AIDS Patient Denied Coverage Retroactively, Has No Remedy

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John McGann – Houston, TX

"Any type of insurance that can be taken away at a moment’s notice is the equivalent of having no type of insurance at all."

According to court documents:

When John McGann was diagnosed with AIDS, he turned to his employer’s health plan, which covered him for $1 million in health benefits. But when he filed his first claim for AIDS-related treatment, the insurer informed him that his benefits would be capped at $5,000, retroactively.

The retroactive change was against state law. But since McGann was insured through his employer, the state’s consumer protection law was nullified by the ERISA loophole.

McGann went to court claiming discrimination, but lost. The judge claimed ERISA’s broad scope did not prohibit the retroactive elimination of coverage even though the benefit change "may stem from prejudice against AIDS.’"

The ruling leaves insurers with an extraordinary degree of immunity from discriminatory and dangerous denials of treatment for people with costly, life-threatening illnesses.

Consumer Watchdog
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