Tested Positive this summer, my story, and Health Insurance ?s

[JustDoIt84]

Hey everyone,

I received the shocking news as all of you have that I had a positive ELISA test in late June of this year.  However, the Western Blot came back indeterminate, and I was wrongly told that because only the P18 (not HIV specific) protein antibodies were detected that this likely meant a negative test.  I got very sick, and this is why these tests were taken in the first place so they figured whatever I had was compromising my immune system.  However, it was recommended that I repeat the tests about 6 weeks later to make sure. 

I was pretty skeptical that the doctors told me that this test was likely negative due to the fact that I am gay and had (stupidly) put myself in high risk situations twice recently.  That coupled with the P18 showing up should have been a red flag to the doctors.  Anyway, as you might have guessed, I did test positive for HIV on August 13 at a new hospital (I was away from home when I got sick).  Because of the indeterminate test, the doctor also took my viral load and T-count and found that they were 127,000 and 360 respectively.  So he suggested started medication right away.  A week later I had another viral load test done along with tests against all the drugs.  My viral load had dropped to 113,000 in that week.

I started Atripla on September 1, and then got my viral load tested on October 1 to monitor the progress.  My doctor just told me that my viral load had dropped all the way to 1,427!  I was just wondering how normal this is, and if anyone had experience a similar (2-log) drop like this?  It's some good news in what has been a very rough summer.

Anyway, that's my background.  Now, I have some questions about Healthcare. 

I am currently 25 years old, and will turn 26 before the end of the year when I will no longer be able to be a dependent on my dad's health coverage.  This is what is covering the cost of everything right now including the meds.  I cannot continue to buy insurance from the same company (aka Cobra) because it is overseas and they only do that for locals.

My options are therefore limited to hoping I can find private healthcare that will cover a pre-existing condition right away, or applying for a pharmaceutical grant.  All of this timing is pretty tricky because through the end of this year I am not making enough money, and should be able to obtain a grant.  However, in January, I will be making too much money to be able to apply for the grant. 

The social worker I've been working with at my hospital suggests that I apply for the grant in December while my paycheck still says I am under the salary limit and that will apparently be good for a year.  Then, at the same time when my dependency on my dad's insurance plan is running out I need to start paying for private insurance (the company I work for is very young and small and does not have benefits yet). 

This way, presumably, I can have health insurance for a year before submitting claims for HIV meds and treatment, hopefully knocking out the pre-existing condition.

So, I was wondering if any of you have or have had similar situations and what you are doing or did about it.  I know it's pretty confusing, so I hope I explained it well enough, but I just want to be assured that I can continue with my treatments.  Does anyone have any private healthcare company suggestions?  Does anyone have any advice to offer concerning all this? 

Thanks in advance for the support, and these forums have been extremely educational and informative! I've been reading them all summer, and finally decided to sign up

[Assurbanipal]

Welcome to the forums, Just

After reading for a few months, you've probably got a handle on the forums and resources, but if you haven't checked them out yet,  do visit the lessons. 

I started Atripla on September 1, and then got my viral load tested on October 1 to monitor the progress.  My doctor just told me that my viral load had dropped all the way to 1,427!  I was just wondering how normal this is, and if anyone had experience a similar (2-log) drop like this?  It's some good news in what has been a very rough summer.

The 2 log drop is a good response to the drugs, but not wildly unusual.

I'd like to be a little more helpful on the health insurance issues, but couldn't quite figure out enough info from your post to be able to say much.  Some of the things you mention sound like you are in the US, but it wasn't quite clear.  Maybe you could provide a little more background?

If you are in the US you might want to check out a local ASO, where someone could sit with you and see what local coverage might be available.  Generally, if you have to buy insurance, COBRA is the best value.  If you aren't eligible for COBRA you should be able to buy a health policy (called a HIPAA policy-- named after the law thar requires each state to set these policies up).  But they are expensive, and the ASO should be able to talk to you about whether there are any other local options that are subsidized in your community.

Be well

A

[phildinftlaudy]

I agree with the guidance that "A" has given -
It really helps to direct you the right way if we have a better idea of whereabouts you are located as you mention the insurance company being overseas, etc.   Are you in the US?  If so, knowing what state you are in also helps.  There is ADAP (AIDS Drug Assistance Program) and Ryan White funding.  Depending on what state you are in (if in the US) depends on eligibility criteria for ADAP (and whether or not there is a waiting list).  Also, if in the states, if you have a public healthcare system in your area they normally have charity care programs which also can offer different types of treatment. 

