his prescriptions to more than $2,200 a month.

“There’s no way I can afford that,” he said.

Blue Cross spokesman John Maginnis said the company has not received the lawsuit and can’t comment at this point.

The Ryan White program helps low-income people with HIV/AIDS pay for prescription drugs and insurance coverage. The program helps about 2,000 Louisiana residents buy health insurance.

East said the Ryan White payments cover 100 percent of his $1,306 monthly premium at Blue Cross.

Blue Cross will stop accepting accept third-party payments, including Ryan White funds, for individual policies on March 1. The company’s stance is that rejecting third-party payments helps prevent fraud.

For example, some providers and medical equipment suppliers steer patients to specific health plans by paying the premiums. The providers churn out profits by billing the insurers for those patients’ services, driving up the cost of health care for everyone. Blue Cross has suggested the Ryan White program make direct payments to the people covered by the program. But according to the U.S. Health Resources and Services Administration, which oversees the program, direct payments to the people who get the services are not allowed under any circumstances.

East is represented by Lambda Legal, a nonprofit advocacy group for gay, bisexual and transgender people and those living with HIV/AIDS. Louisiana and North Dakota are the only states where private insurers won’t accept Ryan White payments for Obamacare coverage, according to Lambda. The organization has yet to file a lawsuit against North Dakota Blue Cross Blue Shield.

Lambda had previously filed administrative complaints with the U.S. Department of Health and Human Services Office of Civil Rights against Blue Cross, the co-op and Vantage over their refusal to accept the Ryan White payments. The three insurers, along with Humana, are the only companies to offer coverage through the online federal insurance marketplace. Humana accepts third-party payments, but its Obamacare offerings are available only in Jefferson Parish.

Lambda and East plan to ask the court to force the insurance companies to accept the Ryan White payments while the lawsuit makes its way through the judicial process.

“The situation is urgent. People living with HIV need health care,” said Scott Schoettes, Lambda HIV project director. “They need consistent access to health care and uninterrupted access to their medications, so we need to take action now to prevent the illegal conduct that’s going on.”

Schoettes said the Affordable Care Act was designed to get everyone into the insurance pool. The legislation wasn’t designed to allow insurance companies to trim their rolls of people living with HIV, whose care is more expensive, he said.