Will Health Insurance Pay for HIV treatment?
HIV is a disease that requires a lot of management including doctor visits, treatments, and pharmaceuticals. Fortunately, most major health insurance will cover HIV treatment under normal circumstances. Unfortunately, there are some exceptions that can occur and some concerns of which you should make yourself aware.
If you had HIV before you signed with a particular health insurance company, they are likely to consider it a pre-existing condition. Pre-existing conditions are almost never covered by health insurance.
Because HIV is a lifelong illness, which often requires expensive treatments, the cost to insurance companies and individuals over time can be huge. This can put an HIV patient in danger of exceeding their lifetime maximum on their health insurance, after which the insurance would pay no more. Insurance companies are usually pretty generous when setting the maximums, so people do not usually reach them unless they have an extra long-term serious illness like HIV.
HIV treatment requires many prescription drugs. If your insurance includes prescription drug coverage, they are required to include coverage for drugs that treat HIV, but some health care plans do not have such coverage. It is very important for HIV patients to stay on their medication, whether it’s covered by insurance or not, because stopping HIV medication can lead to an illness or infection that could be fatal.
Because HIV is a relatively new disease, a lot of treatments and medications for it are still experimental. For the most part, insurance companies are not required to cover experimental medications and treatments for HIV. It is sometimes possible to sign up for clinical studies to have some or all of the costs covered for experimental drugs and treatments, but failing that, you’re out of luck.
How have changes to health care affected HIV coverage?
With the Patient Protection and Affordable Care Act, there is a provision that could help HIV patients. The law allocates 5 billion dollars for the creation of high-risk pools. The idea is that these pools of money would allow insurance companies to provide insurance to people who have trouble getting insurance due to pre-existing conditions like HIV at standard insurance rates.
The high-risk pool provision of the Patient Protection and Affordable Health Care Act isn’t scheduled to kick in until 2014, and there are still some hurdles to pass. The law has been challenged in several states based on the idea that it may be unconstitutional, and if the political landscape changes, it’s possible that the law could be repealed altogether. This particular law is politically polarizing and is often a target of opponents of the administration that created it.
What can someone do if they have HIV and they’re not insured?
If someone has HIV, but does not have health insurance, the biggest concern is often getting medication. The first step is to find an AIDS Service Organization (ASO). A coordinator or social worker at the ASO would then put the patient in contact with their state’s drug assistance program, which will probably be able to help.
In terms of immediate care and treatment, HIV patients face the same challenges as other patients without insurance. They can try to use free clinics or use regular medical facilities and try to work out payment plans with them. No hospital will refuse a patient over financial issues, but that patient will be charged with finding a way to pay the hospital back eventually.
What other sorts of non-HIV treatments are not covered by health insurance?
Many people depend on chiropractors for treatment of back injuries, neck injuries, headaches and more. Unfortunately, the majority of health insurance companies do not cover chiropractic care. In some cases, they will offer coverage if you are referred to a chiropractor by another doctor and in others they may allow a limited number of visits, but in general, chiropractic coverage is rare.
Holistic or alternative treatment, including Reiki, aromatherapy, herbalism, and other treatments, is almost never covered by health insurance. These industries are hard to regulate and there is some question as to their effectiveness, so it is easier for the insurance companies to avoid dealing with them altogether.
Optometry is sometimes covered by health insurance, but not often. It’s a shame, because with eye examinations, lenses, frames and other optional extras, eye care is a health care cost that adds up quickly. When optometry is covered, it’s usually just a set amount for each type of service, rarely the full amount.
Many health care plans consider mental health care to be elective and either refuse to cover it or cover it at a reduced rate. There is a growing partnership, however between health care and mental health care, which is leading to mental health care becoming more mainstream and accepted. It is likely that more and more health insurance policies will cover mental health care in the future.