Wednesday, August 5, 2009

Peter, I am afraid my insurance provide will drop me. What can I do?

[Peter Pointers is here 4 YOU, as a service to LifeLube readers - whatever question you may have regarding sexual health, physical health, mental/emotional and spiritual health - ask him. He will find the answers you are looking 4. Below is a recent Q&A you may be interested to read.]

Question: I currently have medical insurance. HIV/AIDS medication is expensive. I'm afraid my insurance provider will drop me should I have the need to go back on medication. What can I do? I live in Chicago and the cost of living is high and while I make a decent living, paying for medication would bankrupt me.

Answer: Thank you for contacting me. I'm happy that you are looking for information to help you stay healthy and get the medications that you may need.

To begin, this question is pretty complex and has lots of layers. It might be good to talk with someone over the phone or in person who may be able to talk through some of the more complex parts with you.

For just this reason, I spoke with two great resources in the field of HIV Case Management and HIV Public Policy: Michael McFadden and John Peller. Michael McFadden, LCSW is the Director of Social Services at Howard Brown Health Center. John Peller is the Director of Government Relations at the AIDS Foundation of Chicago.

Both of them had similar referrals to share for information regarding insurance coverage and access to medications. Below is a summary of their input.

1. Contact your insurance company to determine what your prescription benefits are and find out what the actual out of pocket costs may be. HIV medications are expensive and depending on your prescriptions coverage, may have significant co-pays. Once you discuss your coverage with your insurance company, you may have to figure out some creative budgeting solutions to determine how you are going to pay for your medications each month.

2. A major determining factor will be if you have an Individual versus a Group Insurance Plan: If you are currently utilizing an individual insurance plan, there is the risk that your insurer may not renew your policy in the future. It is also possible that the insurance company would raise your rates significantly to the point where you couldn't afford coverage, although that would not automatically happen. If you have group (or employment-based) insurance, the insurer cannot drop you. It is possible that through the utilization of the insurance, the insurer may increase premiums for group rates.

3. Dealing with benefits can be very complicated. It might be good to work with a Case Manager to sort through some of the details. Also, there are some programs available specifically for folks impacted by HIV. Case Managers are familiar with these programs. To get connected to a case manager, you can contact the AIDS Foundation of Chicago at 312.922.2322

4. ADAP & CHIC: There are two programs through the State of Illinois that provide a tremendous benefit to Illinois residents living with HIV. ADAP (AIDS Drug Assistance Program) provides free HIV medications to eligible patients. ADAP eligibility is for individuals who earn less than $54,150 per year (for an individual, more for a family - 500% of federal poverty level, if you want to get technical). ADAP also will most likely coordinate with your private insurance program and help to pay your out-of-pocket costs. CHIC (The Continuation of Health Insurance Coverage) Program helps people who have AIDS or HIV and have left their jobs. Many people who no longer work for an employer can still, by law, receive health insurance coverage through their employers for 18 months. This program helps pay the monthly payments (premiums) for the health insurance you continue to receive, including family insurance that covers your spouse or children

5. You could also talk with your doctor about ways to pay for HIV medications. Many drug companies have programs that will help you pay the out-of-pocket costs, called "Patient Assistance Programs" for the medications they supply. You can check to see if there are patient assistance programs for the medications you take and to determine what the eligibility criteria may be.

6. MOST IMPORTANTLY - AIDS Legal Council of Chicago is a fantastic resource for individuals with HIV. They have developed some wonderful legal guides that are available on their website, locally at (312) 427-8990, or toll-free at (866) 506.3038. Also, they can help you with applying for ADAP, understanding your private health insurance benefits, and other issues. You should absolutely call them if for any reason your insurance company screws you over, because there's a chance the company is doing something illegal.

7. Finally (and this is pretty obvious), stay healthy and take care of yourself! Learn how to manage your stress, including worrying about how to pay for HIV meds. Stress will weaken your immune system over time, and make it more likely that you'll have to go on meds.

8. And finally finally, as an important aside from Mr. Peller: "THIS IS WHY WE NEED HEALTH REFORM NOW! You are living with a chronic health condition, and you shouldn't have to worry about getting coverage or care when you need it to stay healthy and continue working (let alone live your life). You shouldn't have to worry about your insurance company cancelling coverage just because the cost goes up. The health reform proposals moving through Congress now would give you more options for affordable coverage and prohibit insurance companies from dropping you because you need more care. For more information on how health care reform would help you and others with HIV, click here."

I hope that some of those possible actions help. Please, feel free to contact me if you have any other concerns. Also, let me know how it goes!

Be Well,
Peter Pointers
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1 comment:

  1. With Single Payer, Universal Health Care, this problem would completely disappear.


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