Tags: Healthcare Reform | Obamacare | high-cost conditions

NYT: Feds Investigate Health Insurers for Alleged Discrimination

By    |   Tuesday, 23 December 2014 10:18 AM

The Obama administration has written a letter to insurance companies, noting it plans to investigate whether they have discriminated against people with high-cost conditions like AIDS, diabetes and even mental illness through prescription drug and other benefit coverage, The New York Times reports.

The administration is looking at the federal insurance marketplace and into whether insurers have discriminated against those with a particular condition by eliminating coverage for a list of drugs used to specifically treat those conditions, the Times said.

The government is reviewing "estimated out-of-pocket costs associated with standard treatment protocols for specific medical conditions using nationally recognized clinical guidelines." The Times noted that those included such conditions as HIV, diabetes, rheumatoid arthritis, bipolar disorder, and schizophrenia.

Under the Affordable Care Act, insurers are required to take everyone who applies for coverage. They can't charge higher premiums based on pre-existing conditions. The administration's new standards also keep insurers from categorizing benefits and costs for certain drugs.

Insurers, also known as insurance issuers, typically classify drugs into three or more categories with different levels of co-payments and cost-sharing, the Times said. "If an issuer places most or all drugs that treat a specific condition on the highest-cost tiers, that plan design effectively discriminates against, or discourages enrollment by, individuals who have those chronic conditions," the administration noted in its letter, which added that "age limits are discriminatory when applied to services that have been found clinically effective at all ages."

In July, two health advocacy organizations, the AIDS Institute and the National Health Law Program, charged in a federal complaint to the Department of Health and Human Services's Office for Civil Rights that four Florida insurers had violated the law "by placing all covered HIV/AIDS drugs, including generics, in the highest drug tiers that require significant patient cost sharing," NPR reported.

Last week, a coalition of 279 patient and advocacy groups urged the federal government to further define "discrimination" under the ACA and to also create stronger language for insurers who might try to limit care and prescriptions for consumers, The Hill reported.

"We call on [the Centers for Medicare and Medicaid Services] and others to begin to enforce the ACA non-discrimination provisions and to issue regulations that further define what discrimination is," read the letter sent from the "I Am (Still) Essential" coalition. "As part of the plan review process for 2015, we thought there would be a better review of the plans for discrimination, but we are finding that the 2015 plans are utilizing the same practices as they did in 2014."

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The Obama administration has written a letter to insurance companies, noting it plans to investigate whether they have discriminated against people with high-cost conditions, The New York Times reports.
Obamacare, high-cost conditions
Tuesday, 23 December 2014 10:18 AM
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