HIV patients get temporary reprieve with lawsuit

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A federal judge has temporarily prohibited three insurance companies from refusing to accept premium payments from a federal program that helps HIV and AIDS patients cover their costs.

U.S. District Judge Brian Jackson issued a two-week restraining order Monday evening, citing the risk of death to people who could lose their insurance coverage. The Baton Rouge-based judge planned a Tuesday hearing to consider a long-term prohibition on the companies.

The order affects Blue Cross and Blue Shield of Louisiana, the Louisiana Health Cooperative and Vantage Health Plan. They are the only companies widely offering insurance coverage across Louisiana through the online marketplace created under the federal health care law.

Blue Cross, the state’s largest health insurer, planned on March 1 to stop accepting payments from unrelated third parties for an individual, citing fraud concerns. The Louisiana Health Cooperative followed suit. Vantage Health Plan said if those companies continue that policy, it will be forced to follow their lead.

Lambda Legal, an HIV/AIDS advocacy group, filed a lawsuit on behalf of John East, who has Blue Cross insurance with premium payments covered by the Ryan White HIV/AIDS program. That program helps more than 2,400 low- and moderate-income people in Louisiana pay for health coverage.

“Given the severe ramifications to Mr. East and other members of his putative class if their insurance coverage is allowed to lapse, the Court is convinced that this order should be issued, thereby ensuring that the status quo is temporarily maintained,” Jackson wrote in his decision.

East said he’s been a Blue Cross policyholder for nearly 30 years. When HIV treatment forced up his premiums five years ago, he started receiving help from the Ryan White fund. Three weeks ago, his AIDS task force caseworker told him Blue Cross was going to stop accepting such payments. He said he can’t afford the $1,306 monthly premium on his own.

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.

Blue Cross denies a discriminatory intent, saying the prohibition will help 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.

Advocacy groups for people with HIV and AIDS say people with Ryan White funds are the largest population that uses third-party payments to cover insurance premium costs.