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Insurance Coverage Change
Mar 5, 2013

Hello, I just received a letter from United Healthcare that beginning 1/1/2014 I will have to pay for my medications out of pocket. I am currently getting them with a $35 co-pay for each medication. (Isentress & Truvada). Every HIV class of medication will be subject to this policy change. (Anti-psychotics and MS medications are impacted also) The way the letter is written, it appears they are not discontinuing coverage, but making me pay their contracted rate for the medications out of pocket in their entirety. It would then apply to my deductible and out of pocket maximums. This change will cause me to hit my deductible in January 2014 and my out of pocket max by July 2014 ($3,000). I'm writing a letter to our grievance depart requesting them to reconsider as it will have a devastating economic impact on me and others. Are not HIV infected people protected by the ADA? Should I speak to an attorney?

Thank you, Jay

Response from Mr. Chambers

If the removal of medications from their formulary only consists of HIV medications, there probably are illegal discrimination issues. ERISA was supposed to bring an end to separate benefit limits based on the medical condition.

I'm glad you are filing a grievance. Hopefully, that will either correct or clarify the issue. It is also possible that they are deleting a lot of medications from their formulary. More insurance plans are looking for ways to make you pay more out-of-pocket for medical services.

If you don't get satisfaction from the grievance, please take the letter and your plan and have it reviewed by someone at an AIDS Legal Service Agency in your area.

Good luck, Jacques

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