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coverage extension for grad student?
Mar 19, 2014

Dear mr.Chambers, I'm currently a grad student w HIV+ w recently terminated health insurance & running out of medication really soon. May you pls help me w a soln? Ive been obtaining my health benefit via fellowship Sep 2007- Aug 2013. Unfortunately , I had to take ~1 yr off from research/school/work due to medical & personal issues. when I came back, the spot was already taken by another student. Since 9/1/2013 I've been paying $397/month premium to Heathpartners . They sent me a notification of termination 3/10/2014 w termination date backtrack to 2/28/2014 1) All my medical & pharmacy claims fr 3/1/14 to 3/10 went through bc during which time the system still showed my status as active. Are they legally able to come after me for those claims , retroactively? 2) There are prescriptions submitted months earlier & got automatic refilled. Can I still get them under the old coverage? 3) Is there any possible way to negotiate w the insurance company or my University (public, in the Midwest USA) to extend my 18months "COBRA" ? They told me they can't named it COBRA since my fellowship & assistantship had that benefits... 4) If not, may you pls recommend a viable option for limited budget student? thank you!

Response from Mr. Chambers

I'll try to answer your questions in the order you asked them:

#1. If they paid medical bills for a period when your coverage was not in effect, they probably have a right to request repayment. However, how hard they will try depends on the size of the overpayment and their belief that you have the resources to pay them back. Given that this was apparently their error, I don't think they will make a big issue out of it, but I've given up guessing what an insurance company will do.

#2. Probably not. The pharmacist should check your eligibility for coverage every time he/she fills a prescription. When you show up on the computer as not covered, that will probably end the refills.

#3. You can try, but I doubt that they would provide any extension unless they are legally obligated to. If your insurance ended when you took the year off and you have been without coverage since then, you have exceeded any time limit on accepting COBRA coverage, assuming there was any to begin with.

You do have the ability to buy health insurance under Obamacare, but you only have until the end of March to do so. Go on line to www.healthcare.gov. If you are in a state with its own exchange, that site will direct you to it.

#4. Your best bet is a plan under Obamacare. If your income is low, the government will pick up a lot or most of the premiums. Depending on what state you live in, the ADAP program (AIDS Drug Assistance Program) may be offering additional premium assistance. Also, ADAP can help with prescription bills over an above what insurance would pay. Check with your local AIDS Service Organization.

Personal note: I can't tell you what a pleasure it is, after over 40 years of watching people forced to go without insurance, to tell them that insurance is available and there is help paying for it if your income is low.

Jacques



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