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Author Topic: Four Insurers Accused of Discriminating Against People With H.I.V.  (Read 2298 times)

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Offline Joe K

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From the New York Times today:

"Health care advocates said on Thursday that four insurers offering plans in the new federal marketplace discriminated against people infected with H.I.V. and AIDS by requiring them to pay high out-of-pocket costs for drugs to treat H.I.V., including generic medications.

Two groups, the AIDS Institute and the National Health Law Program, filed a complaint on Thursday with the Department of Health and Human Service’s Office for Civil Rights, saying that the insurers violated a provision in the new health care law that bars companies from discriminating against consumers because of their medical conditions. They said that the insurers subjected people infected with H.I.V. to restrictions on medications that most patients take daily to keep the virus in check.

“The companies are going out of their way to discourage people with H.I.V. and AIDS from enrolling in their plans — a blatantly illegal practice,” Wayne Turner, a staff attorney with the National Health Law Program, said in a statement.

The complaint claims that the four insurers — CoventryOne, Cigna, Humana and Preferred Medical — placed H.I.V. drugs on the highest payment tier for midlevel, or silver, plans on the federal health insurance exchange in Florida.

CoventryOne, for example, placed every H.I.V. drug, including generics, on the most restrictive tier, meaning that consumers were required to exhaust a $1,000 deductible and were then asked to contribute 40 percent toward the cost of their drugs, the groups said. Similarly, Humana requires that members spend their $1,500 deductible and then contribute 50 percent, they said. Many of the plans, the groups said, also placed other requirements on the drugs, like advance authorization by a doctor or a limit of a 30-day supply.

CoventryOne, which is owned by Aetna, did not respond to a request for comment, and Preferred Medical could not be reached for comment.

Karen Eldred, a spokeswoman for Cigna, said the company’s H.I.V. drug coverage was in line with accepted medical practice. She noted that Cigna, like many other insurers, offers an array of plans in the federal marketplaces, including some that offer more comprehensive coverage.

A spokesman for Humana, Alex Kepnes, also noted that patients have different plan options, with varying levels of coverage, and that drugs for other diseases like rheumatoid arthritis and multiple sclerosis were also placed on a high payment tier.

Insurers have been asking consumers to pay more for the most expensive so-called specialty drugs, a trend that only accelerated in the new marketplaces as insurers competed fiercely to keep premiums low. Patients with serious conditions, like cancer or rheumatoid arthritis, are finding that their pharmacy bills are skyrocketing.

But the health care groups said that what made this case different was that not every insurer placed such across-the-board restrictions on H.I.V. drugs.

“What is unique here is that it’s every single drug, no matter whether it is generic or not,” said Carl Schmid, deputy executive director of the AIDS Institute. “Other plans don’t do this for H.I.V., and that’s why we’re proving that it’s discrimination.”

Other insurers offering silver plans in Florida’s marketplace, including Florida Blue, Ambetter and Molina, offered more generous coverage, with most out-of-pocket costs ranging from $10 to $25 per prescription, often after meeting a deductible, the groups said.

Mr. Schmid said many people with H.I.V. and AIDS welcomed the arrival of the new health care act because it meant that they would have access to insurance after years of being shut out; before the law took effect, insurers could deny coverage to people with existing medical conditions like H.I.V.

But he said some patients were shocked when, newly covered, they were asked to pay pharmacy bills of up to $1,000 a month, in addition to the premiums they were already paying.

Under the new health care law, out-of-pocket costs cannot exceed $6,350 per year, and some people with H.I.V. and AIDS can get assistance for out-of-pocket costs through the federal Ryan White Program. But help is limited to those whose income falls below certain levels, which vary by state.

Mr. Schmid said that has left many consumers on their own. He noted that even a few hundred dollars a month could deter some patients from getting the treatments they needed. He said there was also a public health concern, since patients who are taking their medications regularly are less likely to spread the virus to others."

Joe

Offline GoForIt

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Re: Four Insurers Accused of Discriminating Against People With H.I.V.
« Reply #1 on: May 29, 2014, 04:09:21 PM »
Really sucks that this is going on which might deter people from being able to get treated.

