Quantcast

Subscribe to:
POZ magazine
E-newsletters
Join POZ: Facebook MySpace Twitter Pinterest
Tumblr Google+ Flickr MySpace
POZ Personals
Sign In / Join
Username:
Password:
Welcome, Guest. Please login or register.
September 01, 2014, 04:35:30 PM

Login with username, password and session length


Members
  • Total Members: 23364
  • Latest: andy1
Stats
  • Total Posts: 636821
  • Total Topics: 48338
  • Online Today: 229
  • Online Ever: 585
  • (January 07, 2014, 02:31:47 PM)
Users Online
Users: 5
Guests: 193
Total: 198

Welcome


Welcome to the POZ/AIDSmeds Community Forums, a round-the-clock discussion area for people with HIV/AIDS, their friends/family/caregivers, and others concerned about HIV/AIDS.  Click on the links below to browse our various forums; scroll down for a glance at the most recent posts; or join in the conversation yourself by registering on the left side of this page.

Privacy Warning:  Please realize that these forums are open to all, and are fully searchable via Google and other search engines. If you are HIV positive and disclose this in our forums, then it is almost the same thing as telling the whole world (or at least the World Wide Web). If this concerns you, then do not use a username or avatar that are self-identifying in any way. We do not allow the deletion of anything you post in these forums, so think before you post.

  • The information shared in these forums, by moderators and members, is designed to complement, not replace, the relationship between an individual and his/her own physician.

  • All members of these forums are, by default, not considered to be licensed medical providers. If otherwise, users must clearly define themselves as such.

  • Forums members must behave at all times with respect and honesty. Posting guidelines, including time-out and banning policies, have been established by the moderators of these forums. Click here for “Am I Infected?” posting guidelines. Click here for posting guidelines pertaining to all other POZ/AIDSmeds community forums.

  • We ask all forums members to provide references for health/medical/scientific information they provide, when it is not a personal experience being discussed. Please provide hyperlinks with full URLs or full citations of published works not available via the Internet. Additionally, all forums members must post information which are true and correct to their knowledge.

  • Product advertisement—including links; banners; editorial content; and clinical trial, study or survey participation—is strictly prohibited by forums members unless permission has been secured from POZ.

To change forums navigation language settings, click here (members only), Register now

Para cambiar sus preferencias de los foros en español, haz clic aquí (sólo miembros), Regístrate ahora

Finished Reading This? You can collapse this or any other box on this page by clicking the symbol in each box.

Author Topic: I dont qualify for ADAP. Will my insurance help me???  (Read 2529 times)

0 Members and 1 Guest are viewing this topic.

Offline CoupleNYC

  • Member
  • Posts: 15
I dont qualify for ADAP. Will my insurance help me???
« on: June 28, 2012, 01:03:11 AM »
I make $55000 and that will be just too much to qualify on ADAP in NY. I have Oxford insurance but don't really know how it all works. Will I have to pay just a little towards my meds, will the Oxford say to me "we can pay 20% or so???" Will they not cover any??? All those questions really worry me!!! I already don't care too much about the fact of taking meds, just don't want to be broke at the same time. So my question is this. How do insurance companies respond to paing for hiv meds, do they really help you with that a lot?? Is the insurance a real life saver or just a little discount card that doesn't help you too much? Is ADAP the only way forward? Please help

« Last Edit: June 28, 2012, 01:09:39 AM by CoupleNYC »
Aug 3 2012-Cd4-450, VL-43000
Our Meds
Norvir, Truvada, Reyataz, (3 pills, once a day)

Offline buginme2

  • Member
  • Posts: 2,843
Re: I dont qualify for ADAP. Will my insurance help me???
« Reply #1 on: June 28, 2012, 02:49:32 AM »
I make $55000 and that will be just too much to qualify on ADAP in NY. I have Oxford insurance but don't really know how it all works. Will I have to pay just a little towards my meds, will the Oxford say to me "we can pay 20% or so???" Will they not cover any??? All those questions really worry me!!! I already don't care too much about the fact of taking meds, just don't want to be broke at the same time. So my question is this. How do insurance companies respond to paing for hiv meds, do they really help you with that a lot?? Is the insurance a real life saver or just a little discount card that doesn't help you too much? Is ADAP the only way forward? Please help

It depends on your policy

Offline J.R.E.

