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Lawsuit: Blue Cross Decision Denies Coverage to HIV-Positive Patients

– February 26, 2014

An HIV-positive man in Louisiana has filed a lawsuit against Blue Cross-Blue Shield, claiming that the insurance company’s decision to change its rules regarding patient coverage effectively denies coverage to low-income HIV-positive patients.

The lawsuit, filed by John East against Blue Cross-Blue Shield and two other insurance companies, alleges that a decision made by the companies just before provisions of the Affordable Care Act prohibiting denial of coverage based on pre-existing conditions became effective was intended to turn away low-income patients that have tested positive for HIV.

Blue Cross claims that it made the decision to not accept premium payments from the Ryan White HIV/AIDS Program, which is a federal fund set up to help pay health insurance premiums for low-income HIV patients, based on a recommendation by the U.S. Centers for Medicare and Medicaid advising against acceptance of premiums from outside organizations.

According to court documents, the Centers for Medicare and Medicaid has since issued an updated advisory recommending that insurers accept premium payments from the Ryan White fund.

East is seeking an injunction against the insurance companies, monetary damages for discrimination under the Affordable Care Act, and that the insurers be required to provide him coverage.

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