Insurer actions and patient interests

  • We are strongly advocating at the federal and state levels against discriminatory practices on the part of insurance carriers.
  • As a business matter, insurers have sought to keep expensive patients with chronic illnesses off of their insurance rolls by disallowing patients who had pre-existing conditions or by placing lifetime caps on coverage for people who had costly illnesses such as cancer, HIV/AIDS and ESRD;
  • Courts have found lifetime caps on specific diseases to be discriminatory and the Affordable Care Act does not allow companies to exclude people with pre-existing conditions from being insured.
  • Now insurers are turning to other strategies to limit their financial exposure related to lifesaving care provided to low-income patients by refusing third-party payments on behalf of patients even though such payments are explicitly allowed by the federal government. 
  • In Louisiana in 2014, insurers embarked on a failed effort to restrict third-party payments of insurance premiums on behalf of people with HIV/AIDS.
  • Now insurers have undertaken numerous efforts to restrict insurance from ESRD patients, including bringing a lawsuit and lobbying state insurance officials to restrict third-party payments for premiums.
  • Some health insurers are implementing policies that say individuals may not receive any support from a charitable organization that might increase their ability to pay for their insurance.
  • Some plans have gone so far as to simply refuse to insure people who need charitable help to afford their expenses. These carriers make applicants sign an attestation that they are not receiving such help, and are announcing that accepting charitable assistance is grounds for coverage termination.
  • A primary tenet of the Affordable Care Act is to provide insurance coverage for all, regardless of their medical condition.  We believe that this pattern of actions on the part of insurers to purge their insurance rolls of medically vulnerable populations violates the guaranteed availability provisions of the ACA. This practice should be stopped so that dialysis patients in need can obtain insurance coverage of their choosing.
  • For more than two years, we have been fighting at the state and federal levels against this growing industry practice. We will continue to stand up for the rights of low-income people who need charitable assistance to afford their health care.