Three national and state hemophilia advocacy groups seek federal action against Wellmark Blue Cross and Blue Shield for allegedly violating HIPAA and the ACA by revealing the condition of a member costing the plan $1 million a month and exiting Iowa's individual marketplace.
The National Hemophilia Foundation, Hemophilia Federation of America and Hemophilia of Iowa filed the discrimination complaint Aug. 15 with HHS' Office for Civil Rights. The complaint claims Des Moines, Iowa-based Wellmark violated HIPAA when it publicly announced a patient with hemophilia — a genetic disorder keeping blood from clotting — receives $12 million worth of care annually. Wellmark said the cost contributed to premium hikes of between 38 percent and 43 percent for 2017.
"The complaint charges that given the rare nature of hemophilia and the relatively low population of Iowa, this public disclosure, done without the patient's consent, was a clear violation of patient privacy protections in HIPPA," the organizations argue.
In addition to violating HIPAA, the organizations argue Wellmark violated provisions of the ACA when it "effectively prevented hemophilia patients from accessing care when it carved certain counties in Iowa out of their ACA plans and then pulled out of the Iowa marketplace entirely."
"Wellmark's wrongful disclosure of the patient's condition and costs, and its decision not to sell policies to individuals with hemophilia, has resulted in other insurers withdrawing from the Iowa marketplace," said Kimberly Haugstad, president and CEO of HFA. Minnetonka, Minn.-based Medica is the only payer offering ACA exchange plans statewide in Iowa for 2018 after Wellmark and Hartford, Conn.-based Aetna decided to exit Iowa's exchange in April. Medica requested an average 43.5 percent rate increase for individual plans next year.
"This increase will make coverage financially prohibitive for many people, which is directly attributable to Wellmark's wrongful disclosure of patient information," the organizations allege.
Wellmark did not immediately respond to Becker's Hospital Review's request for comment. This article will be updated if more information becomes available.