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Author Topic: Help finding an insurance plan with ObamaCare to cover Atripla costs  (Read 1541 times)

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Offline ocguy79

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Hey all,

So I'm panicking trying to find an insurance plan on Coveredca.com (ObamaCare) that will help me get my Atripla meds at a affordable price. I have until February 15th to choose a plan in order to have insurance in March.
I'm assuming Atripla falls under the Specialty Drug column of which most of the plans want me to pay 10, 20 and 30% of the cost after deductible. Even paying 10% the cost of Atripla ($2503.98) is out of the question.

I guess I'm hoping to find someone in the same boat as me who has suggestions on what to do here. I was getting my meds 100% covered through the adap program, but that has since lapsed and I have 5 days of meds left.

Thanks for any help,

Shaun  :o
3/21/09 - Tested Poz   Tcells/374   VL/109,000
9/02/09 - Tcells/290  VL/189,000
9/11/09 - Approved for ADAP
9/15/09 - Started Truvada, Isentress and Kaletra
6/15/11 - Undetectable - (On same meds as above)
7/20/11 - Started Atripla
12/10/13 - Tcells/620 - VL/0

Offline BT65

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Re: Help finding an insurance plan with ObamaCare to cover Atripla costs
« Reply #1 on: February 09, 2014, 03:05:19 AM »
Well, you should not have let adap lapse nor gotten down to only 5 days of meds without any type of coverage to get more meds. 

At the ASO I was working at, we were helping people get signed up for the right ACA plan.  I would encourage you to contact your nearest ASO and speak with a case manager who should be able to either help you in picking a plan, or point you in the direction of an organization that can help you in finding the right plan.
I've never killed anyone, but I frequently get satisfaction reading the obituary notices.-Clarence Darrow

Offline ocguy79

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Re: Help finding an insurance plan with ObamaCare to cover Atripla costs
« Reply #2 on: February 09, 2014, 03:39:26 AM »
Well, you should not have let adap lapse nor gotten down to only 5 days of meds without any type of coverage to get more meds. 

At the ASO I was working at, we were helping people get signed up for the right ACA plan.  I would encourage you to contact your nearest ASO and speak with a case manager who should be able to either help you in picking a plan, or point you in the direction of an organization that can help you in finding the right plan.

Thanks BT, I should have added "Im already aware that I should have not let adap lapse and that im foolish for running so low without a backup plan". I used to only have to go for a financial appointment once a year in Los Angeles, but since I started going to another city for my adap, its now every 6 moths that they want a financial appointment. Somehow that appointment slipped my mind and now im here asking for advice.

Thanks for advice on contacting a local ASO. I will do that on Monday first thing. But until then, I would love to hear any other advice that members here may have.
3/21/09 - Tested Poz   Tcells/374   VL/109,000
9/02/09 - Tcells/290  VL/189,000
9/11/09 - Approved for ADAP
9/15/09 - Started Truvada, Isentress and Kaletra
6/15/11 - Undetectable - (On same meds as above)
7/20/11 - Started Atripla
12/10/13 - Tcells/620 - VL/0

Offline Ann

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Re: Help finding an insurance plan with ObamaCare to cover Atripla costs
« Reply #3 on: February 09, 2014, 07:50:52 AM »
Sorry to hear you got yourself in a pickle, Shaun. I can be bad at remembering to do stuff like this too and it sucks when there are consequences. :-\

If you need help finding a local ASO, try using poz.com's Health Services Directory.

You might also try calling your doctor to see if they might be able to help with some meds to tide you over and you never know, a forum member may also be able to step up and help you out with a few. You should let your doctor know what's going on anyway, even if you don't think they will/can help. If you don't ask, you don't get!

Good luck, keep us posted.

Ann


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"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline ocguy79

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Re: Help finding an insurance plan with ObamaCare to cover Atripla costs
« Reply #4 on: February 09, 2014, 11:15:24 AM »
Sorry to hear you got yourself in a pickle, Shaun. I can be bad at remembering to do stuff like this too and it sucks when there are consequences. :-\

If you need help finding a local ASO, try using poz.com's Health Services Directory.

You might also try calling your doctor to see if they might be able to help with some meds to tide you over and you never know, a forum member may also be able to step up and help you out with a few. You should let your doctor know what's going on anyway, even if you don't think they will/can help. If you don't ask, you don't get!

Good luck, keep us posted.

Ann

Hi Ann,

I currently do not have a primary doctor as Ive been going to the local clinic here since my employer cut off our insurances 2-3 years ago. I did send an email to my previous primary doctor to see what insurances they accept. I will give them a call Monday morning as well. Thanks for the directive on finding a local ASO in my area. Im usually not this forgetful with such an important issue, but lately Ive been so very busy. I do need to focus on me more. Its a horrible feeling when you go to pick up your prescription and they tell you your adap is not covering the bill.

Thanks again! I will keep the thread updated  :)
Shaun
3/21/09 - Tested Poz   Tcells/374   VL/109,000
9/02/09 - Tcells/290  VL/189,000
9/11/09 - Approved for ADAP
9/15/09 - Started Truvada, Isentress and Kaletra
6/15/11 - Undetectable - (On same meds as above)
7/20/11 - Started Atripla
12/10/13 - Tcells/620 - VL/0

Offline Robert

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Re: Help finding an insurance plan with ObamaCare to cover Atripla costs
« Reply #5 on: February 09, 2014, 03:23:44 PM »
sean.

I'm no expert. I'm just a client. But here is what I do know. ADAP is a state program and just because you're moving within the state, doesn't mean the rules change. As far as I know, in California you only have to renew 1/year. On your birthday. Now it may  have changed at the beginning of the year but being an ADAP customer you would think they would have notified us.

So you forgot your appointment. It doesn't take more than 15 minutes, a half hour at the most, to re-up. When I re-up with my counselor I take the required documents (dl, bank statement & car insurance/utility bill). He makes copies of everything, I sign a few forms and that's it. The next day I get an email from him and everything is good to go for another year.

Go back to your ADAP people tomorrow and see what the deal is. If they insist you need another interview, then tell them to fit you in because you can't go without your meds. Even they know that much. And while you're at it, ask them why they make you come 2X/year. It doesn't sound right.....robt
..........

Offline BT65

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Re: Help finding an insurance plan with ObamaCare to cover Atripla costs
« Reply #6 on: February 09, 2014, 05:33:48 PM »
OC, I didn't mean to be crass, sorry.  I know here in Indiana people have to re-certify twice a year.  But I'm sure it's different depending on the state.

Often times ASO's will also have emergency meds available.  Are you already a client somewhere?  Or were you where you could have your paperwork faxed to the ASO you're closest to now? 

Good luck, please let us know how it's going.

Betty

OC, just wanted to add....at the ASO I was working at, when it's time to re-certify for the insurance programs, we call people multiple times, and even send letters reminding when the appointment is, as well as the consequences of a missed appointment.  We don't want anyone going without coverage.  If your case manager did not do this, maybe you need a different one. 
« Last Edit: February 09, 2014, 05:36:41 PM by BT65 »
I've never killed anyone, but I frequently get satisfaction reading the obituary notices.-Clarence Darrow

Offline ocguy79

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Re: Help finding an insurance plan with ObamaCare to cover Atripla costs
« Reply #7 on: February 10, 2014, 12:33:11 AM »
OC, I didn't mean to be crass, sorry.  I know here in Indiana people have to re-certify twice a year.  But I'm sure it's different depending on the state.

Often times ASO's will also have emergency meds available.  Are you already a client somewhere?  Or were you where you could have your paperwork faxed to the ASO you're closest to now? 

Good luck, please let us know how it's going.

Betty

OC, just wanted to add....at the ASO I was working at, when it's time to re-certify for the insurance programs, we call people multiple times, and even send letters reminding when the appointment is, as well as the consequences of a missed appointment.  We don't want anyone going without coverage.  If your case manager did not do this, maybe you need a different one. 

Hi Betty,

When I was going to ADAP appointments in Los Angeles, it was only required once a year to go over financials. Moving One county over in Orange County, they told me that they require financial appointments Twice a year. I didn't really ask why, I just said REALLY?! Her response was Yes...

Ive tried contacting my case worker numerous times including faxing over a letter asking her to call me ASAP to discuss. Ive been a client in Orange count for 1.5 years now, maybe 2. Prior I was going to Los Angeles for 3-4 years once a year.

Im thinking my financial appointment was about 2-3 months ago. I had it set in my phone on my calendar, but Ive since got a new phone and lost that info.

I haven't received any calls from them to remind me of appointments, even though they said they would during my first appointment with them. I usually get everything done there... financial, labs and doctor visits. Its like they just dropped off the edge of the earth. The last time I was in about 4 months ago, they drew blood and never called me back to schedule an appointment. They usually schedule one before I leave, but that particular day they said they would call me to schedule my next appointment. That was the last I heard from them. When I call, its a voice mail saying they will call me back within 2 days. Ive done that Twice with no return call.

