My life is a turmoil .....

[Maggie]

Hi to everybody who don't know me as well as those who do remember me.

I've been poz since 1992, started meds after 10 years of being diagnosed and now am off meds again (knock on wood).   At the present, my counts are okay.

I am about to be divorced very soon.  I have lost my job over this (my fault for not communicating with my supervisor). 

I am wondering what other's opinions are of having hiv caseworkers.   I do have one.  She seems to think that I am "mentally unstable".   I asked her if she herself would be if she had just lost her job and also was in the midst of a divorce. 

It just seems to me that sometimes this caseworker tries to pry into my life a little more than I care for.

As of right now, the loss of my job (which is a career that I've been involved in for almost 20 years) is horrifying to me.  I am not used to "not working". 

I was wondering what any other's opinions are of hiv caseworkers.

Right now, I really don't have much choice as far as listening to what they are telling me.  I have no job, no health ins., nothing.  I have no idea where I will be living. 

I am afraid that if I would happen to find a job (the unemployment rate in this small town is next to "zilch") and if they do offer health insurance, that scares me also.

I realize that "supposedly" the ins. company is not supposed to reveal your health status to the employer.  But.... it seems that in the past I've read where they do let the employer know of this fact, and then the employer will find a reason to terminate the employment.

[david25luvit]

The ones in Mobile suck...my house burned down and he suggested I contact the Red Cross...he was going on vacation!

You're in good company sweeetie.............
maybe I'm crazy too!

[emeraldize]

Hi Maggie,

I'm sorry to hear you're going through such an extraordinary amount of stress. I have no firsthand experience with caseworkers.

If you aren't clicking with this person is it possible to be reassigned to another? Or, must you suck it up and take this person's limited perspective and broadbrush diagnosis?

You seem to indicate that you lost your job because you didn't communicate about your impending divorce. Am I reading that accurately? If so, something doesn't sound quite right.

And, if something isn't right, is there another entity you need to consult such as the Labor folks, or the company/organization for which you worked? Was this a firing or a "lay off"? We've got some HR-savvy folks in the forum who might weigh in on negotiating for career counseling,

Is COBRA out of reach in terms of maintaining your insurance coverage? If not, you may still be within the decision-making period.

I have questions, but not anything to offer other than sometimes in the midst of multiple shocks, we are not inclined to think creatively about options and resources available to us. And, your caseworker doesn't sound like a prize winner (yet?) in being supportive and offering constructive suggestions.

Regarding your concern as to a health insurance company informing a future employer about your health status, that would constitute a HIPAA violation and that kind of information is closely guarded. If a person were to do that, he or she could lose their job and more.

Try not to fret about that which should not ever come to pass and concentrate on what you can do to uncover and maximize what the former employer may be able to do for you. Be creative.

If you were in your field for twenty years, then you have some allies---perhaps even the person who ended your job (I know it sounds odd as hell). Can you get a letter of recommendation? Can you inquire of HR and get assurances that if someone calls for a job reference they'll only be affirming period of employment, salary, etc.  Will the call go to HR? Or will it go directly to the former boss? What is the organization's policy on handling such calls?

Fact gather. It will not only help you, it will also distract you from the incessant what-iffing that occurs with  and feeds into anxiety-producing times.

Best regards.
Em

[skeebo1969]

  I have had no success with case workers in the past, but I think it really was based on the individuals I dealt with.  Insurance companies will not tell your employer of your status, and even if this were to be figured out by someone in HR being fired for having HIV is discrimination and there are laws that protect against that, so do not worry about it.  I have had two jobs since being diagnosed and so has my wife.  We both receive company insurance and I've even spoken to HR regarding my status.  A good HR department will know to handle you with kid gloves... and even advise you of certain options you have if you suffer from a debilitating illness during your tenure there.

   I don't think you are unstable, stressed out maybe, but not unstable.  Divorce is hard and add to that possibly losing ones job can make things understandably difficult to deal with.  Just don't give up, keep your chin up and keep pushing forward.