Luckily I am with Florida Blue which was noted in this article as being really good.
08/09/2013   Diagnosed WB positive
08/20/2013   CD4-506(28%)  VL-10,800
09/12/2013   CD4-391(28%)  VL-14,900
09/17/2013   Start ART (Truvada & Tivicay)
10/11/2013   CD4-377(26%)  VL-UD
12/20/2013   CD4-590(??%)  VL-UD
03/18/2014   CD4-660(29%)  VL-UD
07/22/2014   CD4-613(29%)  VL-UD
08/01/2014    Start TAF Clinical Trial
10/09/2014   CD4-498(29.5%) VL-UD

Offline mecch

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Re: Four Insurers Accused of Discriminating Against People With H.I.V.
« Reply #2 on: May 29, 2014, 04:13:19 PM »
Similarly, Humana requires that members spend their $1,500 deductible and then contribute 50 percent, they said.

And typing this note I am also watching The Normal Heart in another window.

Jesus Christ plus ca change plus c'est la meme chose.

“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline AusShep

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Re: Four Insurers Accused of Discriminating Against People With H.I.V.
« Reply #3 on: May 29, 2014, 04:15:43 PM »
But he said some patients were shocked when, newly covered, they were asked to pay pharmacy bills of up to $1,000 a month, in addition to the premiums they were already paying.

I guess these were all people who've never had insurance before?  I can't imagine having a condition needing $2,500 in meds a month and not checking that the drugs are covered and payment tiers.

Offline mecch

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Re: Four Insurers Accused of Discriminating Against People With H.I.V.
« Reply #4 on: May 29, 2014, 04:19:14 PM »
It's an obscene rip-off of ignorant consumers, and discriminatory practice to those who knew to avoid these policies, and its enraging! 
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline mitch777

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Re: Four Insurers Accused of Discriminating Against People With H.I.V.
« Reply #5 on: May 29, 2014, 04:20:34 PM »
It's an obscene rip-off of ignorant consumers, and discriminatory practice to those who knew to avoid these policies, and its enraging! 

THIS! ^
32 years hiv+ (oct. 2013) with a curtsy.

Offline Dachshund

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Re: Four Insurers Accused of Discriminating Against People With H.I.V.
« Reply #6 on: May 29, 2014, 04:36:11 PM »
I guess these were all people who've never had insurance before?  I can't imagine having a condition needing $2,500 in meds a month and not checking that the drugs are covered and payment tiers.

I have a condition (HIV) that require meds that cost 2100 a month. I did my due diligence before I chose an insurance policy through the ACA. I checked with all the providers about what was covered and the costs when it came to meds. All of them provide literature listing drugs and what tiers they fall under. Unfortunately none of them had any HIV drugs on the list. It really came down to a roll of the dice and I went with Blue Cross. Thankfully Ryan White picks up the cost of my meds because I doubt I could afford it. I'm spending this year getting everything checked, colonoscopy, etc, all my preventatives. You never know when this might get yanked out from under me.

Offline Jeff G

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Re: Four Insurers Accused of Discriminating Against People With H.I.V.
« Reply #7 on: May 29, 2014, 04:52:09 PM »
I have a condition (HIV) that require meds that cost 2100 a month. I did my due diligence before I chose an insurance policy through the ACA. I checked with all the providers about what was covered and the costs when it came to meds. All of them provide literature listing drugs and what tiers they fall under. Unfortunately none of them had any HIV drugs on the list. It really came down to a roll of the dice and I went with Blue Cross. Thankfully Ryan White picks up the cost of my meds because I doubt I could afford it. I'm spending this year getting everything checked, colonoscopy, etc, all my preventatives. You never know when this might get yanked out from under me.

I urge everybody to click the link at the bottom of Dachs page ... nuff said .

Offline AusShep

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Re: Four Insurers Accused of Discriminating Against People With H.I.V.
« Reply #8 on: May 29, 2014, 05:04:26 PM »
I have a condition (HIV) that require meds that cost 2100 a month. I did my due diligence before I chose an insurance policy through the ACA. I checked with all the providers about what was covered and the costs when it came to meds. All of them provide literature listing drugs and what tiers they fall under. Unfortunately none of them had any HIV drugs on the list. It really came down to a roll of the dice and I went with Blue Cross. Thankfully Ryan White picks up the cost of my meds because I doubt I could afford it. I'm spending this year getting everything checked, colonoscopy, etc, all my preventatives. You never know when this might get yanked out from under me.

