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Lambda Legal Sues Blue Cross Louisiana for Not Accepting the federally-funded premium subsidies/Ryan White that enable low-income Louisianans living with HIV to purchase health insurance
  "Blue Cross-Blue Shield is leading the way toward freezing low-income people with HIV out of the private insurance market and leaving them with no options," Sommer said.
lawsuit Lambda Legal filed yesterday against BlueCross Blue Shield and two other health insurance companies in Louisiana:
Group sues to force insurers to take AIDS money
Associated Press February 20, 2014
NEW ORLEANS - An advocacy group said in a lawsuit Thursday that an insurance company is violating the Affordable Care Act by refusing to take premium payments from a federal program that helps HIV and AIDS patients pay for care. Lambda Legal, which represents gay, lesbian, transgendered and bisexual people and those with HIV or AIDS, filed the suit in a Baton Rouge federal court. Plaintiff John East said he has been a Blue Cross policyholder for nearly 30 years. When HIV treatment sent his premiums up to $650 a month about five years ago, he learned he could get help from the Ryan White fund. Without insurance, he would have to pay $1,306 a month for his medicine. But three weeks ago, he said, his AIDS task force caseworker called to tell him Blue Cross was going to stop accepting such payments.
"I am a contributing member of society. I vote. I pay taxes. I obey our laws," said East, 59, who is represented by Lambda Legal attorney Scott Schoettes. East said he now works part-time at a bed and breakfast, but was a Navy medical corpsman during the Vietnam era and, after an honorable discharge, spent 30 years in medical billing and collection.
"It's difficult to stand here and expose my privacy to discrimination and ridicule," but the suit is essential for him and others living with HIV or AIDS, he said at a news conference Thursday.
More than 2,400 people in Louisiana were getting help from the Ryan White program as of Jan. 7, said Olivia Watkins, spokeswoman for the state Department of Health and Hospitals.
Blue Cross and Blue Shield of Louisiana spokesman John Maginnis said the company had not seen the lawsuit Thursday. In a prepared statement, he said the company was concerned about fraud and that the policy change is meant to ensure that third-party payers don't steer people to a specific product or health provider.
The U.S. Department Of Health and Human Services said in November that insurers should reject third-party payments from businesses such as hospitals or healthcare providers. But that does not apply to state and federal programs such as the Ryan White HIV/AIDS program, or to qualified health plans for people enrolled through Indian tribes or urban Indian organizations, officials said in a Feb. 7 clarification.
"Even after CMS repudiated BCBS's sole justification for refusing these payments, BCBS did not acknowledge its misinterpretation - or mischaracterization - of the earlier guidance and did not resume its longstanding policy to accept Ryan White HIV/AIDS Program payments," a draft of the lawsuit said.
Lambda Legal confirmed Thursday night that the lawsuit had been filed. The advocacy group filed the suit in an effort to keep the three companies with the widest reach among those in Louisiana's insurance exchange from following through on an announced policy change scheduled to take effect March 1. It violates Affordable Care Act provisions against denying insurance to people with pre-existing conditions, Schoettes said.
"The situation is dire. That's why we're asking for emergency relief," said Schoettes (SHOT-uhs). "These people need consistent care and uninterrupted access to their medicines."
Lambda Legal earlier filed complaints with federal agencies after Blue Cross/Blue Shield of Louisiana said it would stop taking payments March 1 from unrelated third parties for individuals. The Louisiana Health Cooperative followed. Vantage Health Plan said that if Blue Cross makes the change, it will have to follow suit. All three are plaintiffs.
The Ryan White program is the largest third-party plan. "We're not aware of any other third-party payer that is focused on a particular population with a disability, and where we're looking at federal funds that have been earmarked for decades now to make insurance affordable," Lambda Legal attorney Susan Sommer said in an earlier phone interview.
East said the company never notified him about the policy change, but did send him a bill.
Only the District of Columbia and Maryland had higher rates of new HIV and AIDS diagnoses than Louisiana in 2011, according to The Centers for Disease Control and Prevention, though at least two other states had higher rates of people living with HIV.
