Feb. 24, 2014
Statement by John Maginnis, Blue Cross and Blue Shield of Louisiana spokesperson
We are aware of the lawsuit that has been filed against us over our third-party payment policy.
In the past two weeks, we have heard from many people who are confused and have heard incorrect information about our policy against accepting third-party payments for individual members’ health insurance premiums.
We intended to put this policy into effect March 1. But, in considering the concerns people have expressed to us, we will delay implementing this policy for another month. This will make the effective start date of our policy consistent with the dates for enrollment on the federal healthcare Marketplace, which is scheduled to remain open through March 31, 2014.
This gives people more time to shop for the right healthcare plan for themselves and their families in the Marketplace, including finding out whether they may be eligible for a subsidy, or tax credit, to help them pay the cost of their healthcare premiums.
For currently insured individual members, we will honor all premium payments, including those that have been received through third parties, through March 31, 2014. Individual members will have to submit their monthly premium payments directly, or have an immediate family member or legal guardian pay on their behalf, beginning in April.
We are working to let our individual members know about this forthcoming requirement, giving them more time to prepare and shop for plans in the Marketplace while enrollment is still open, if they are eligible.
This policy does not affect anyone’s healthcare coverage, benefits or services. No one is experiencing any loss of or gap in their healthcare coverage because of this policy.
About Our Policy
Effective April 1, 2014, Blue Cross and Blue Shield of Louisiana will no longer accept third-party payments for our individual members’ premiums. Only the policyholder or an immediate relative (by blood or marriage) or legal guardian of the policyholder (e.g. parent, spouse, sibling) can pay for that policyholder’s healthcare premium.
The vast majority of our individual members already pay their premiums directly or have an immediate family member pay for them, such as parents who pay for their child’s policy. Very few of our individual members will be affected by this policy. It’s also important for people to understand that those affected are not all Ryan White program clients. We are applying this policy across the board to all individual members, regardless of their health status, type of plan purchased or previous method of paying for their healthcare coverage. It does not affect only one organization or single group of people.
Why Did Blue Cross and Blue Shield of Louisiana Establish This Policy?
The Affordable Care Act (ACA) is now the law of the land for healthcare coverage. And, the ACA creates an environment where anyone can purchase coverage, which means many people who were not previously insured or did not have access to commercial health insurance can now get health plans through the federal healthcare Marketplace.
In Louisiana, Blue Cross and Blue Shield of Louisiana is the only insurer that is fully participating in the Marketplace, offering plans at every metal level in every parish and every ZIP code in the state. While there are other health plans on Louisiana’s Marketplace, their offerings are much more limited. Our competition has chosen, for the most part, not to participate in any meaningful way. Our company chose to take part to the greatest possible extent because we believe this is in line with our mission to provide Louisianians with health guidance and affordable access to quality care. We are pleased that we can offer such a variety of plans to new customers.
But, because we are offering the majority of the Marketplace products in Louisiana, we also feel a great responsibility to maintain the integrity of the ACA and ensure that all individuals are free to choose the health plans that are best for them and their families, free of influence or manipulation, without being steered or manipulated by people or organizations trying to take advantage of their situations for their own personal gain. We developed this policy as a safeguard against this type of patient steering and other fraudulent activity. In November, the Centers for Medicare and Medicaid Services (CMS), which oversees the Marketplace, issued a communication to health plans strongly advising them not to take any third-party payments. Our policy was in line with this guidance until CMS changed its position two weeks ago and issued a different communication that encouraged health plans to accept third-party payments from the Ryan White program.
Unfortunately, we know from experience that there are people who want to game the system and take advantage of the uncertainty healthcare reform is creating. For example, there have been instances here and elsewhere in which certain providers or medical equipment suppliers will steer people to a specific health plan and offer to pay those people’s premiums so that the provider/supplier can bring in financial benefits through billing the insurance company for the member’s covered services. This kind of activity can lead to improper use of services, wasted money and increased healthcare costs for everyone.
Therefore, we are acting in the best interest of our current and future policyholders to take as many precautions as we can to protect the financial stability of our company and our customers’ premium dollars. That’s why we are strengthening our payment process to ensure we are dealing directly with our policyholders and reducing the chance that other parties could take advantage of this situation.
We hope this clears up any misunderstanding and helps everyone better understand why this payment policy protects the more than 1.4 million members that Blue Cross and Blue Shield of Louisiana insures.
What does this mean for people who have had the Ryan White program (or another third party) pay their premiums? How will they get coverage?
First, to be absolutely clear, this policy only applies to our payment processes. It has no impact at all on anyone’s coverage, benefits or services.
Our policy against accepting third-party payments takes effect April 1, 2014, and all payments received for members’ March premiums are in place through March 31, 2014. In the meantime, we are letting people who have used third-party payers for their premium payments in the past know about this new policy so that, beginning with their April premium payments, they can pay us in ways we can accept.
Our policy on payment processes has no effect on anyone’s coverage, benefits or services. It is a protection for all of our policyholders against fraud, waste and abuse. People can still get healthcare coverage through Blue Cross and Blue Shield of Louisiana regardless of any pre-existing medical conditions, but their premium payments must come directly from the policyholder or an immediate family member or legal guardian of that person.
We realize that some organizations have directly paid premiums for members in the past, and we are working with those organizations to communicate this change. Those organizations can still provide the members with financial support toward their premiums, but they must let the members make the premium payment directly for their health insurance policies. For example, we could accept payments in situations where nonprofits, foundations or others provide grants to their clients so that their clients can use the funds to freely choose, and directly pay for, their own healthcare premiums.
Are the Ryan White program, or members who have HIV/AIDS, the only ones affected by this policy?
No. Ryan White program members or members with HIV/AIDS who are using federal funds to pay for their healthcare are not the only ones affected by this policy. Most of our individual members already pay their own premium or have an immediate family member or legal guardian pay it for them (such as parents who pay for their children’s premiums). But we do have a limited number of third-party payers who pay for individual members, and they will no longer be able to do so after March 31. It’s important to understand that this policy applies to all of our individual members and is not specific to any one organization or group of members. Also, this policy applies regardless of members’ health status, previous method of payment or level of healthcare coverage.
Does Blue Cross and Blue Shield of Louisiana still cover HIV/AIDS patients?
Blue Cross and Blue Shield of Louisiana currently covers members throughout the state who have HIV/AIDS, as well as other chronic medical conditions, and we will continue to do so. It’s important to note that not all members who have HIV/AIDS or other chronic medical conditions pay for their coverage through third-party payments. Many of them have been paying directly for their individual healthcare plans in accordance with our policy, and they can continue to do so. Some of these members may get their healthcare coverage through an employer or other group, which is not affected by this policy.
Furthermore, the Affordable Care Act, which is the law of the land for healthcare now, requires health plans to accept any members, regardless of any pre-existing conditions they have. Blue Cross and Blue Shield of Louisiana is fully complying with this requirement of the healthcare reform law, and we will continue to do so.
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