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Author Topic: When should I use my new individual insurance?  (Read 2914 times)

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Offline Ocean1617

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  • Posts: 19
When should I use my new individual insurance?
« on: January 16, 2012, 02:05:56 PM »
I have just applied and gotten a new individual insurance this month (Blue Shield of CA PPO), effective date 01/05/12. Prior to that I was covered under another individual insurance since June 2011. Before that I was under COBRA for about 1.5 year. I went in for a routine HIV rapid test on 01/07/12, and it was preliminary positive. I got a retest and it came back positive. I think I was exposed and went through seroconversion around 11/15.

The problem that I'm concerned the most now is paying for the HIV care. I don't make a lot of money, working as a temp. So, I may or may not have income some month. I have always been frugal and lived within my means so I have some saving. I'm glad that I was approved for the health insurance before my test. However, I'm afraid to use it because of pre-existing condition. It is likely that I was infected before the change over even though I wasn't diagnosed.

Should I not get treated for 6 more months so it won't be considererd pre-existing condition? Is 6 months enough time for that? So far, I only have the anonymous testing so no paper-trail just yet. I have been and am still healthy--except, I don't know my CD count, viral load, etc. The counselor at the HIV/AIDS organization told me to go on Ryan White, but I have to lie that I don't have any health insurance for six months. But, if I did that I will create the paper trail, and it could be pinpoint that I have been infected before the effective date of the insurance.

I don't know what I should do. I am so worried, scared for my health and that I can't afford to pay for care. Any expert please advise.

Thank you.

Online leatherman

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Re: When should I use my new individual insurance?
« Reply #1 on: January 16, 2012, 02:54:10 PM »
I don't know my CD count, viral load, etc.
quite frankly, until you have a cd4/viral load count, you have no idea whether treatment is neccesary yet or whether it may still be years off.  (also as a recent infection some of those counts can be crazy right now as the HIV infection has recently begun and not leveled off). There is a very good chance that you won't have to be medicated, but just need regular monitoring (ie every 3 to 4 months) for quite some time. But without that preliminary data, there's no way to tell. You should do whatever it takes (sorry, I don't have the answers to those questions of yours. hopefully someone else will chime in) to get those initial tests done. ;)
leatherman (aka mIkIE)


chart from 1992-2013; updated 2/09/13  Reyataz/Norvir/Truvada

Offline liketheboat

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Re: When should I use my new individual insurance?
« Reply #2 on: January 16, 2012, 04:34:43 PM »
Just as long as you have had continus converage, no lapses longer than 30 days, than a preexsisting clause should not come into play. i would check with the plan administrater to be sure on the specifics of what your plan offers. I would rather get into care right away and risk the waiting period than have untreated hiv. there are always lots of programs like ADAP and ASO's that can cover a gap in insurance coverage.
Aaron
Memorial Day 2010 Seroconverted
Labor Day 2010 tested positive
Oct 2010 cd4 359 vl 6,500
Dec 2010 cd4 vl 306
Jan 2011 started Atripla
Feb 2011 cd4 250 vl ud
April 2011 cd4 399 vl ud
June 2011 cd4 293 vl ud
October 2011 cd4 354 vl ud
March 2012 cd4 561 vl ud

Offline Ocean1617

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  • Posts: 19
Re: When should I use my new individual insurance?
« Reply #3 on: January 16, 2012, 07:06:34 PM »
Thank you Leatherman and Likeaboat for the replies.

Likeaboat:  I have had continuous coverage since 2008. I'm just concerned that I can be denied coverage. I have been searching the web for answer but I haven't found a definitive answer. I want to get all the tests done as suggested by leatherman but I am afraid to pay so I haven't. are you pretty sure that pre existing condition not applied if continuous coverage? Is my situation a pre existing condition?

Anybody else who went through this? I would really appreciate your input.

Thank you.

Offline Ann

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Re: When should I use my new individual insurance?
« Reply #4 on: January 17, 2012, 10:35:08 AM »
Your insurance kicked in before you were tested for hiv and before your hiv infection was confirmed. They cannot say you had a pre-existing condition before you were diagnosed with it.
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Offline Ocean1617

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Re: When should I use my new individual insurance?
« Reply #5 on: January 17, 2012, 10:41:54 AM »
Thank you Ann for your reply. It makes me feel better.

I've done more search on this, and found a website that I can ask questions about legal issues and answered by attorneys. If I get more information, I'll post it here. Just in case, anybody else in the future has this problem.

