Third-party payment for kidney patient insurance premiums – it is about patient rights

LaVarne A. Burton  |  Posted

People who have chronic illnesses like diabetes, hypertension, cancer, HIV or kidney disease have always been challenged when it comes to insurance coverage. There was a time when insurance companies could deny coverage to people with pre-existing conditions, so when people needed insurance the most —when they got really ill and needed care—they didn’t have it. Insurers had other ways of avoiding paying for treatment of expensive illnesses as well. They placed “caps” on a policy—saying that if you had cancer or AIDS, for example, then the total amount payable under your policy would be limited. Today, thankfully, those practices are no longer legal.
 
Instead, insurers are engaging in a different kind of effort to avoid covering people with expensive illnesses—by refusing to accept third-party payments for health insurance premiums. While today a policy cannot be denied because of your illness, it can still be denied if you need help paying for it.
 
The American Kidney Fund (AKF) is a charity that pays health insurance premiums for low-income dialysis patients so that they can access lifesaving treatment. Dialysis patients are some of the sickest—and most expensive—patients, and we have been helping them financially for decades. Insurers would like to force these patients off their rolls and are targeting our Health Insurance Premium Program (HIPP), refusing to accept AKF’s checks on behalf of patients. Some have gone so far as to threaten patients with termination of their policies if they receive charitable assistance.
 
A recent article in the Minneapolis Star Tribune profiled the issue (See Insurers Wary of Premium Help for Patients, July 30, 2016).
 
We have the HIPP program because we know that health insurance is the gateway to medical care. It’s vital for anyone with a chronic illness, and essential for people with kidney failure who will die without ongoing dialysis treatment or a transplant. Our nearly half-century of experience in helping patients with kidney disease has taught us that poverty is often a byproduct of this condition, because staying employed while undergoing dialysis can be difficult or impossible.

With murky national guidance on this issue from the Centers for Medicare & Medicaid Services (CMS) allowing (but not requiring) acceptance of premium payments from charities, insurers are taking action state-by-state. We’re very concerned about any state regulatory actions that would cause harm to patients by making it easier for insurers to terminate coverage. We have been working at the federal and state levels for more than two years to protect insurance coverage for people with kidney disease. We are talking to insurance commissioners about insurance company efforts to curb acceptance of third-party payments, asking them to carefully review 2017 plan filings for language that would harm patients who rely on charitable assistance. On the federal level, nearly 100 members of the U.S. House of Representatives have signed on as cosponsors of H.R. 3742, which would require insurers to take third-party payments from legitimate charities. States should not go in the opposite direction.
 
Over the next weeks you are going to see us talk more about this issue, because we consider it vitally important not only to people with kidney disease, but to people with all kinds of chronic illness who need charitable support. For us, the bottom line is that the focus should not be on insurance companies, it should be on patients. And that is what we intend to talk about.

LaVarne A. Burton is president and chief executive officer of the American Kidney Fund.

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