Pre-existing condition bans still on the way out


As of Jan. 1 2014, the Affordable Care Act prohibits insurers from charging more or denying coverage to anyone with pre-existing conditions, such as diabetes, asthma or cancer. But one Kaiser Health News reporter found discrepancies regarding pre-existing condition bans.

A welcome letter from Bloomfield, Connecticut-based Cigna told reporter Julie Rovner she was placed on a one-year waiting period for any pre-existing conditions, Kaiser Health News reported. Despite a mix-up regarding continuous coverage, Rovner learned that the Jan. 1 date wasn't set in stone but was instead a rolling plan year effective date to ban discrimination against pre-existing conditions.

So as plans renew in 2014, pre-existing condition exclusions will get dropped. And by the end of this year, the requirement to eliminate pre-existing condition exclusions "will have become effective for all plans," a Cigna spokeswoman told KHN.

Yet those still affected by pre-existing condition bans include HIV/AIDS patients. In December 2013, 31 HIV/AIDS patient advocacy groups asked the government to investigate whether insurers are discriminating against HIV patients by not covering available HIV drugs or applying "egregious" cost sharing to them in exchange plans.

They have gone a step further, suing insurers for violating the ACA's pre-existing condition provision by designing insurance plans that make it so difficult for people with HIV/AIDS to obtain their medications that they choose not to sign up, Healthline News reported. The AIDS Institute and National Health Law Program filed a complaint late last month with the Office of Civil Rights at the U.S. Department of Health and Human Services against CoventryOne, Cigna, Humana and Preferred Medical.

With so much confusion surrounding ACA changes, such as those related to pre-existing conditions, education is key to helping members understand new insurance policies, according to the Cap Times.  Insurers use 24-hour help lines to assist people frustrated with the new health insurance system. For example, Philadelphia-based Independence Blue Cross is calling members with an unresolved issue to work out the problem and assisting them with their inquiries, FierceHealthPayer previously reported.

For more:
- read the KHN article
- here's the Healthline News article
- read the Cap Times article

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