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HIV AND HEALTH INSURANCE !!
Dec 4, 2010

Dear Sir/Madam,

Hope you find this mail in your good health!!!!!!!

I am a hiv patient. I have been married for several years now. My wife is not hiv patient. After many years of our marriage we thought of having baby.

We have seen Dr. R. Gargiulo at Brigham womens hospital at Boston and did all the necessary lab test for IVF.According to Dr. Gargiulo all the lab result came out good for the IVF and then we approch the insurance. Our insurance is HMO BLUE but for some reason the isurance denied our case. HMO Blue says we did not meet the critarea.....and honestly I didn't understand their critarea after all I am paying $130 every week!!!!!!!!!!!!!!!!!!!!! And $40 copay for my meds.!!! We had repeal the case with insurance and they denied again. In this case what would you suggest us ??

Response from Dr. Frascino

Hello,

I am not a benefits counselor and do not know the specifics of your HMO insurance coverage. I'd suggest you enlist the help of your HIV specialist and the obstetrician you saw for the preliminary IVF assessment. Sometimes physicians can help sway insurance company decisions by advocating for their patient. Technically, discrimination against HIVers is not legal; however, specific health plans (and now some Republican lawmakers, see below) have become very good at denying coverage for a whole lot of reasons. The new healthcare legislation should help rectify many of these injustices when it kicks in fully in 2014. That is unless the clueless cold-hearted Republicans repeal or eviscerate it!

If the above is not helpful, ask your HIV specialist for a referral to an HIV-knowledgable benefits counselor in your area.

Good luck.

Dr. Bob

Arizona Strikes Again By GAIL COLLINS, December 3, 2010 (New York Times)

Let us revisit the matter of pulling the plug on grandma. You may remember the historic day in 2009 when Senator Chuck Grassley brought the issue to the fore at a town meeting in Iowa. "We should not have a government plan that will pull the plug on grandma," he said to loud cheers. This was when Grassley, a Republican, was negotiating with the Democrats on a bipartisan health care reform bill. Optimistic spirits felt his plug-pulling metaphor was simply an attempt to reassure his constituents, while he continued working in good faith with the Finance Committee chairman, Senator Max (I Am Always Wrong) Baucus. Later, President Obama asked Grassley whether he would vote for the bill if all his suggestions for change were included. Grassley said probably not. This was taken to be a bad sign. Then all hell broke loose and the Republicans kept ranting about how "Obamacare" would put the federal government between you and your doctor and try to save money by prohibiting said doctor from using the best treatments and procedures. All this came to mind when I was talking to Flor Felix, whose husband, Francisco, a 32-year-old truck driver with four kids, was denied a liver transplant because the Arizona Legislature had yanked funds for it out of a state Medicaid program. As Marc Lacey reported in The Times this week, Francisco had been prepped for surgery after a friend whose wife was dying asked that he be given her liver. "It was good news when we heard the liver matched," Flor said. "The doctor said: 'Everything's going well. We're going to proceed with the surgery.' " But Francisco, who has hepatitis C, had lost his health insurance when he had to stop working and had gotten coverage under the state Medicaid program. And Gov. Jan Brewer had signed a law eliminating Medicaid coverage of certain kinds of transplants as a cost-cutting measure. Flor said the next words she got from the doctor were: "You need to bring $200,000 as a deposit for the hospital." Francisco was summarily discharged. The Arizona state government, which is totally controlled by Republicans, got between him and his doctor. "The state only has so much money and we can only provide so many optional kinds of care. Those were one of the options that we had taken liberty to discard," said Governor Brewer, who we all remember for her path-breaking efforts to convince the world that the Arizona desert is strewn with the headless bodies of illegal immigrants. Felix was one of 98 people in the transplant pipeline when the law went into effect. Arizona claims cutting them off will save $4.5 million this year. Advocates have called on Governor Brewer to use some of the state's $185 million in federal stimulus funds to restart the procedures. Brewer, who opposed the stimulus, says all the money is gravely needed for other projects. Which she will not name. The best possible spin to put on all this is that it was a terrible mistake. The chairman of the Arizona House Appropriations Committee, John Kavanagh, says that the lawmakers got bad information from the state Medicaid experts, who said that the transplants weren't effective. "Based on the information I've received, it looks like most of them should be reinstated and we hope to do that in January," he said. Ironically, trying to answer questions like this is one of the great goals of the Obama health care law. "What it promises to do is attack the vast reservoirs of ignorance about relative benefits of different ways of treating different diseases to see which is most effective," said Henry Aaron of the Brookings Institution. Although, as Aaron carefully pointed out, the law steers clear of any mention of cost effectiveness. This is because Republicans in the House and Senate kept howling about death panels and plug-pulling. It's hard to give Arizona the benefit of the doubt on anything these days, what with the state's dubious performances in matters like illegal immigrant hysteria, the selling of the State Capitol to help balance the budget, and the electing of Jan Brewer. However, let's accept that given their economic problems, it would be natural for the Legislature to want to try to cut the Medicaid budget. Although preferably in some saner, less brutal manner. But try to imagine what the Republicans would have said if someone in the Obama administration proposed cutting off liver transplants for Medicare recipients. We heard a lot from John McCain during the health care debate about how reform would restrict Medicare services. We have not heard a word yet on how McCain feels about the Arizona transplant issue. His office did not respond to inquiries about whether he approves his state's pulling the plug on a 32-year-old father.



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