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Blue Cross Blue Shield won't pay for my VL Test

Aug 3, 1998

Please help me my friend has Aids and his v load is undetectable now. He has had several VL tests at Palos Community Hospital Palos Park, IL. and they bill his Blue Cross Blue Shield and everytime they refuse to pay because they say these are routine test and his Insurance doesn't cover routine tests. Well needless to say this is ruining him finacially. He's paying for them in payments and collection agencies are hounding him for the total due even though he always atleast send $100.00 a month . His doctor even says they should be paying. What can he do? He shouldn't have to pay for these tests should he? Please help if you can 'cause if he should get his money back that would help alot. He has come along so well. Takes his medicine faithfully, eats well, has family and friend support, his cat, and we laugh all the time...which I think is also very important. Please help?

Response from Dr. Holodniy

Insurance reimbursement is a thorny issue. There are published guidelines from the NIH and International AIDS Society-USA, which have been recently published in Morbidity Mortality weekly report(MMWR)from the CDC, Journal of the American Medical Association(JAMA),6/98 treatment guidelines (including viral load measurement),and Nature Medicine,6/96, Viral load consensus statement. Your friends physician should be able to inquire as what BC/BS position really is. The use of viral load testing is common practice and standard of practice in HIV treatment. There may be a limit as to the number of tests BC/BS is willing to reimburse for in a given year. It's very variable around the country. It may be helpful to talk to other patients in your community and find out what their insurance status is and policy for viral load testing. If they absolutely will not pay for even one, talk to the doctor about what the minimum number of tests are that he could get by with, and still provide quality care. Good Luck. MH

Viral Load, Cell count before treatment
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