  • Member
  • Posts: 7,126
  • Joined Dec-2003 Living positive, since 1985.
Re: I dont qualify for ADAP. Will my insurance help me???
« Reply #2 on: June 28, 2012, 07:41:08 AM »
Hi,

Do you have an insurance card, supplied by the insurer?  If so take a look at it. There must be a way for you to register and enroll for online information.

Once you are registered, you will be able to access, the type of coverage you have, and all your benefit information, including co-pays and you should very easily find what you would pay for medications, etc

Is this private insurance , or a group plan through your employer?


Ray
Current Meds ; Viramune, Epzicom, 40mg of simvastatin, 12.5mg of Hydrochlorothiazide.
Metoprolol tartrate 25mg



http://forums.poz.com/index.php?topic=40802.0

http://forums.poz.com/index.php?topic=45159.0

http://forums.poz.com/index.php?topic=39722.msg495621;topicseen#msg495621

http://forums.poz.com/index.php?topic=46806.0

http://forums.poz.com/index.php?topic=39414.msg491701#msg491701


 In October of 2003, My t-cell count was 16, Viral load was over 500,000, Percentage at that time was 5%. I started my first  HAART regimen  on October 24th,03.

 As of 8/2514,  t-cells are at 402, Viral load <40

 Current % is at 11%

  
 62 years young.

Offline CoupleNYC

  • Member
  • Posts: 15
Re: I dont qualify for ADAP. Will my insurance help me???
« Reply #3 on: June 28, 2012, 09:41:25 AM »
Hey Ray, thanks for your post. The insurance its a group plan trough good size company. Is it all depending on the plan that they signed into? I should know more today but the policy will start in 3 months from now. I wonder if I can check what they pay for and how much before that 3 months.
Aug 3 2012-Cd4-450, VL-43000
Our Meds
Norvir, Truvada, Reyataz, (3 pills, once a day)

Offline CoupleNYC

  • Member
  • Posts: 15
Re: I dont qualify for ADAP. Will my insurance help me???
« Reply #4 on: June 28, 2012, 12:27:59 PM »
Off topic question:
I'm very new to all this and it trying to keep it together. Is it possible to privat talk to ppl on this forum or do I have to post my questions on public forums only?
I tried to send some private messages but I wasn't able to do that last night. :-(
Thank you guys for all the help.
Aug 3 2012-Cd4-450, VL-43000
Our Meds
Norvir, Truvada, Reyataz, (3 pills, once a day)

Offline sshortguy1

  • Member
  • Posts: 118
Re: I dont qualify for ADAP. Will my insurance help me???
« Reply #5 on: June 28, 2012, 02:42:59 PM »
yes u can i think its like as u posted 3-5 posts by then as i read earlier hope u can get coverage for the meds

Offline CoupleNYC

  • Member
  • Posts: 15
Re: I dont qualify for ADAP. Will my insurance help me???
« Reply #6 on: June 28, 2012, 03:16:08 PM »
yes u can i think its like as u posted 3-5 posts by then as i read earlier hope u can get coverage for the meds

Thank you for posting your answer, rainy days here... :-(
Aug 3 2012-Cd4-450, VL-43000
Our Meds
Norvir, Truvada, Reyataz, (3 pills, once a day)

Offline drewm

  • Member
  • Posts: 1,084
  • I have a sling and a dungeon :-P
Re: I dont qualify for ADAP. Will my insurance help me???
« Reply #7 on: June 28, 2012, 03:22:04 PM »
Do you have a medical case manager for HIV? You might want to Google this in your area. The services are usually free to HIV infected folks and they can address insurance issues etc and help get through the red tape.
Diagnosed in  May of 2010 with teh AIDS.

