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Author Topic: So I have this friend..  (Read 1895 times)

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Offline FLrenman

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So I have this friend..
« on: December 01, 2011, 06:47:20 AM »
Growing up he was on his guardian's group plan though employer, but his parents split up almost 3 years ago and was lead to believe that the insurance ended when the marriage ended (it was a step parent).

In the meantime he tested positive for HIV, he qualified for a government assistance program to pay for doctors visits, but isn't on any meds..yet.

Now he is working full time, and when gathering information for application for the HIS employee insurance, he finds out that all this time he was never taken off his step-parents plan.
The insurance he is soon to get from his employer is from the same company that he is still covered under.

Now what?
Will this condition fall under his continuous credible coverage? Even though it was never (and still isn't) claimed on current policy.
Will this be considered a pre-existing condition that must wait the 12-18 months before it's covered?

Also, could he be facing any legal trouble? Or any trouble at all from ADAP, the insurance company, or his doctor's office?

He is holding off on turning in the paper work for his own insurance until he gets a better idea of what ramifications it will cause.

He really appreciates your help on this one!

Offline Assurbanipal

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Re: So I have this friend..
« Reply #1 on: December 01, 2011, 11:29:08 AM »
If he was continuously covered by creditable insurance it doesn't matter whether or not he submitted a claim for any specific disease.  He was continuously covered.

As to whether ADAP will want his insurer to reimburse them for back coverage, well what if they do?

I wouldn't hold off getting insurance in his situation.  It is better to be insured and with the potential that he might have to fight some paperwork battles (although he might not) than not to be insured and not get easy access to treatment if he gets into an accident or comes down with the flu. 
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
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2010 VL UD CD4 573-680 26.1% - 30.9% 12/10 VL 20
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2014 VL UD - 48
2015 VL 130 Moved to Triumeq

Offline Miss Philicia

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Re: So I have this friend..
« Reply #2 on: December 01, 2011, 12:01:24 PM »
I'm surprised that they didn't locate his other coverage when he applied for ADAP. I'm quite sure at least in the state I live in (Pennsylvania) they now can access instantaneously what coverage someone has and if it's currently active.

It's certainly plausible that he could get some audit type letter from his state's Dept. of Health that runs ADAP asking him to submit claims to his insurance and reimburse the Dept. of Health.
"Iíve slept with enough men to know that Iím not gay"

Offline FLrenman

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Re: So I have this friend..
« Reply #3 on: December 01, 2011, 04:33:33 PM »
That you assurbanipal and miss philicia for your input.

I mistakenly refered to ADAP as the 'government assistance' he is on, its only Ryan White that he is on, which was applied for in his ADAP office at the health department. I didn't realize they were different programs..

He is still insured under his guardian's group plan, but only until the end of the year. He will be turning in his own application through his employer first thing!
Hopefully everything will go smoothly and his new coverage starts before the old ends.

Thank you again!


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