Nearly 19,400 people in Louisiana were living with HIV or AIDS at the end of 2013, Louisiana's Department of Health and Hospitals estimates.
"Blue Cross-Blue Shield is leading the way toward freezing low-income people with HIV out of the private insurance market and leaving them with no options," Sommer said.
Lambda Legal Files Federal Lawsuit Against Louisiana Insurers for Dumping People with HIV
"This discriminatory policy keeps low-income people living with HIV off of BlueCross BlueShield's insurance rolls, perpetuating the deliberate insurance industry practice of denying coverage to those living with HIV."
Date: 02/20/2014
(New Orleans, LA, February 20, 2014) - Lambda Legal today filed a federal class action discrimination lawsuit in U.S. District Court for the Middle District of Louisiana against BlueCross BlueShield of Louisiana (BCBS), which will no longer accept the federally-funded premium subsidies that enable low-income Louisianans living with HIV to purchase health insurance. Two other insurers included as defendants-Louisiana Health Cooperative and Vantage Health Plan-are also following the lead of Louisiana's largest insurer, BCBS. Lambda Legal is seeking an emergency injunction to force all three defendants to accept the premium payments and to provide health insurance until the lawsuit is heard. "The situation is urgent. Refusing federal funds that provide life-saving care to people living with HIV could potentially affect thousands of low-income Louisiana residents," said Scott Schoettes, HIV Project Director at Lambda Legal. "This discriminatory policy keeps low-income people living with HIV off of BlueCross BlueShield's insurance rolls, perpetuating the deliberate insurance industry practice of denying coverage to those living with HIV that the Affordable Care Act was designed to reverse. Continuous coverage is critical for people living with HIV. The health care crisis these insurers have created must be stopped."
Lambda Legal filed today's lawsuit on behalf of John East, a part-time worker in the hospitality industry, and other low-income Louisianans living with HIV. East, a 59-year-old New Orleans man insured by BCBS for nearly 30 years, learned in mid-January that BCBS would no longer accept the federal Ryan White subsidies for which he qualifies. Without the subsidies, East will not be able to afford his medical care and HIV medications. Lambda Legal's lawsuit follows earlier efforts-including complaints filed with the U.S. Department of Health and Human Services Office of Civil Rights-to persuade the insurers to continue accepting federal Ryan White premium subsidies. The New Orleans AIDS Task Force is assisting in this advocacy.
"I couldn't believe it when I was told BCBS would no longer accept my Ryan White insurance subsidies," East said. "What am I supposed to do now? I've been with BCBS for 29 years. I paid my premiums that whole time, and now they are finding a way to dump me just because I'm living with HIV. I need these medications to stay healthy, so that I can continue to work and contribute to my community." The Louisiana Ryan White Health Insurance Program is a federally-funded program that functions as the payer of last resort, helping low-income individuals living with HIV purchase health insurance they could not otherwise afford. Beginning this month, BCBS of Louisiana abruptly stopped accepting Ryan White premium subsidies, from current policyholders and new enrollees alike. Lambda Legal sent a letter to BCBS of Louisiana on January 27, 2014, asking that the insurance provider reverse its policy change and resume accepting Ryan White premium subsidies or explain the rationale for its abrupt and harmful policy shift. Lambda Legal requested a response by January 30, 2014, but BCBS of Louisiana never responded.
Lambda Legal attorneys Kenneth Upton, Scott Schoettes and Susan Sommer are handling the case, joined by pro-bono co-counsel Jeffrey J. Bushofsky, Timothy R. Farrell, Amanda R. Phillips, and Anthony C. Biagioli of Ropes & Gray LLP; and Harry Rosenberg of Phelps Dunbar LLP. AIDSLaw of Louisiana is also assisting with advocacy in this matter.
The case is East v. BlueCross BlueShield of Louisiana. A Link to the complaint is here:
Contact Info
Tom Warnke, Cell: 213-841-4503: Email:
: Health Care Fairness

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