PCP Pneumonia . CD4 8 . VL 500,000

ATRIPLA - VALTREX -  FLUOXETINE - FENOFIBRATE


Numbers consistent since 12/2010 - VL has remained undetectable and CD4 is anywhere from 275-325

Offline Solo_LTSurvivor

  • Member
  • Posts: 1,176
  • Twerk Baby Twerk
Re: I dont qualify for ADAP. Will my insurance help me???
« Reply #8 on: June 28, 2012, 03:33:18 PM »
Couple, here's some information that might be helpful:

You can take a look at the Oxford site and check the Member Portal here:

https://www.oxhp.com/Member/MemberPortal/navigation.do?method=TOOLSRESOURCES

You can call the Pharmacy Customer Service at (800) 905-0201

Also they have a Speciality Pharmacy Program which is at (866) 429-8177

It looks like all of the ARV drugs fall under specialty coverage.  You can take a look here to check meds alphabetically:

http://uhcspecialtyrx.com/index.php/medications

[Snipped from the Specialty site:]

How do I know what Pharmacy or Medical Benefits I have?

To find out which benefits are included in your health insurance plan, please call the number on the back of your health insurance ID card.

don't equate intelligence with lack of masculinity
Jim Phelps, Mission Impossible
____________________________

Seroconverted: Early 80s
Tested & confirmed what I already knew: early 90s

Current regimen: Atripla. 
Last regimen:  Epzicom, Sustiva (since its inception with NO adverse side effects: no vivid dreams and NONE of the problems people who can't tolerate this drug may experience: color me lucky ::))
Past regimens
Fun stuff (in the past):  HAV/HBV, crypto, shingles, AIDS, PCP

Jan 2012: 818/21%
Apr 2012: 964/22%
Jul. 2012: 890/21%
Oct. 2012: 920/23%

Still UD after all these years

Offline CoupleNYC

  • Member
  • Posts: 15
Re: I dont qualify for ADAP. Will my insurance help me???
« Reply #9 on: June 28, 2012, 11:59:13 PM »
Do you have a medical case manager for HIV? You might want to Google this in your area. The services are usually free to HIV infected folks and they can address insurance issues etc and help get through the red tape.

I'm going to check that out tomorrow. There is a Cobra or something like that in the area. I hope it
will be usefull for some info. The social worker I talked to at the clinic didn't even know the limit amount for ADAP
I couldn't believe it!!! She was like 42k..... I'm like, What!!! I thought it was 48.5k...She is like n.o no no.... I'm know it is 42k she goes. How can a person like that help you with anthing that you can't do it yourself (it is 48.5k by the way) Little knowledge is dangerous... for all I know she probably messed my ADAP app. up if anything. I wonder if they are going to leave us on ice.....
Aug 3 2012-Cd4-450, VL-43000
Our Meds
Norvir, Truvada, Reyataz, (3 pills, once a day)

Offline gadawg1979

  • Member
  • Posts: 142
Re: I dont qualify for ADAP. Will my insurance help me???
« Reply #10 on: June 29, 2012, 02:32:48 AM »
Try a co-pay card.  www.needymeds.com
Diagnosed March 2012
Initial CD4- 156 VL 200K (started Complera) Genotype test no resistance
First labs on meds CD4- 246 VL 2K Taken after 30 days on Complera
90 Day labs VL 306 No CD4 Drawn
8/21/2012 CD4 474 VL Undetectable (40) %20.6
11/27/2012 CD 4 522 VL Undetectable (40)
2/14/2013 CD 4 464 VL Undetecable (30) 19.6%
6/8/3013 CD 4 528 VL Undetectable (30)
9/24/2013 CD 4 546 VL Undetectable (40)
1/30/2014 CD4 560 VL Undetectable (40) 22 %
6/19/2014 CD4 584 Vl Undetecable (30)