Offline liketheboat

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Re: When should I use my new individual insurance?
« Reply #6 on: January 17, 2012, 02:49:45 PM »
I have been working in the medical billing feild for over seven years, three of which i processed bills for an insurance company, now im back to the doctor side of thing. Just as long as your positive test was done after your insurance was in effect you will be fine. I am about to swich insurances myself and i will be fine because there is no gap in coverage. I know that this is a scary situation given the cost of some of the lab work, and espically the cost of medications. but its best to go to the doctor and get it all done. Insurance does love to deny for stupid and picky reasons (trust me i have done it a ton myself), but as far as a pre-exsisting condition you are in the clear.
Aaron
Memorial Day 2010 Seroconverted
Labor Day 2010 tested positive
Oct 2010 cd4 359 vl 6,500
Dec 2010 cd4 vl 306
Jan 2011 started Atripla
Feb 2011 cd4 250 vl ud
April 2011 cd4 399 vl ud
June 2011 cd4 293 vl ud
October 2011 cd4 354 vl ud
March 2012 cd4 561 vl ud

Offline OneTampa

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Re: When should I use my new individual insurance?
« Reply #7 on: January 17, 2012, 07:58:33 PM »
I agree with what others have said.

A few points to highlight:

-You do not appear to have had a lapse in coverage.  This is important regardless of pre-existing conditions.
-You should not sacrifice your health which, I assume, is why you've held insurance in the first place and want to keep it.
-You should get a medical assessment so you know your current state of health.
-You should review your insurance coverage and look at the costs for prescriptions and doctor visits (e.g., does your policy have co-pay tables so you can assess costs and match to your budget?).

Take care.
"He is my oldest child. The shy and retiring one over there with the Haitian headdress serving pescaíto frito."

Offline Ocean1617

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  • Posts: 19
Re: When should I use my new individual insurance?
« Reply #8 on: January 18, 2012, 08:51:24 AM »
Thank you Liketheboat and OneTampa for your valuable input.

The past week I think I'm going crazy, running around like a chicken with the head cut off--going to work, trying to focus on work, worried about the future state of my health, thinking about death and dying, feeling my lymph nodes and how to pay for the HIV care. Then I was back on the net trying to get answers to my insurance questions. I just want to let you guys know that I really appreciate your replies, Liketheboat and OneTampa. It makes me feel less crazy and reassuring that I will be fine with the insurance stuff.

Liketheboat:  Are you on a group plan or individual plan? Are you switching to another group or individual plan? For me, my recent switch (01/05/12) was from an individual (Anthem Blue Cross) to another individual (Blue Shield). Does it make a difference whether it's group of individual plan?

OneTampa:   - You're correct. I have not had a lapse in coverage since 2008. Is there a length or time required, like 18 continuous months of coverage to be considered enough for pre existing condition?
- you're correct I have health insurance because I don't want to sacrifice my health. Like a car insurance, health insurance is something that I have but hope and pray that I won't need it, yet I keep paying. But now that I need the benefits, I'm afraid to use it because of fear of rejection for the benefits. My fear is big enough to make me consider sacrificing my health--this is not good so thanks for the reminder.
- I completely agree that I should get a medical assessment. On one hand, I want to know the current state of my health. On the other hand, if I get the assessment, everything will be official and I might be denied for coverage, and facing money problem. That scares me. I know sooner or later it will be official. It's just that I so much don't want it to be so. This is irrational, I know. That's why I feel like I'm going crazy.
- The reason I switched because I wanted a policy that fits my budget, and that I'm doing better financially. So, I can afford higher premium. Luckily, I've been healthy so I was able to applied for the best (I think) individual plan offered by Blue Shield. Just curious, even if the policy didn't fit my budget, I don't think I could make any changes to the policy now at this point with what I know about my condition. Am I right?

Again, thanks you guys for the reply. I just read somewhere that the things that we hold so close to ourselves are the things that cause us the most suffering. For me, it's good health. Now, that's it threatened. I suffer a lot. The more I try to hold on to it, the more I suffer. Then I realize that I will die sometimes and that my good health reduces with each passing year regardless of HIV. I guess I am beginning to let go of the idea that my good health is forever. Realizing that I'll die anyway strangely makes me feel calmer. Isn't it crazy or what?

Peace of mind to you guys.




Offline Assurbanipal

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  • Posts: 2,173
  • Taking a forums break, still see PM's
Re: When should I use my new individual insurance?
« Reply #9 on: January 19, 2012, 09:51:09 PM »

Individual health insurance policies are regulated by the state insurance departments.  If you have any questions about the minimum coverage rules in your state you should ask your state's insurance supervisor to get a definitive answer.  Most state insurance regulators have a web presence these days, and many have an 800 number.