Yeah, more individual State vs. Federal exchange nonsense I guess.  They did make it easy to check drug coverage.  I helped people look at several plans in TX.  They all covered all of the HIV drugs, and almost exclusively at a middle pricing copay tier.  I don't think any of the bronze plans had Rx coverage before hitting a deductible amount, but there were silver plans without a separate Rx/regular deductible before coverage.

Online zach

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Re: Four Insurers Accused of Discriminating Against People With H.I.V.
« Reply #9 on: May 29, 2014, 05:06:18 PM »
edited, my math was wrong

« Last Edit: May 29, 2014, 05:12:06 PM by zach »
gonna go up to the mountain, for to find a little peace
looking over the valley, for the beauty i see
out across the hills, forevermore

Offline mitch777

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Re: Four Insurers Accused of Discriminating Against People With H.I.V.
« Reply #10 on: May 29, 2014, 05:11:40 PM »
 
Posts: 909
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Re: More on mail order

« Reply #4 on: Today at 11:01:56 AM »

in the last couple days, my fathers insurance company has deemed some of his heart medication specialty meds too

it ain't just us they want to do this too. i see an attempt at a big shift coming in how meds are distributed

The above is a quote from Zach on another related topic. I see BOTH of these as topics being intertwined. $$$ and Greed without concern or regulation. The hen house door is wide open.








32 years hiv+ (oct. 2013) with a curtsy.

Online zach

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Re: Four Insurers Accused of Discriminating Against People With H.I.V.
« Reply #11 on: May 29, 2014, 05:38:03 PM »
Re: More on mail order
« Reply #4 on: Today at 11:01:56 AM »

in the last couple days, my fathers insurance company has deemed some of his heart medication specialty meds too

it ain't just us they want to do this too. i see an attempt at a big shift coming in how meds are distributed
-------

The above is a quote from Zach on another related topic. I see BOTH of these as topics being intertwined. $$$ and Greed without concern or regulation. The hen house door is wide open.

to add to that earlier post you quoted, my father has coventry, and they want him to mail order his meds now, surprise surprise. i spoke to the lady, i know when someone is trying to con me, and it pisses me off when they try to con elderly family. she said she wanted him to be able to take advantage of cost savings using mail order. i asked how he would be saving any money, he'd be paying the same co-pay. sputter sputter
« Last Edit: May 29, 2014, 05:40:09 PM by zach »
gonna go up to the mountain, for to find a little peace
looking over the valley, for the beauty i see
out across the hills, forevermore

Offline mitch777

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Re: Four Insurers Accused of Discriminating Against People With H.I.V.
« Reply #12 on: May 29, 2014, 05:46:29 PM »
to add to that earlier post you quoted, my father has coventry, and they want him to mail order his meds now, surprise surprise. i spoke to the lady, i know when someone is trying to con me, and it pisses me off when they try to con elderly family. she said she wanted him to be able to take advantage of cost savings using mail order. i asked how he would be saving any money, he'd be paying the same co-pay. sputter sputter

They never get that cost saving explanation down. lol.

Oh, and I just got a letter of "request" 2 days ago from Anthem that kindly asked that I consider getting all of my meds from the mail order pharmacy that I already despise. Ya, right.
32 years hiv+ (oct. 2013) with a curtsy.

Offline vertigo

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Re: Four Insurers Accused of Discriminating Against People With H.I.V.
« Reply #13 on: May 29, 2014, 05:48:24 PM »
Problems with insurers are par for the course.  You should see the fights my partner has to go thru with his mother's crappy Medicare supplemental plan.  I'm very glad we have these watchdog advocacy groups, though.  Hard to battle the big companies on your own.

What would really be nice is to have better pricing on the meds.  I think both patients and insurers might agree on that point.

Yeah Zach, your Dad's experience somewhat like my own.  Switching my Truvada to mail order didn't reduce the co-pay.  The savings are all being retained upstream.

Offline mecch

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Re: Four Insurers Accused of Discriminating Against People With H.I.V.
« Reply #14 on: May 29, 2014, 06:00:00 PM »
The for-profit insurers deserve the shame and hopefully a legal correction here.  However its somewhat to be expected as thats what many businesses do - screw everyone and anyone as far as they can get away with it, to make the revenues and pay their executives and if public their shareholders...

