Home' South Florida Gay News : SFGN 070815 Contents 16 // 7.8 .2015 // SFGN.com //
The Center for Health Law and Policy
Innovation (CHLPI) has developed templates
forpeople infected with HIV to file complaints
about Health Insurance Discrimination.
They are developing additional templates
for people with Hepatitis C or with a generic
Health Insurance Discrimination refers to
those policies designed to drive away people
with expensive conditions. For example,
plans may place needed medications on
the most expensive tier, require onerous
pre-authorizations, or fail to provide an
appeals process. Besides discriminating
against the affected individuals, it drives
high cost patients to competitors. It not
only discriminates, but it also subverts fair
HIVHealthReform.org and the CHLPI
presented a webinar “A New Tool to Fight
Health Insurance Discrimination.” Carmel
Shachar, from CHLPI, led this webinar. This
webinar introduced two templates for filing
complaints with insurance regulators: a
longer one for providers and advocates, and
a shorter one for consumers. Consumers can
Complaints to insurance companies
frequently fail to resolve issues. Some just
give a perfunctory review re-affirming
the denial, and others just fail to respond.
When one level does not work, Shachar
recommends that people move up to the
next higher level. The next level consists of
filing a complaint with insurance regulators
at the state level. These CHLPI templates
should facilitate that process.
Under the Affordable Care Act (ACA),
state insurance regulators must enforce
its anti-discrimination provisions. Most
states have failed to align their regulations
with the new insurance landscape. If a
state has sympathetic or neutral regulators,
complaints on file can provide them with
political cover and counterbalance lobbyists.
If a state has hostile regulators, complaints
on file can become evidence in subsequent
litigation and facilitate moving up to the
federal level. This process draws attention
to the issue, and avoids the adversarial
relationship of litigation, with its slow pace
and high costs.
Shachar identified three types of
1. Changing the terms of coverage
after its purchase
2. Refusing to cover standard care for
3. Unreasonably high costs for
standard medications or treatment
The template consists of the following
1. The complaint
2. Relevant sections of the ACA
3. The standard of care for HIV
4. Federal anti-discrimination law and
the responsibility of state insurance
regulators to enforce it.
Some insurance regulators may lack
familiarity with the standards for HIV
care. One complaint can include multiple
problems. Shachar stressed that people
should feel free to contact her if they had
CHLPI based these templates on
Marketplace plans and HIV infection.
Some people will have complaints about
other types of plans or other conditions.
People with such complaints should contact
Shachar, rather than modifying the template
The CHLPI will update the template
when regulations or standards of care
change. People should always download the
templates to ensure they are current, rather
than storing them on their computer.
Shachar recommends sending copies of
the complaint to the insurance company,
to the CHPLI, and to sympathetic state
politicians. They also suggest sending both
hard and electronic copies to the state
regulator, as well as a follow-up meeting.
One of the unintended consequences of
the ACA involves increased public education
about resolving complaints about plans and
getting results. This may be one of its many
To download the templates or to view this
webinar, visit: http://bit.ly/1gdoSkd
For questions about the template and its
use, contact Carmel Shachar 617-390-2588
For more information, visit Center
for Health Law and Policy Chlpi.org
or HIV Health Reform http://www.
To access the Florida Office of Insurance
Regulation, please visit Floir.com.
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