   Best Wishes,

   Thomas

[emeraldize]

Hey Maggie,

 I went fishing for some info and a woman who does worldwide benefits for Fox, Inc. posted this response to a question/uncertainty similar to yours. Her reply is important information regarding which type of insurance arrangement could leave you more vulnerable.

And, then below that I've included an even more formidable chunk of info from the American Medical Association's website which is worth reading and ought to put your mind at ease with regard to the legal implications of revealing your information.

By the way, I'm with Skeebo on many HR people and bosses being able to understand and deal apprpriately with HIV positive staff.

Em

"An insurance company cannot legally share that information with the employer. However, it is important to know whether the plan is insured or self-insured. In an insured plan, the insurer would not share this with the employer. Under a self -insured arrangement, it might be possible for the Group Insurance Department to find out information with respect to an individual's illness through reports provided to them, such as utilization review reports. However, most of the reports provided to an employer by the administrator in a self-insured arrangement are total dollars spent on claims by inpatient vs. outpatient treatment, by diagnosis, by type of service including dollars spent on prescriptions, total dollars spent per covered employee or dependent for claims in excess of a certain dollar amount but without any diagnosis, etc. The simple answer is, legally, no. The practical answer is, it is possible. "- Lynn Franzoi



HIPAA Violations and Enforcement
Failure to comply with HIPAA can result in civil and criminal penalties (42 USC § 1320d-5).

Civil Penalties
Violations of the Administrative Simplification Regulations can result civil monetary penalties of $100 per violation, up to $25,000 per year.

Criminal Penalties
In June 2005, the U.S. Department of Justice (DOJ) clarified who can be held criminally liable under HIPAA. Covered entities and specified individuals, as explained below, whom "knowingly" obtain or disclose individually identifiable health information in violation of the Administrative Simplification Regulations face a fine of up to $50,000, as well as imprisonment up to one year. Offenses committed under false pretenses allow penalties to be increased to a $100,000 fine, with up to five years in prison. Finally, offenses committed with the intent to sell, transfer, or use individually identifiable health information for commercial advantage, personal gain or malicious harm permit fines of $250,000, and imprisonment for up to ten years.

Covered Entity and Specified Individuals
The DOJ concluded that the criminal penalties for a violation of HIPAA are directly applicable to covered entities—including health plans, health care clearinghouses, health care providers who transmit claims in electronic form, and Medicare prescription drug card sponsors. Individuals such as directors, employees, or officers of the covered entity, where the covered entity is not an individual, may also be directly criminally liable under HIPAA in accordance with principles of "corporate criminal liability." Where an individual of a covered entity is not directly liable under HIPAA, they can still be charged with conspiracy or aiding and abetting.

Knowingly
The DOJ interpreted the "knowingly" element of the HIPAA statute for criminal liability as requiring only knowledge of the actions that constitute an offense. Specific knowledge of an action being in violation of the HIPAA statute is not required.

Full DOJ memorandum
(This link will take you off the AMA Web site. The AMA is not responsible for the content of other Web sites.)

Exclusion
The Department of Health and Human Services (DHHS) has the authority to exclude from participation in Medicare any covered entity that was not compliant with the transaction and code set standards by October 16, 2003 (where an extension was obtained and the covered entity is not small) (68 FR 48805).

Enforcing Agencies
The DHHS Office of Civil Rights (OCR) enforces the privacy standards, while the Centers for Medicare & Medicaid (CMS) enforces both the transaction and code set standards and the security standards (65 FR 18895). Enforcement of the civil monetary provisions has not yet been tasked to an agency.

Please refer to the AMA's FAQs on the privacy regulations for additional information on enforcement of the privacy standards.

No Private Cause of Action
While HIPAA protects the health information of individuals, it does not create a private cause of action for those aggrieved (65 FR 82566). State law, however, may provide other theories of liability.

