In her response, Sebelius reaffirmed CMS' statement that charities were allowed to help with premium payments as long the assistance was income- and not condition-based.
However, although any stories of church assistance being refused by insurance companies are "anecdotal right now," insurers are sending letters stating that they are not accepting third-party payments by non-profit organizations, Dana Kuhn, founder and president of the patient advocacy group Patient Services, Inc. told CNA.
60 plans in 38 states "are returning checks from non-profit organizations, once they find out they're a non-profit organization that is paying a premium on behalf of a person with a chronic condition," he said.
The fact that the prohibitions stand for "third parties," without specifying that income-based assistance by charities and churches will be accepted, is troubling, he said.
For instance, a March, 2014 letter from BlueCross BlueShield of Louisiana stated that they were "not accepting premium payments from any third parties who are not related (by blood or marriage) to the subscriber."
UnitedHealthcare of North Carolina told members in a coverage packet that they could not "accept any direct or indirect contribution or reimbursement by or on behalf of any third party." The only exempt parties were, again, those exempted by CMS. Churches and charities were not specifically mentioned.
A November, 2014 letter From BlueCrossBlueShield South Carolina stated that CMS "has encouraged insurance companies offering plans through the Federally Facilitated Marketplace to reject premium payments made by third parties on behalf of members in certain circumstances."
Regardless of churches and other charities, patient advocacy groups"like Patient Services, Inc. that help people with specific chronic conditions say their payments should be accepted anyhow. They are now pushing for the passage of the bill in Congress to have insurers accept their premium payments.
Medical costs for people with chronic health conditions can be high, and despite the health care law capping out-of-pocket medical expenses, some situations still may require financial assistance.
According to the National Hemophilia Foundation, someone suffering from severe hemophilia could incur up to $300,000 a year in treatment costs. Someone waiting for a kidney transplant – currently more than 100,000 Americans – will need expensive weekly treatments just to survive, according to the American Kidney Association.
Unable to pay for a health plan they need, people might resort to skipping treatments, enrolling in Medicare or Medicaid, or using emergency rooms for health care, the Marketplace Access Project claims.
(Story continues below)
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Rejection of third-party payments by patient advocacy groups for those with chronic health conditions "is really a backdoor way of a pre-existing condition, which the ACA was supposed to absolve," Kuhn maintained.
"The people who need the help have a health condition," he said.
So the bill, introduced by Rep. Kevin Cramer (R-N.D.) last November, allows these charities and other third parties to continue making these payments. The list of 98 co-sponsors is bipartisan: more than 30 Democrats have co-sponsored the bill.
A valid concern – and a reason behind the regulation, Kuhn admitted – is that certain groups "in conjunction with" pharmaceutical companies and other providers "were putting people on the marketplace plans because the reimbursement is better," although the patients qualified for Medicaid and Medicare.
He said that Patient Services, Inc. ensures that patients qualify for Medicare and Medicaid first before exploring plans on the exchanges.
"We've got to figure out a way to fix this so that charitable non-profits aren't penalized because of other maybe charitable organizations that were created at the bequest of a provider, to just be able to sidestep this," he concluded.