Insurance Policies Affecting Your HIV Treatment? Take That Complaint to the State
What can you do when your insurance company stands in the way of your access to HIV treatment? According to the Center for Health Law and Policy Innovation at Harvard University and HIVHealthReform.org, you may want to consider taking it to the state. The two HIV care policy powerhouses teamed up for a webinar to provide information on everything consumers, providers and advocates need to know to file complaints to state-level departments of insurance to fight HIV health insurance discrimination.
The groups have found that filing complaints can be an effective tool to not only bring about justice in individual cases but also change the regulations that oversee and mandate the actions of insurance companies. In the webinar slides they note, "Even if the complaint is initially unsuccessful, it can help support a successful litigation campaign to combat health insurance discrimination."
This tactic could help remedy discriminatory practices that include:
- Refusing to cover the care and treatment that people living with HIV need.
- Disproportionately high copays, coinsurance and deductibles that make it impossible for someone living with HIV to afford coverage.
- No coverage for antiretroviral or other expensive drugs.
- An unfair appeals process that doesn't provide a chance to appeal an eligibility or coverage denial.
- Not allowing patients to change coverage after the open enrollment period ends.
States have traditionally had a large role in insurance regulations and monitoring, and that role has continued even in the era of the Affordable Care Act. However, say the advocates, the states' departments of insurance must hear from patients to know what the regulators need to do.
There's no shortage of stories about widespread problems with insurance policies and HIV treatment access, but they reported that few insurance regulators have received complaints from the HIV community documenting discriminatory practices. And that means the states can ignore the discriminatory actions of their local health insurers, they explained.
To make it easier for people to turn their horror stories into formal complaints, the groups provided step-by-step instructions on the webinar and a link to a template complaint form. You can watch a video of the webinar, or download the slides from the presentation.
Julie "JD" Davids is the managing editor for TheBody.com and TheBodyPRO.com.