$12M patient may have contributed to insurer’s exit from Iowa

A single patient’s astronomical medical bills may have been a factor in Iowa’s largest insurer, Wellmark Blue Cross and Blue Shield, exiting the state’s individual market for 2018. Talking about that patient, however, may have put a company executive in violation of HIPAA.

When Wellmark announced its departure from the individual market in April, it blamed a “small subset” putting its larger customer base in jeopardy as it racked up $90 million in losses in three years on the Affordable Care Act exchange.

That small subset contained a particularly expensive patient: a teenage boy with hemophilia. Wellmark Executive Vice President Laura Jackson described that patient, without giving his name or hometown, to a Des Moines Rotary Club meeting, according to the Des Moines Register.

The disease can be managed with concentrated solutions of “factors,” proteins which help the blood’s ability to clot. Some severe cases require several shots per day of the expensive treatment, but the Hemophilia Foundation of America said the upper limit for care is usually $1 million per year, not per month.

Read the full article at the link below: