POZ Community Forums
Main Forums => Living With HIV => Topic started by: CoupleNYC on June 28, 2012, 01:03:11 am
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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
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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
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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
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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.
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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.
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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
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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... :-(
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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.
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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 (http://uhcspecialtyrx.com/) 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.
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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.....
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Try a co-pay card. www.needymeds.com
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i'm glad the healthcare reform passed yesterday
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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 (http://uhcspecialtyrx.com/) 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??
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Did you read none of this after he bothered to post it??
Betty, the OP has several threads all asking the very same questions ::)
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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 (http://uhcspecialtyrx.com/) 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.
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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 (https://www.oxhp.com/secure/materials/brokers/ny/pos_ny_ind_rates.pdf)
HMO Plan (https://www.oxhp.com/secure/materials/brokers/ny/hmo_ny_ind_rates.pdf)
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.
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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 (https://www.oxhp.com/secure/materials/brokers/ny/pos_ny_ind_rates.pdf)
HMO Plan (https://www.oxhp.com/secure/materials/brokers/ny/hmo_ny_ind_rates.pdf)
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
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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