When I was unemployed and then under-employed I was able to qualify for Ryan White, ADAP, and charity care in my area.  Now, I have insurance that covers all the treatment/labs and did not have a pre-existing condition exclusionary clause - so that was also a positive thing.

If you can provide more info as to your location, you will probably be able to get a lot more focused responses to your health care question.

[JustDoIt84]

Hey thanks for your responses.  Sorry, I am in South Carolina.

What is ASO? I can't seem to find anything on google that might be applicable.  Also, there are Ryan White programs here, but they only cover doctor visits and labs (which is a lot of money, I know!!).  So, how do I go about getting the meds covered?  Are there any private insurance companys in SC that don't have pre-existing condition clauses?  Any advice would be appreciated! Thanks

[livelife83]

ASO stands for Aids Service Organizations. I too just started Atripla so far so good except for the dizziness and lightheaded feeling. Try ADAP from South Carolina. ADAP stands for Aids Drug Assistance Program and they help those that don't have insurance or can't not pay for there medication. I am in FL and was placed on a waiting list but Atripla has a patient assistance program to give medication to those that are on waiting list. Hope this helps.

[Assurbanipal]

Sorry, that was a pretty acronym-heavy post  (ASO/COBRA.......

Here's a link to a directory where you can search for local services:  http://directory.poz.com/

Check out the AIDS Service Organizations in that link.  And let us know if there are other ways we can help

A

[surf18]

when i just renewed my prescription my pharmacy told me the truvada was on some sort of deal and all i had to do was call and get a discount card. so i called and poof no co pay. so maybe there is something like that for the medicine your on. and i do think most drug companies offer help to those in unfourtante situations.

[JustDoIt84]

Hey thanks for your responses.

livelife - I know for sure I'd be placed on a waiting list in SC because the budget was cut in March.  What is the Atripla assistance program? I currently get $200 off my copay, but once I'm off my dad's insurance, even $200 off isn't going to be much...

A - The hospital I go to actually turned up on that link you posted.  I guess I just need to ask more questions when I talk to my social worker next.  I'm just worried about getting a grant and/or getting insurance because the company I work for doesn't have group insurance (7 employees), and I will be making too much money in January for the pharmaceutical grants.  :\

surf - I've got a discount card for Atripla (the $200), but I dunno if that'll be enough if I'm uninsured, or I can't find an insurance company that doesn't have a pre-existing condition clause.

[Assurbanipal]

OK, back to your original post.

You said you couldn't get COBRA coverage under your current (father's) policy because it (?) is overseas.  Frankly that statement is a bit puzzling, since you are covered in the US.  There are weird odd exceptions to the COBRA continuation laws, but ...have you actually called up the company to confirm you cannot get COBRA?

If you have confirmed that you aren't eligible for COBRA, every state is required by law (the specific law is called HIPAA) to either set up an insurance pool or mandate that insurers offer a policy for people who are no longer covered by COBRA, or not eligible for it.  These policies can be expensive, but they have to offer one that covers you if you meet certain criteria (covered under a prior policy for 18 months, etc.)  To find out about HIPAA policies in South Carolina you should call the state department of insurance:

A google search turned up this info (on about.com):
South Carolina Health Insurance Pool (SCHIP)

The South Carolina Health Insurance Pool offers coverage to individuals who are unable to purchase an individual health insurance policy because they have pre-existing health conditions. It also covers "HIPAA-eligible" individuals, as described above.


South Carolina Health Insurance Pool  http://doi.sc.gov/Pages/default.aspx
Phone: 803-788-0500, ext. 46401 (Columbia) or 800-868-2500, ext. 46401 (Outside Columbia)

Good luck
A

[JustDoIt84]

Thanks so much for your reply A!

I actually talked to Blue Cross Blue Shield, and they told me about SCHIP and will be sending me my options.  So, it seems as if I've found something that can cover me until I manage to get into some other form of group insurance (through work).  The premium is expensive (about $330), but not nearly as expensive as the drugs/treatment are every month.

Thank you all for your help, I appreciate you finding a solution with me.

Just out of interest, are you all covered by your work?  Does anyone at work know that you are positive?  What if my company (which currently only has 7 employees) does get group care... will everyone's premium be higher because of my expensive claims?

[Lucky2behere]

Hey, I don't make alot of money myself. Last year was a really bad year for me financially and I spent up most of my savings on medical bills and just surviving, so I was able to apply for a Ryan White Grant and it pays for my doctors and my meds for a year anyway. Since I have been sick for alot of this year, I most likely will get another grant next year or hopefully this new health care plan will cover pre-existing conditions so I can afford to buy some health care insurance. Good luck to you!