Generally, though, if you have had continuous coverage you shouldn't need to worry.
5/06 VL 1M+, CD4 22, 5% , pneumonia, thrush -- O2 support 2 months, 6/06 +Kaletra/Truvada
9/06 VL 3959 CD4 297 13.5% 12/06 VL <400 CD4 350 15.2% +Pravachol
2007 VL<400, 70, 50 CD4 408-729 16.0% -19.7%
2008 VL UD CD4 468 - 538 16.7% - 24.6% Osteoporosis 11/08 doubled Pravachol, +Calcium/D
02/09 VL 100 CD4 616 23.7% 03/09 VL 130 5/09 VL 100 CD4 540 28.4% +Actonel (osteoporosis) 7/09 VL 130
8/09  new regimen Isentress/Epzicom 9/09 VL UD CD4 621 32.7% 11/09 VL UD CD4 607 26.4% swap Isentress for Prezista/Norvir 12/09 (liver and muscle issues) VL 50
2010 VL UD CD4 573-680 26.1% - 30.9% 12/10 VL 20
2011 VL UD-20 CD4 568-673 24.7%-30.6%
2012 VL UD swap Prezista/Norvir for Reyataz drop statin CD4 768-828 26.7%-30.7%

Offline MitchMiller

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  • Posts: 464
Re: When should I use my new individual insurance?
« Reply #10 on: January 20, 2012, 12:45:25 AM »
I was in somewhat of the same circumstance you are in when I was infected, except I was working for a very small company that had a history of laying off people as soon as they became seriously ill.  I was lucky enough to find a clinical trial for the treatment naive.  Not sure if this might be an option these days, given the large number of drugs now on the market.  It gave me about a year to figure out what to do. 

It is important to know your TCell count, because mine had dropped to 112 when I finally got into the trial... and that was only eleven months after infection (yes infection, not diagnosis).  I was dropping about 30 TCells/month.

Offline Ocean1617

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  • Posts: 19
Re: When should I use my new individual insurance?
« Reply #11 on: July 02, 2012, 03:13:03 PM »
So I want to do an update to my post for future referece to others that maybe in the same situation. I haven't done an update on this topic because I want to wait until I'm sure that all claims are finalized. So, here's what happened.

I finally got up my nerve to see the doctor around mid April for blood work. I was put on Complera at the end of April. I had claims for both lab work and doctor's fee that had been pending since April. All the claims first got denied. I called Blue Shield and they said that it was a routine denial until more information was received from the doctor and me.

The doctor was sent questionnaire regarding pre-existing condition which she made clear on the questionnaire that it was not a pre-existing condition.

I was sent a letter requesting proof of credical coverage for at least 6 months prior to the coverage of the current policy which I mailed the proof in immediately.

I was told that either one of the requests to the doctor or me is sufficient to fulfill the eligibility to claims adjustment. In my case, both the doctor and I sent in the requested information. Still, it took Blue Shield about 2.5 months to adjust the original claims. I still have one more claim from mid April to be adjusted. The representative says it's eligible for coverage, it's just that their system is slow in adjustment.

My latest lab work claims done in mid June has already been fianalized. It seems that my HIV condition is covered. It just takes Blue Shield a long time to decide on the first claim for this condition.

Lastly, I'm happy to report that Complera works on me. The viral load goes from 59,000 to 250 and CD4 from 300 to 350 in six weeks. I'm lucky that the side effect I experiece is numbness in the small area on the ball of my right foot. I hope that the numbness will go away soon.

So, liketheboat and Ann are correct about previous coverage and pre-existing condition. It was unnerving waiting to hear from insurance company about the coverage. Thank you for all your input and supports. I hope that my experience will help others facing the same situation.

Offline MitchMiller

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  • Posts: 464
Re: When should I use my new individual insurance?
« Reply #12 on: July 14, 2012, 12:04:10 AM »
Hopefully the Dems will stay in power so pre-existing conditions will no longer be a factor post 2014. 

You could try contacting some doc directly to see if you can get a price quote on a VL test.  Whatever you do, don't let the lab bill you without some guarantee of the cost.  I seem to remember the one and only doc I saw in LA said he could do the VL for $200.

Also, just thought of this... if you're near the border, you can go into Mexico for affordable care.  I've read a lot of people go to clinics in Tijuana.
« Last Edit: July 14, 2012, 12:09:23 AM by MitchMiller »

 


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