I'm just hoping to find a compatible insurance that's affordable vs. jumping through hoops and stressing myself out.

Hopefully better luck on Monday,
Shaun

3/21/09 - Tested Poz   Tcells/374   VL/109,000
9/02/09 - Tcells/290  VL/189,000
9/11/09 - Approved for ADAP
9/15/09 - Started Truvada, Isentress and Kaletra
6/15/11 - Undetectable - (On same meds as above)
7/20/11 - Started Atripla
12/10/13 - Tcells/620 - VL/0

Offline BT65

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Re: Help finding an insurance plan with ObamaCare to cover Atripla costs
« Reply #8 on: February 10, 2014, 03:47:10 AM »
Shaun, it sounds as though they are quite negligible with their care, follow up etc.  I'm really surprised they didn't get a hold of you when you missed your appointment.  Is there another ASO in your area you could utilize?  The one you are signed up with just sounds unacceptable.  I hope you're able to get help soon!

Betty
I've never killed anyone, but I frequently get satisfaction reading the obituary notices.-Clarence Darrow

Offline ocguy79

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Re: Help finding an insurance plan with ObamaCare to cover Atripla costs
« Reply #9 on: February 10, 2014, 04:38:27 PM »
Thanks for the help Betty,

Its insane how hard it is to find a list of "covered drugs" per insurance company listed with ObamaCare on CoveredCa.com


3/21/09 - Tested Poz   Tcells/374   VL/109,000
9/02/09 - Tcells/290  VL/189,000
9/11/09 - Approved for ADAP
9/15/09 - Started Truvada, Isentress and Kaletra
6/15/11 - Undetectable - (On same meds as above)
7/20/11 - Started Atripla
12/10/13 - Tcells/620 - VL/0

Offline Ann

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  • It just is, OK?
    • Num is sum qui mentiar tibi?
Re: Help finding an insurance plan with ObamaCare to cover Atripla costs
« Reply #10 on: February 11, 2014, 06:15:56 AM »


Shaun, did you have any luck in locating an ASO that can help?


I currently do not have a primary doctor as Ive been going to the local clinic


Also, about ringing your doctor about meds to tide you over, ring the clinic from which you've been getting your prescriptions for your meds. While they might say no, they also might say yes. If you don't ask them you'll never know - leave no stone unturned.

I hope you get this sorted out ASAP - I've got my fingers, toes, legs, arms and eyes all crossed for you.
Condoms are a girl's best friend

Condom and Lube Info  



"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline ocguy79

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Re: Help finding an insurance plan with ObamaCare to cover Atripla costs
« Reply #11 on: February 15, 2014, 02:55:54 PM »
Update: Went to Orange County, AIDS Services Foundation in Irvine, CA and received plenty of information on what insurance plan to chose for my needs through the affordable care act. What I was also surprised with, was that he also signed me up for HIPP (Ryan White Program) that will ultimately take care of my monthly premiums no matter what plan I chose as long as I have ADAP. After I picked my insurance plan, I had another appointment with ADAP of which I was approved for 30 days until I can fax over my proof of income of which I meet the requirements for.

Not only now do I now have a good PPO insurance and ADAP, my costs are now limited to minimal co-pays on doctor visits, labs and prescriptions if not one of the many already covered at no cost through ADAP. Now its just up to me to stay on top of all 3 of these programs that all work as a group to support one another.

I sorta knew this was all out there, It was just learning how to put it all together in order for it to work out that was the most stressful.

Thanks to everyone who has replied and PM'd me with recommendations and support.

Shaun  :o
3/21/09 - Tested Poz   Tcells/374   VL/109,000
9/02/09 - Tcells/290  VL/189,000
9/11/09 - Approved for ADAP
9/15/09 - Started Truvada, Isentress and Kaletra
6/15/11 - Undetectable - (On same meds as above)
7/20/11 - Started Atripla
12/10/13 - Tcells/620 - VL/0

Offline BT65

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Re: Help finding an insurance plan with ObamaCare to cover Atripla costs
« Reply #12 on: February 16, 2014, 05:05:42 AM »
Shaun, so glad to read that it's all coming together.  That's great news, and I'm sure a relief for you!

Betty
I've never killed anyone, but I frequently get satisfaction reading the obituary notices.-Clarence Darrow

 


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