[edfu]

HIV caseworkers are like doctors:  Sometimes the interpersonal match simply doesn't work.  Much also depends on the organization the caseworker is employed by and its policies and supervision.  I've had an HIV caseworker since January, and she's been a complete gem and has proved invaluable to me since I moved to a new state.  I rely on her completely, and she's hasn't let me down yet.   If she's pried into my life, it's only because I felt it was to my advantage.  She even visited me in my new apartment.  Admittedly, she hasn't called me "mentally unstable," but she did arrange for me to see a psychiatrist so I could continue to receive my psychotropic medications.

I'm sorry for your troubles.  As has been suggested, see if you can be reassigned to another.   

[BT65]

I have a pretty good HIV care coordinator (which is what they prefer to be called here).  I've had one in the past I didn't click with, but those situations can be remedied.  You can always request another one, and start over. 

I'm sorry about everything you're going through.  Major stressors, for sure.  Please hang in there.

[Ann]

Hi Maggie, good to see you here again, although I wish you had better news for us. But you did have some - you're on a sucessful treatment break. I only hope that you can get your medical situation sorted out so you can continue to be monitored and go back on meds when the time comes.

As you know, living on the Rock, I don't have a clue about getting insurance. But I do wish you good luck. The sooner the American medical care situation is sorted out, the better. It would be unthinkable here where I live that someone should end up without medical care just because they got divorced or lost a job. It sucks.

((((((Maggie))))))

Have you noticed we have a Women's forum now?

Hugs,
Ann
xxx

[Maggie]

I guess I wasn't in such a good mood the day that I wrote this.  This caseworker is still trying to help me as of now.   

I didn't explain everything very clearly.   I am in Illinois and my hiv doctor was also my primary care doctor.  The hiv portion is of course covered through Ryan White & public health.

However, I also have blood pressure problems plus I have no thyroid and am on thyroid replacement.

When the bill got out of hand for this particular clinic/hospital, this doctor decided to drop me as a patient and said that he would only take care of my hiv-related issues (which he knows are covered).  But... that's it.  I now have NO primary doc.

Little did I know all that had been going on with this particular clinic/hospital.   After doing some research on the net, I found out that for years there have been class action lawsuits, etc. for extreme measures of collecting medical debt.

Here is one... http://webreprints.djreprints.com/858821310103.html

There is also one entitled "Are Debtor's Prisons coming to America"? by Amy Goodwin of the Wall St. Journal. 

I could not believe this was flying so far under the radar that nobody around here was even aware that this was going on.

There are multiple other websites with this information. 

I cannot believe that people are actually going to jail if they miss a court date over a medical debt.  I mean, I realize these hospitals need to be paid.... but if a person doesn't have the money, they just don't, ya know?

And here I am .... a patient of this very clinic.

When I let my caseworker know that I would love to get out of this state (for many reasons), she informed me that I had really better think about that for awhile.  She said that Illinois and New York are the best states as far as funding for HIV.

Does anyone have an opinion about this "Illinois" & "New York" supposedly being the best as far as care?

I realize that my thoughts are all over the place right now - Sorry if I've made this so confusing.

Ann... yep!  I saw the women's forum :-)

[Maggie]

Actually it's a practice known as "Body Attachments". 

This one guy had made it to several court dates but knew that he also had to go to work also.  So, the CFO of the hospital ordered a "body attachment" on this guy.

I also know of someone about 170 mi. from here who was stopped on a simple traffic violation.  The police notified him that there was a warrant out for him.  He didn't understand this at all.   

I guess the police even told him that they didn't want to do it, but they had to take him to jail over a warrant that was put out on him for not paying a hospital debt.  (This is for a different hospital in Illinois).

[emeraldize]

Holy crappoli, may as well be body snatchers!! 

Body attachment sounds as parasitic as the namers must be.

[Maggie]

I know it emerald!   

It's downright scary!!