After the Health and Human Services Department gave a tentative go-ahead for some hospitals to help pay for health plan costs and an uproar ensued over funding for HIV/AIDS patients, Blue Cross and Blue Shield of Louisiana is planning to stop accepting premium payments from most third parties.
The new policy at Louisiana's largest health insurer was supposed to go into effect this month, but that's been delayed until April, as the issue of accepting funding from the Ryan White HIV/AIDS program is sorted out by a federal court.
The policy, taking effect after the 2014 open enrollment period, would prohibit third-party payment for individual health plan premiums, with payments required to come from members or their blood or marriage relatives or legal guardians.
The decision comes after Health and Human Services Secretary Kathleen Sebelius said in a recent federal guidance that healthcare foundations -- like the parent organizations of nonprofit hospitals -- can help cover the costs of patients' health plan premiums and deductibles with financial assistance programs.
That federal policy may end up being more significant than the issue of accepting third-party assistance from the Ryan White program.
Because HHS does not consider qualified health plans being sold in public insurance exchanges "federal health programs" under the Social Security Act, federal anti-kickback laws that would typically prevent provider assistance or "inducements" to patients don't apply.
It seems, though, that if nonprofit hospitals are free to help patients pay for new health plans, insurers are not obliged to accept payments originating from third parties.
"(W)e know from experience that there are people who want to game the system and take advantage of the uncertainty healthcare reform is creating," said John Maginnis, Blue Cross and Blue Shield of Louisiana communications vice president, in a statement.
"For example, there have been instances here and elsewhere in which certain providers or medical equipment suppliers steered patients to a specific health plan and offered to pay those patients' premiums so that the provider/supplier earned financial benefits through billing the insurance company for the member's covered services," said Maginnis.
Blue Cross and Blue Shield of Louisiana has actually had a ban on third-party payments since 2012 with only a few exceptions, such as for HIV patients getting assistance from Ryan White HIV/AIDS program, which CMS is considering requiring for all health plans.
Blue Cross and Blue Shield of Louisiana and other insurers in the state were recently taken to court, however, for planning to stop accepting Ryan White assistance. They've agreed to continue accepting those payments at least until April, while a federal judge considers whether to institute a long-term order requiring them to accept assistance from the Ryan White program specifically.