AIDS Healthcare Foundation Files Suit Against PacifiCare Over State Law Mandating ‘Standing Referrals’ for HIV/AIDS Patients Enrolled in HMOs
The Los Angeles-based AIDS Healthcare Foundation, the "largest provider of specialized HIV/AIDS medical care in the United States," on Friday filed a lawsuit against PacifiCare of California, charging that the insurer has violated state law by not providing "standing referrals" to people with HIV enrolled in its HMO plans (AHF release, 8/13). The law, which was signed by Gov. Gray Davis (D) last September, requires California HMOs to ensure that patients with HIV or AIDS receive referrals to doctors who specialize in treating the disease (Kaiser Daily HIV/AIDS Report, 9/18/2000). AHF states that by failing to comply with this law, PacifiCare is engaging in "unlawful, unfair and deceptive practices." AHF President Michael Weinstein said, "We believe PacifiCare is simply not complying with California law regarding HMO specialty referrals or providing access to appropriate medical care for their clients living with HIV and AIDS. Whether it is benign neglect or deliberate indifference, the health of many working Californians living with HIV/AIDS and covered by one of PacifiCare's HMO plans suffer greatly." Former state Assembly member Martin Gallegos (D), author of the state law, said that he is "disappointed" that "most managed care plans have not followed the letter or the spirit" of the legislation. AHF is seeking an injunction directing the insurer to adhere to the law (AHF release, 8/13).
The AIDS Healthcare Foundation has also begun a public campaign to collect information on other HMOs, releasing a flyer that says, "Have You Had Problems with Your HMO?" The flyer continues, "AIDS Healthcare Foundation wants to improve the care HIV/AIDS patients in HMOs receive. If you've been denied adequate HIV/AIDS healthcare by your HMO, we want to hear about it." The flyer provides a contact name and phone number and at the bottom states, "You can help improve the care you and others receive" (AHF release, 8/14).