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Author Topic: Which tests does CA ADAP cover?  (Read 3057 times)

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Offline freaky_dream

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Which tests does CA ADAP cover?
« on: October 12, 2009, 01:20:18 AM »
Hey guys I am getting billed up the wazoo by both labcorp and my clinic for my blood tests and such but I thought whatever your insurance does not cover ADAP would. BTW I had self insurance which by the time I got on ADAP was all used up.  Is there a limit to how many times a particular test is paid for or if certain tests are not covered? I would contact my clinic but they always give me the run around I end up with a voice mail with no one ever calling me back. Any of you ADAP expereinced people in California could help out with some infos would appreciate it.

Offline sdguyloveslife

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Re: Which tests does CA ADAP cover?
« Reply #1 on: October 12, 2009, 07:35:35 PM »
I can try to help you out here, but I'm certainly no expert...

ADAP covers some prescription drugs only when they are related to your HIV diagnosis.  Do you have any other health insurance?  Your health insurance plan should cover lab tests, etc.  Have you met your deductible for the year?  Are you having tests done that are above and beyond what your insurance plan allows? 

If you do not have or are not eligible for insurance, you should inquire at your clinic or with a case manager on how to get on Medi-CAL or Ryan White coverage.  Either Medi-CAL or Ryan White will cover your blood work, and doctor visits, etc..

I have ADAP in CA and it only covers my drugs ONLY - but does not cover my health care. 
« Last Edit: October 12, 2009, 09:32:42 PM by sdguyloveslife »
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Offline Puckslinger

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Re: Which tests does CA ADAP cover?
« Reply #2 on: October 12, 2009, 08:00:41 PM »
Hey there,

I live in California too; and I agree with sdguyloveslife: ADAP covers drugs. I have MediCare and MediCal; and they cover my labs.

Here are some FAQs regarding ADAP in California:


I hope this helps.    :)

Offline edfu

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Re: Which tests does CA ADAP cover?
« Reply #3 on: October 13, 2009, 02:34:08 AM »
I don't believe there is any state in which ADAP covers lab tests.  After all, it does stand for AIDS DRUG Assistance Program (emphasis added). 
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Offline Miss Philicia

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Re: Which tests does CA ADAP cover?
« Reply #4 on: October 13, 2009, 11:10:08 AM »
I don't believe there is any state in which ADAP covers lab tests.  After all, it does stand for AIDS DRUG Assistance Program (emphasis added).  


Pennsylvania began doing it almost a year ago.

Also I think as a technical matter ADAP is simply a component of the Ryan White Care Act, and most people (perhaps like the OP) conflate the two.  Funds from the act are divided up in different sections/titles and are used for non-pharmaceutical uses, though yes the bulk of the money is specifically for medication.  And also IIRC different states supplement the federal monies for all of this to different degrees depending on what programs they need, so it's hard from my link to ascertain if the money paying for this comes from Ryan White, or if PA just added money in or a combination of both.

Like with anything using Ryan White money, all other coverage avenues must be exhausted (i.e. private insurance and Medicare) before one taps into this on the patient side.

As far as freakydreams and California goes, if (and that's a huge "if" from what I've read about California cutting back on state health budgets) the allow the use of ADAP/Ryan White for lab costs the clinic/doctor would have to submit payment claims correctly I would assume, having ADAP/Ryan White as the secondary insurer if there is also a primary payment source.  If it's a simple error like this then avoiding calling one's clinic because you get "voice mail runaround" is not going to be productive.
« Last Edit: October 13, 2009, 11:14:20 AM by Miss Philicia »
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Offline freaky_dream

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Re: Which tests does CA ADAP cover?
« Reply #5 on: October 14, 2009, 12:58:19 AM »
Thanks guys for the responses. From what I was told initially was that any HIV related tests were covered by ADAP/Ryan White or the clinics own foundation. I guess I am going to have to head on down to the clinic and appear in person. I had self insurance but that had a limit and I had already reached that limit by the time I started going to the clinic. I think what happened was the clinic submitted the claims to my insurance not realizing I had reached my cap even though I did tell them and then they started bouncing the claim back and forth. I have a feeling that both bills from each party are for the same tests.

Offline MitchMiller

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Re: Which tests does CA ADAP cover?
« Reply #6 on: October 14, 2009, 01:49:30 AM »
Just curious how much you were billed. 

I've forgone blood work for two years now to avoid what I believe would be huge bills.  If one day I do need to have blood work in CA (live in LA), I'm wondering what it would cost.  The doc said he has no idea since the labs bill the patients direct.


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