Offline sshortguy1

  • Member
  • Posts: 118
Re: I dont qualify for ADAP. Will my insurance help me???
« Reply #11 on: June 29, 2012, 10:47:20 AM »
i'm glad the healthcare reform passed yesterday

Offline BT65

  • Global Moderator
  • Member
  • Posts: 9,915
Re: I dont qualify for ADAP. Will my insurance help me???
« Reply #12 on: June 29, 2012, 02:14:26 PM »
Couple, here's some information that might be helpful:

You can take a look at the Oxford site and check the Member Portal here:

https://www.oxhp.com/Member/MemberPortal/navigation.do?method=TOOLSRESOURCES

You can call the Pharmacy Customer Service at (800) 905-0201

Also they have a Speciality Pharmacy Program which is at (866) 429-8177

It looks like all of the ARV drugs fall under specialty coverage.  You can take a look here to check meds alphabetically:

http://uhcspecialtyrx.com/index.php/medications

[Snipped from the Specialty site:]

How do I know what Pharmacy or Medical Benefits I have?

To find out which benefits are included in your health insurance plan, please call the number on the back of your health insurance ID card.

Did you read none of this after he bothered to post it??
I've never killed anyone, but I frequently get satisfaction reading the obituary notices.-Clarence Darrow

Offline denb45

  • Member
  • Posts: 5,051
  • "1987 Classic Old School POZ+"
Re: I dont qualify for ADAP. Will my insurance help me???
« Reply #13 on: June 29, 2012, 02:20:26 PM »
Did you read none of this after he bothered to post it??

Betty,  the OP has several threads all asking the very same questions  ::)
"it's so nice to be insane, cause no-one ask you to explain" Helen Reddy cc 1974

Offline CoupleNYC

  • Member
  • Posts: 15
Re: I dont qualify for ADAP. Will my insurance help me???
« Reply #14 on: June 29, 2012, 06:04:51 PM »
Couple, here's some information that might be helpful:

You can take a look at the Oxford site and check the Member Portal here:

https://www.oxhp.com/Member/MemberPortal/navigation.do?method=TOOLSRESOURCES

You can call the Pharmacy Customer Service at (800) 905-0201

Also they have a Speciality Pharmacy Program which is at (866) 429-8177

It looks like all of the ARV drugs fall under specialty coverage.  You can take a look here to check meds alphabetically:

http://uhcspecialtyrx.com/index.php/medications

[Snipped from the Specialty site:]

How do I know what Pharmacy or Medical Benefits I have?

To find out which benefits are included in your health insurance plan, please call the number on the back of your health insurance ID card.



Thank you for all the info. Actually I didn't think about checking their website and I didn't know about speciality medications group.

the thing is this.
I have oxford insurance WITHOUT!!!! Perscription benefit (I couldn't believe it).
My fiance has just started her new job so she has to wait 3months to get hers group insurance.
We both applied for Adap I have missed a few days on my pay slip so it shouldn't be over the limit
If we got married then we could both go on hers insurance but for now she doesn't have the group number yet so its hard to tell how much the insurance would cover.

Ps. Sorry for a late reply but my life is upside down at the moment. We are starting to sleep  better so that's a good sign.

Thank You to all of you guys.
Aug 3 2012-Cd4-450, VL-43000
Our Meds
Norvir, Truvada, Reyataz, (3 pills, once a day)

Offline Solo_LTSurvivor

  • Member
  • Posts: 1,176
  • Twerk Baby Twerk
Re: I dont qualify for ADAP. Will my insurance help me???
« Reply #15 on: June 29, 2012, 06:30:11 PM »
Thank you for all the info. Actually I didn't think about checking their website and I didn't know about speciality medications group.

the thing is this.
I have oxford insurance WITHOUT!!!! Perscription benefit (I couldn't believe it).
My fiance has just started her new job so she has to wait 3months to get hers group insurance.
We both applied for Adap I have missed a few days on my pay slip so it shouldn't be over the limit
If we got married then we could both go on hers insurance but for now she doesn't have the group number yet so its hard to tell how much the insurance would cover.