It bears mentioning in this discussion that the drugs are too damned expensive and even the rich countries are straining.  If tomorrow you doubled the number of people on HIV treatment in the USA, there has to be a new model to pay for that. Say if there were a million prescriptions out there. And THERE REALLY SHOULD BE.

Truvada is a MAJOR expense to Swiss insurers and thus to all the population paying their premiums..

In the USA the insurers have got to be held to the spirit and law of the ACA.  And the governments have got to figure out a way to negotiate to get these prices down from big pharma....   I say this as I am now 1.5 hours into Normal Heart and it is ALL coming back to me...   

HIV is an epidemic and there is such a good response to it, great treatment, and business and governments are still fucking dicking around....  What a colossal loss and shame.
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline Theyer

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Re: Four Insurers Accused of Discriminating Against People With H.I.V.
« Reply #15 on: May 29, 2014, 06:32:29 PM »
A friend who is an economist , working freelance for both Government and Private sector was discussing a debate he was involved in about future funding re,health care. Basically future thinking for those concerned in all things financial and medical. He said that there is a lot off thinking around "Preventable illness" and "Fate illness" those who are deemed to contribute by "Life style Choices" would be expected to pay higher costs at all levels . The groups who fell into this catergory where weight linked, Smoking, Drink/drugs and HIV .

Remember this is a group off academics discussing future trends . but I do for see if things are deemed to be tighter this will come up. This off course would be preferable to Drug companies as it deflects argument from price,s set by them.

In some respects this is already happening as Private medical insurance in UK is more expensive for smokers I do not know about weight and other factors.
"If we can find the money to kill people, we can find the money to help people ."  Tony Benn

Offline mecch

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Re: Four Insurers Accused of Discriminating Against People With H.I.V.
« Reply #16 on: May 29, 2014, 06:45:19 PM »
"Preventable illness" and "Fate illness"

This is why "economists" driven by business values should have less power in government than humanists driven by the common good of people.
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline YellowFever

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Re: Four Insurers Accused of Discriminating Against People With H.I.V.
« Reply #17 on: May 29, 2014, 10:37:47 PM »
This is why "economists" driven by business values should have less power in government than humanists driven by the common good of people.

To also quote an economist: "Economics is a political argument"

Quote
But more importantly, all markets are in the end politically constructed. A lot of things that we cannot buy and sell in markets used to be totally legal objects of market exchange - human beings when we had slavery, child labour, human organs, and so on. So there is no economic theory that actually says that you shouldn’t have slavery or child labour because all these are political, ethical judgments. When the market itself is constructed as a result of some political and ethical judgment, how can you say that this area can somehow be separated from the rest of society and the political system?
http://www.huffingtonpost.com/2014/04/09/ha-joon-chang-economics_n_5120030.html

Exactly why 'free market' doesn't work when it comes to healthcare. It shouldn't be a trade-able commodity. Its the wellbeing of a fellow human.
08/2010 HIV- 08/2012 HIV+
10/2012 CD4 415(15%)
04/2013 CD4 457(15%)
10/2013 CD4 520 (20%) VL 650 (wtf?)
02/2014 CD4 410(20%) VL 390 (yay!)
08/2014 CD4 580(?%)

Offline WindySkies

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  • Tested + 10/11/12
Re: Four Insurers Accused of Discriminating Against People With H.I.V.
« Reply #18 on: May 30, 2014, 02:09:52 AM »
The high deductibles are the biggest hidden gem that is ObamaCare.  The premiums look attractive, then consumers are hit with the real cost when they actually need to use the coverage they are paying for.  Wait until the whole thing is so far upside down that the whole thing collapses.  It's a castle of bricks built on a foundation of matchsticks.
10/11/2012 Journey Started
10/17/2012 First Labs: VL=57,645  CD4+=730  37%
10/31/2012 Started Complera
11/30/2012 Labs: VL=80  CD4+=929 40%
12/24/2012 Started Stribild

Undetectable since 1/15/13 CD4+= Over 1,400 and 49%

Offline J.R.E.

