Did Wellmark Blue Cross and Blue Shield cross the line? Leading hemophilia groups, National Hemophilia Foundation (NHF), Hemophilia Federation of America (HFA), and Hemophilia of Iowa (HOI) believe that they did. In August, the groups filed a discrimination complaint against the insurance provider.
The groups claim that the insurance companies denied treatment to a protected group. They also believe the Wellmark violated a patient’s privacy. They say this last strike adds to a history of discrimination Wellmark has practiced for a long time.
Since hemophilia is a rare disease, many patients feel that this leaves them vulnerable to being cut out of the insurance others benefit from. Hemophilia is a rare, hereditary bleeding disorder. People with hemophilia are missing a factor in their blood, which prevents it from clotting. Without treatment, hemophilia has the potential to be fatal. There are multiple types of hemophilia, which you can learn more about here and here.
Hemophilia is a protected condition under the Affordable Care Act (ACA). This means that it’s illegal for health care provider to refuse to cover someone because they have hemophilia. To do so would be considered discriminatory in the eyes of the law.
According to the complaint, Wallmark has gone to lengths to avoid hemophilia claims, or even intimidate their way out of covering hemophilia patients.
This behavior reached another level in the beginning of April, when Wallmark decided to pull its company out of several Iowa counties, and then out of the state of Iowa all together. This decision was announced just a few days after a Wallmark executive gave a speech explaining what motivated this change. He listed an example that may have violated several laws. He exposed that the company was paying a million dollars a month to keep a seventeen-year-old male with hemophilia alive.
This implied that the company was making whatever moves they had in their power to avoid covering treatments for hemophilia. Not only is that discriminatory, but the speech also may have violated Health Insurance Portability and Accountability Act of 1996 (HIPAA).
Since the comment was publicly given without the patient’s consent, and taking into account how few people in Iowa suffer from hemophilia, the groups claim that this is a clear HIPAA violation. The news of the expensive patient spread throughout the media, both locally and nationally. A researcher said that everyone was trying to figure out who he was, so that they could avoid covering him. That had implications stretching beyond just his right to obtain health care after his private information was leaked. It also affects what is considered acceptable for the entire hemophilia and rare disease community.