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URGENT - HIV Coverage
Feb 26, 2004

Hello there, i got a question that is killing me....

I became HIV about 2 years ago, i have a Individual PPO 500 plan with Blue Cross / Blue Shield way before i got tested...

Now, when i first saw an Infectious Dissease doctor about my HIV condition she told me i wasnt ready to start treatment, that i needed to wait until my viral-charge was lower... (or something like that, she told me to wait tho) this heppened over a year from now.

I have not been in a specialist since then, because im afraid my Insurance plan will not cover the whole thing... what i mean by this is the following... A friend of mine is HIV and he had insurance trhu his employer everything was fine except that his company change providers and he got to choose Blue Cross / Blue Shield.... 6 months after he got switched BCBS told him he had met his quota and that he needed to pay for any prescriptions or doctor visits.

I dont want this to happen to me for one reason, what if i start the treatment and then i can not affod to pay the medicine at full price? i mean, in case they decide i meet my quota also !!

I was never told there will just cover a determinated ammount if i needed service !!

Can i upgrade in order to be covered???

I dont mind to pay the premium (is that what you call the monthly payments, right) what i dont want is unexpected bills...

Please let me know if i should go to a specialist again... (i have no syntoms whatsoever, i feel and look as helthy as a horse)

When i got tested my primary care phisician told me the insurance plan i have it was VERY GOOD and that i shouldnt worry about getting covered, because that individual PPO 500 plan was perfect to cover the medicines and doctor visits...

Should i believe the doctor, or should i base on my friends experience???

THank you !

Response from Dr. Pierone

It sounds like you need to discuss your situation with an insurance benefits manager. You also should be able to get a sense of what will be covered by reading your health insurance benefits package (who really reads those things). It sounds like your numbers are good so you may not need drug treatment for some time. It would be helpful for you to actually know your numbers (viral load and CD4 count) so that you can plan better. Good luck!

still trying to understand the numbers
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