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Re: Four Insurers Accused of Discriminating Against People With H.I.V.
« Reply #19 on: May 30, 2014, 10:46:10 AM »


This is an additional article that was on our Bay news 9 page yesterday :

http://www.baynews9.com/content/news/baynews9/news/article.html/content/news/articles/ap/2014/05/29/Complaint_accuses_4_Fla_insurers_of_discrimination.html



Complaint accuses 4 Fla insurers of discrimination
By KELLI KENNEDY,

FORT LAUDERDALE, Fla. --

(AP) Two health organizations filed a complaint with federal health officials Thursday alleging some Florida insurance companies are violating the Affordable Care Act by structuring their insurance plans in a way that discourage consumers with HIV and AIDS from choosing those plans.

The National Health Law Program and The AIDS Institute said four insurance companies offering plans in Florida through the federal online exchange required HIV and AIDS patients to pay a percentage of their often expensive drugs instead of a flat co-pay.

Instead of paying a flat $10 co-pay at the pharmacy, the plans require patients to pay 40 to 50 percent of the cost of their drug, which could run into the thousands of dollars, according to the complaint which health experts say could have national implications.

The groups also alleged that the plans charged high up-front costs and require unwieldy prior authorizations. The complaint, filed with the Office for Civil Rights at the Department of Health and Human Services, asks the agency to investigate the Florida plans offered by CoventryOne, Cigna, Humana and Preferred Medical and require the insurance companies to take corrective actions if necessary.

Federal health officials said they are reviewing the complaint.

The report alleges that CoventryOne requires consumers to pay 40 percent co-insurance for the cost of all HIV drugs, including generics, after a $1,000 deductible. "That would be about $1,000 per month per drug in most instances. What patient could afford that?" said Carl Schmid, deputy executive director of The AIDS Institute.

Health advocates warn high costs cause patients to skip doses or go off their medications altogether, causing serious health complications.

Cigna, Humana and Coventry said in separate statements that their plans follow the latest HHS guidelines, cover all medically necessary HIV drugs and offer a variety of options so consumers can pick a plan that best meets their health needs. Preferred Medical did not immediately return a call seeking comment.

South Florida attorney Vicki Tucci said she's trying to help more than 30 clients with HIV and AIDS to get off Humana, Coventry and other plans and switch to insurer Florida Blue, which advocates said offers better coverage for those conditions.

"They go to the pharmacy and find their drug is not covered and they can't afford them. There's no way," said Tucci.

Tucci is working with advocacy groups that would pay the cost of medication while those with HIV and AIDS are without insurance until the next open enrollment period later this year.

Even before the Affordable Care Act took effect, insurers had increasingly begun requiring patients to pay a percentage of their drug costs instead of a flat co-pay, but experts say patients often spend more for their prescriptions in plans offered under the health law because of the co-insurance.

The organizations said they didn't know how many HIV and AIDS patients had purchased health plans from companies being targeted in the complaint. But a study from the nonpartisan Kaiser Family Foundation estimates about 23,000 uninsured people in the U.S. being treated for HIV and AIDS would be eligible for coverage through the online exchange.

Although the complaint filed Thursday specifically addresses HIV and AIDS, other health advocates have expressed concerns about high co-insurance for others with serious illnesses, including cancer and rheumatoid arthritis, which require expensive drugs.

The Leukemia & Lymphoma Society found exchange plans in several states that charged patients with blood cancer as much as 50 percent co-insurance rates. The National Multiple Sclerosis Society recently addressed the issue at a conference in Washington.

Health advocates are quick to point out that before the Affordable Care Act, many of their patients struggled to have health insurance at all. The law forbids insurers from discriminating against those with pre-existing conditions.

The law also bans insurers from charging an individual more than $6,350 in out-of pocket costs a year and no more than $12,700 for a family policy. But patients advocates warn those with serious illnesses could pay their entire out-of-pocket cap before their insurance kicks in any money.

Current Meds ; Viramune, Epzicom, 40mg of simvastatin, 12.5mg of Hydrochlorothiazide.
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 In October of 2003, My t-cell count was 16, Viral load was over 500,000, Percentage at that time was 5%. I started my first  HAART regimen  on October 24th,03.

 As of 8/2514,  t-cells are at 402, Viral load <40

 Current % is at 11%

  
 62 years young.

 


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