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Author Topic: Insurance Question  (Read 2667 times)

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Offline LoboDog

  • Member
  • Posts: 82
Insurance Question
« on: January 12, 2013, 09:35:55 AM »
Hey, I have Blue Cross Blue Shield... on my last 2 sets of exams they did not pay for lab work to determine my viral load.... Is this common? Just seems like it would be a required test for someone with HIV... any help is appreciated.

Offline phildinftlaudy

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  • Posts: 2,985
  • sweet Ann what you think babe...
Re: Insurance Question
« Reply #1 on: January 12, 2013, 09:40:06 AM »
Hey, I have Blue Cross Blue Shield... on my last 2 sets of exams they did not pay for lab work to determine my viral load.... Is this common? Just seems like it would be a required test for someone with HIV... any help is appreciated.

All insurance plans are different - but I would think that if they are doing CD4, they should also be doing VL. I have Aetna and doc orders both as part of my labs every three months and both are always covered. The actual amount Aetna has to pay for it is pretty small (just a few dollars) - even though Quest bills it at a substantially higher.

Have you put a call in to your insurance company?
Now, when it comes to Lipid panel, my insurance will only cover that every 6 months - so, doc only orders it every other blood draw.
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 Iggy

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  • Posts: 2,434
Re: Insurance Question
« Reply #2 on: January 13, 2013, 06:04:15 PM »
I have BCBS as well and I think they do actually have some kind of qualifications on # of VL tests.

I emphasize the word think because I was in a trial for the once a day Viramune for about 14 months but I vaguely remember at some point after the trial (and when I was back to insurance) my first or second blood work didn't include VL for some insurance reason.

I was undetectable for a while so didn't really think much about it at the time.   I may be completely wrong here and agree with phildinftlaudy that it's worth double checking with the BCBS.

Offline Miss Philicia

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  • celebrity poster, faker & poser
Re: Insurance Question
« Reply #3 on: January 13, 2013, 06:32:57 PM »
When I was on private insurance the only time viral load was limited was maybe the first year or two when the test was first available in the late 90's. And I had them done frequently from 1997-2006 because my viral load wasn't suppressed, so at least six per year maybe more. And half of that was on BCBS.

I know that they do, generally, limit the number of geno/phenotype tests in a calendar year but those are much more expensive.

I've never had issues on Medicare for viral load tests.
"Iíve slept with enough men to know that Iím not gay"

Offline Denver Toad

  • Member
  • Posts: 169
Re: Insurance Question
« Reply #4 on: January 14, 2013, 12:12:40 PM »

I too have BCBS (OF Tennessee) our plan is limited to two VL tests per year. When I had BCBS in Colorado VL was a quarterly benefit. I'm guessing it's very much plan dependent. Best way to determine is a phone call.
Life is short, Break the rules, Forgive quickly,
Kiss slowly, Love truly, Laugh uncontrollably, And never regret anything that made you smile.

Offline mewithu

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  • Posts: 160
  • mewithu
Re: Insurance Question
« Reply #5 on: January 16, 2013, 08:30:00 AM »
The cost to medicare is about 3000 dollars  test when VL and Cd4 are tested as I see on my medicare summary . It shouldn't matter though because the Dr should be able to order these test as needed and if no unusual problems it is usually done every quarter so they know where your health is at . that has been the norm for me anyway.
1997 is when I found out, being deathly ill. I had to go to the hospital due to extreme headache and fever. I fell coma like,  two months later weighing 95 pounds and in extreme pain and awoke to knowledge of Pancreatis, Cryptococcal Meningitis, Thrush,Severe Diarea,  Wasting, PCP pneumonia. No eating, only through tpn. Very sick, I was lucky I had good insurance with the company I worked for. I was in the hospital for three months that time. 
(2010 Now doing OK cd4=210  VL= < 75)
I have become resistant to many nukes and non nukes, Now on Reyataz, , Combivir. Working well for me not too many side effects.  I have the wasting syndrome, Fatigue  . Hard to deal with but believe it or not I have been through worse. Three Pulmonary Embolism's in my life. 2012 520 t's <20 V load


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