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Author Topic: Insurance question  (Read 3244 times)

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Offline scaredom

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  • Posts: 23
Insurance question
« on: September 10, 2011, 12:23:37 AM »
I've been on Atripla for a while and doing very well.  In a management meeting today I heard the boss comment he that our insurance company supplied a cost analysis to him and the cost of HIV meds stuck out to him. It was a little unnerving for me. Of course they don't have any idea who and the conversation moved on to other items. Has anyone had their company negotiate not covering HIV meds due to cost?

Offline jkinatl2

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  • Posts: 6,007
  • Doo. Dah. Dipp-ity.
Re: Insurance question
« Reply #1 on: September 10, 2011, 01:25:55 AM »
What your boss did was pretty unethical. If your company is large enough, I would have a talk with the HR person.
"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline liketheboat

  • Member
  • Posts: 44
Re: Insurance question
« Reply #2 on: September 12, 2011, 10:24:25 PM »
Thats a gross violation of HIPPA. As someone that works in medical billing i am socked that the insurance company even supplied a list of medications to your employer. i would consider a complait either to HR, or the insuance company.
Memorial Day 2010 Seroconverted
Labor Day 2010 tested positive
Oct 2010 cd4 359 vl 6,500
Dec 2010 cd4 vl 306
Jan 2011 started Atripla
Feb 2011 cd4 250 vl ud
April 2011 cd4 399 vl ud
June 2011 cd4 293 vl ud
October 2011 cd4 354 vl ud
March 2012 cd4 561 vl ud

Offline Mus1cl0V3R

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  • Posts: 38
Re: Insurance question
« Reply #3 on: September 13, 2011, 03:20:53 PM »
Thats a gross violation of HIPPA.
They will probably make the claim that the health information provided had been de-identified and not subject to regulation.

See "What information is Protected" here: http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/index.html

Offline phildinftlaudy

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  • sweet Ann what you think babe...
Re: Insurance question
« Reply #4 on: September 13, 2011, 03:36:37 PM »
To respond to your question:

If employers offier an employee group insurance plan, that insurance plan that is offered is not allowed to exclude specific illnesses - that has been my understanding.
I will have to do a bit of research to find citations supporting this - you could probaby do the same by doing a search on "can employer offered insurance plans exclude coverage for certain medical conditions."

Hope this helps.


Edited to add (because I spoke to soon):
I found the following:

Can plans exclude or limit benefits for certain conditions or treatments?
Group health plans may exclude coverage for a specific disease, limit or exclude benefits for certain types of treatments or drugs, or limit or exclude benefits based on a determination that the benefits are experimental or medically unnecessary - but only if the benefit restriction applies uniformly to all similarly situated individuals and is not directed at individual participants or beneficiaries based on a health factor they may have. (Plan amendments that apply to all individuals in a group of similarly situated individuals and that are effective no earlier than the first day of the next plan year after the amendment is adopted are not considered to be directed at individual participants and beneficiaries.)

Compliance with HIPAA’s nondiscrimination provisions does not in any way reflect compliance with any other provision of ERISA (including COBRA and ERISA’s fiduciary provisions). Nor does it reflect compliance with other State or Federal laws (such as the Americans with Disabilities Act).

Here is the source: http://www.dol.gov/ebsa/faqs/faq_hipaa_ND.html
« Last Edit: September 13, 2011, 03:40:14 PM by phildinftlaudy »
September 13, 2008 - diagnosed +
Date    CD4    %   VL     Date  CD4  %   VL
10/08  636    35  510   9/09 473  38 2900  12/4/09 Atripla
12/09  540    30    60   
12/10  740    41  <48   
8/11    667    36  <20  
03/12  1,041  42  <20
05/12  1,241  47  <20
08/12   780    37  <20
11/12   549    35  <20
02/12  1,102  42  <20
11/12   549    35  <20

Offline scaredom

  • Member
  • Posts: 23
Re: Insurance question
« Reply #5 on: September 26, 2011, 05:51:19 PM »
I guess the additional concern would be if they supply how much they spend on an individual employee.

Offline Assurbanipal

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  • Taking a forums break, still see PM's
Re: Insurance question
« Reply #6 on: September 26, 2011, 07:25:36 PM »
In the US, the privacy provisions of a law called HIPAA generally prevent the insurer from sharing information on which employee generated which costs.*  

It is not uncommon for employers to get a piece of paper that shows the distribution of costs incurred by people covered under the policy.  But unless you were also hospitalized, HIV is not at all likely to be at the top.  And that piece of paper will not identify the specific individuals by name or other identifier.

The general rule under the law is that the employer is allowed to know what medical conditions affect their own workers as a group, but not specifically which individual is affected.  In theory, and occasionally in practice, that allows employers to set up programs to help employees with the most common medical problems at that specific workplace.

A different law (the Americans with Disabilities Act (ADA)) allows you or the government to bring suit if your employer fires or otherwise discriminates against you at work and you can show it was due to HIV.

If you believe you have been discriminated against in the workplace you should talk to a lawyer who specializes in employment discrimination (if you need to find one, your ASO may be able to help you) and/or contact the US Equal Employment Opportunity Commission to discuss what happened.


* In some very large companies sometimes this knowledge is shared with certain workers in human resources who monitor the employer's health plan -- but they and the company have to sign agreements that the information will not be shared with other employees at the company or used in personnel decisions.
« Last Edit: September 26, 2011, 07:27:31 PM by Assurbanipal »
5/06 VL 1M+, CD4 22, 5% , pneumonia, thrush -- O2 support 2 months, 6/06 +Kaletra/Truvada
9/06 VL 3959 CD4 297 13.5% 12/06 VL <400 CD4 350 15.2% +Pravachol
2007 VL<400, 70, 50 CD4 408-729 16.0% -19.7%
2008 VL UD CD4 468 - 538 16.7% - 24.6% Osteoporosis 11/08 doubled Pravachol, +Calcium/D
02/09 VL 100 CD4 616 23.7% 03/09 VL 130 5/09 VL 100 CD4 540 28.4% +Actonel (osteoporosis) 7/09 VL 130
8/09  new regimen Isentress/Epzicom 9/09 VL UD CD4 621 32.7% 11/09 VL UD CD4 607 26.4% swap Isentress for Prezista/Norvir 12/09 (liver and muscle issues) VL 50
2010 VL UD CD4 573-680 26.1% - 30.9% 12/10 VL 20
2011 VL UD-20 CD4 568-673 24.7%-30.6%
2012 VL UD swap Prezista/Norvir for Reyataz drop statin CD4 768-828 26.7%-30.7%
2014 VL UD - 48
2015 VL 130 Moved to Triumeq


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