Ps. Sorry for a late reply but my life is upside down at the moment. We are starting to sleep  better so that's a good sign.

Thank You to all of you guys.

No problem.  So, do you mind clarifying this for us? You called the number and they told you that there is NO prescription benefit with the plan?

I only ask because many years ago I had coverage through United Healthcare through my job at the time - and Oxford is now a part of them.  And all my drugs were a part of the PPO plan I selected when I chose whatever plan that worked best for me.

I just did a little more digging and see that the prescription plans are still set up that way - meaning the drugs are included within whatever plan you choose.

POS Plan

HMO Plan

If you don't mind telling us more (either by posting to this thread or sending me a PM), maybe we can help you sort things out -- or try to point you in the right direction so you don't lose any more sleep.
don't equate intelligence with lack of masculinity
Jim Phelps, Mission Impossible
____________________________

Seroconverted: Early 80s
Tested & confirmed what I already knew: early 90s

Current regimen: Atripla. 
Last regimen:  Epzicom, Sustiva (since its inception with NO adverse side effects: no vivid dreams and NONE of the problems people who can't tolerate this drug may experience: color me lucky ::))
Past regimens
Fun stuff (in the past):  HAV/HBV, crypto, shingles, AIDS, PCP

Jan 2012: 818/21%
Apr 2012: 964/22%
Jul. 2012: 890/21%
Oct. 2012: 920/23%

Still UD after all these years

Offline CoupleNYC

  • Member
  • Posts: 15
Re: I dont qualify for ADAP. Will my insurance help me???
« Reply #16 on: June 29, 2012, 09:23:04 PM »

No problem.  So, do you mind clarifying this for us? You called the number and they told you that there is NO prescription benefit with the plan?

I only ask because many years ago I had coverage through United Healthcare through my job at the time - and Oxford is now a part of them.  And all my drugs were a part of the PPO plan I selected when I chose whatever plan that worked best for me.

I just did a little more digging and see that the prescription plans are still set up that way - meaning the drugs are included within whatever plan you choose.

POS Plan

HMO Plan

If you don't mind telling us more (either by posting to this thread or sending me a PM), maybe we can help you sort things out -- or try to point you in the right direction so you don't lose any more sleep.

I post it here so people will see it and get more information.
Yes I've called them and gave them my group number and member id. They told me that there is no perscription benefit on my plan.

 The plan is:
- united health care oxford, liberty network, HMO
I spoke to my boss about it he said that when they did the survey for insurance back in January very few ppl asked for perscriptions. That's why they didn't go for it.

The other part is that my fiance just started a new job and she will have Oxford HMO with persctiption coverage in 3months time. Will that cover the visits to hiv specialists and prescribed medications? We are concerned that the insurance will not cover all these costs such as visits, medication.

Thank you
Aug 3 2012-Cd4-450, VL-43000
Our Meds
Norvir, Truvada, Reyataz, (3 pills, once a day)

Offline CoupleNYC

  • Member
  • Posts: 15
Re: I dont qualify for ADAP. Will my insurance help me???
« Reply #17 on: June 30, 2012, 08:28:43 AM »
Wow...I just clicked on the HMO link from your post. For some reasonn my cell phone wouldn't let me do that before. That is some great info!!!! It almost seems unreal. If everything works out that way we will get out lifes back and deal with this conndition.

We are very impressed to see how people on this forum come together everyday to look out
for each other. It makes us feel soo... much better  ;D  :-*

Thank you guys
Aug 3 2012-Cd4-450, VL-43000
Our Meds
Norvir, Truvada, Reyataz, (3 pills, once a day)

 


Terms of Membership for these forums
 

© 2014 Smart + Strong. All Rights Reserved.   terms of use and your privacy
Smart + Strong® is a registered trademark of CDM Publishing, LLC.