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Author Topic: Insurance Question  (Read 1283 times)

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Offline tucker

  • Member
  • Posts: 35
Insurance Question
« on: January 18, 2008, 07:55:43 PM »
One more question for the people who know the ropes, since this is new to me... I am uninsured, and have been since I finished school and went off my parents policy, which was eight years ago.  I am self employed, and do fairly well, but not nearly well enough to buy my meds out of pocket and still have a home and car.  I have read some topics on here that have me pretty scared that I will never be able to get insurance... I was thinking I just had to close up shop, and get a job with a corporation with good benefits.  Now I see some people saying that I still won't be able to get insurance because I am now officially HIV+ and have not been under some sort of group policy prior... Is this true?  My doctor insists I need not worry about affording meds, that between assistance from drug manufacturers, and the fact that I qualify for some state/local assistance, I will be OK... and she says I may not need meds for a few years anyway so that gives me time to get my ducks in a row.  Anyone have any ideas on what the deal is regarding getting health insurance once you are officially hiv+?  This causes a lot of anxiety for me, and sometimes I feel that my only hope is our new president follows through on some sort of national health care plan... Thanks so much, and I appreciate all the wisdom and care and humor you all dispense on a daily basis. ; )
confirmed diagnosis 10.1.07
10/07  cd4 504 vl 40,000
1/08  cd4 524 vl 73,000
4/08  cd4 484 vl 48,060
6/02/08 started Truvada, Reyetaz, Norvir
7/08 cd4 605! vl 400
9/08 cd4 713 vl 175

k103 mutation :(

Offline aztecan

  • Member
  • Posts: 5,382
  • 29 years positive, 56 years a pain in the butt
Re: Insurance Question
« Reply #1 on: January 18, 2008, 09:33:12 PM »
Howdy Tucker,

Well, let's start with being self employed and insurance-less. Depending on your income, your doc was right about state programs. These vary from state to state, so what services you are eligible for I can't say.

What I would do first would be to locate an ASO (AIDS Service Organization) in your neck of the woods. The care workers there should be able to tell you where you stand regarding services, ADAP, etc.

Affording insurance on your own would be very costly. I know someone who is paying close to $800 a month for his and he has a lot of restrictions on things like co-pays.

Just because you have HIV does not mean you cannot get insurance though. If you go to work for a corporation that provides health insurance as one of its benefits, that company's insurance carrier cannot refuse to cover you.

They can, however, enforce a pre-existing condition clause. That would mean that, for the length of time the policy establishes for pre-existing conditions, you cannot claim anything related to that condition. In other words, doctor visits, labs and, I think, medications. It depends on the policy how long, but it cannot be longer than one year, if memory serves.

But I would go to the local ASO and see what they say about services, etc. The time to do it is now, not later when a crisis erupts.

I hope this helps somewhat.

HUGS,

Mark
"May your life preach more loudly than your lips."
~ William Ellery Channing (Unitarian Minister)

Offline dvinemstre

  • Member
  • Posts: 96
  • hot in carolina
Re: Insurance Question
« Reply #2 on: January 18, 2008, 09:59:05 PM »
hi tucker, i live in a nearby city to you and would be more than happy to meet with you sometime or email or post on here. I have an agency that serves persons with disabilities which are paid out through medicaid. I am self employed and have been under medicaid insurance for a variety of reasons for while. I was recently diagnosed and am not on meds yet and this is a source of concern for me as well. i think that the physician you see could refer you, if they are not part of an infectious disease clinic in your town. then they can tell you what's up. you can go ahead and see someone at vocational rehabilitation and open a case and let them know you do not have insurance and you will need ongoing testing, etc to stay healthy enough to maintain employment. They will crunch some numbers and then you will be told if you qualify for FREE services or if you will have to pay a certain amount out of pocket, etc. there are also drug assistance programs they can link you to. VR is designed to help people with disabling conditions to get a job or MAINTAIN their present employment. I would think if you start now then by the time you need medications you will have things formalized. there should also be a grant funded nonprofit in your area that provides that sort of case management and other services (like food pantry and condoms). i know you may be thinking, well I'm not there at this point, but i would really advise you to get all the help you can at this point and forward. once yo get linked into some social services things can be a lot less stressful, which will keep you well longer, which is the hope for all of us i think! thanks, Zan

Offline tucker

  • Member
  • Posts: 35
Re: Insurance Question
« Reply #3 on: January 18, 2008, 10:38:58 PM »
Zan and Mark-- Thanks a bunch!  I all ready have a case manager, and am being seen at a clinic for the uninsured, so I have that covered.  I also have a great HIV specialist as part of the clinic, and she has assured me (over and over again, lol) that when the time comes, if I am still self-employed, we will find a way to get the meds.  My question was more out of concern about the 'preexisting' clause, if I chose to get a job with a company that provided insurance.  I hate to give up my little business just now, but was thinking I needed to just to get insurance.  I was concerned that even doing that would not cover my HIV treatment, but if what Mark said is true, that it could not be more than one year, I could handle that.  I thought I was just doomed... which, to me, in the good ole USA, just did not seem right.  Anyway, thanks again for your advice, I take it seriously.  And Zan, that is cool that you live nearby.  I would love to get together sometime and comiserate...  ;)
confirmed diagnosis 10.1.07
10/07  cd4 504 vl 40,000
1/08  cd4 524 vl 73,000
4/08  cd4 484 vl 48,060
6/02/08 started Truvada, Reyetaz, Norvir
7/08 cd4 605! vl 400
9/08 cd4 713 vl 175

k103 mutation :(

Offline dvinemstre

  • Member
  • Posts: 96
  • hot in carolina
Re: Insurance Question
« Reply #4 on: February 08, 2008, 08:21:17 PM »
well not sure i can commiserate  :Pbut we can share a meal and enjoy each other's company. please feel free to send me a PM. I also work for myself and have flexible hours, so that would be great! i can probably also help you with advise on vocational rehabilitation, etc. for those of you folks who are on the sort of oh shit! part of your journey with hiv, then you should know that vocational rehabilitation services are FREe and also are geared to assist folks to REMAIN in their present jobs, RETRAIN for a different job, and LOCATE employment. best to get in now and then you will have a case going. they also assist self employed folks. i have two men with AIDS on my case load when i worked as an RC at voc rehab. hugs, z

 


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