appealing a claim

isn't it nice when you appeal a health insurance claim denial, mail in all the info *with* the explanation of benefits and they SOMEHOW re-process the *wrong* claim

i included a document *from you* that included the plan details, the claim id, the dates and providers of service, AND why the claim was denied, and yet somehow you didn't realize that was the claim I appealed

Originally tweeted by Maybe: Leo Ji (@theleoji) on March 8, 2021.

About this $1,800 drug

A claim for pharmacy services through Aetna reduced the drug's cost from $1,752.03 to $30.

I would not have been able to afford this life-saving drug without health insurance.

This $1752.03 drug is Truvada, the brand-name antiviral medication manufactured by Gilead for pre-exposure prophylaxis, or PrEP. The FDA-approved medication greatly reduces the chances of getting HIV — by as much as 90 percent, according to the U.S. Centers for Disease Control and Prevention.

On November 20, 2018, the U.S. Preventative Services Task Force, an independent panel of national experts on preventative medicine, recommended all people at high risk of HIV infection should be offered PrEP.

But it’s not easy. Gilead points out it has financial assistance programs to help patients, but it’s still an incredibly high sticker price. Sure, very few people might pay it all when health insurance foots the bill, and Gilead has programs to try to catch the rest.

What about the people who can’t afford their deductibles, co-pays, or co-insurance? What about the uninsured patients Gilead misses?

What of the reality that “new HIV diagnoses are disproportionately concentrated among injection drug users and black and Latino men who have sex with other men”?

I recognise how fortunate — and how privileged — I am to be on such excellent commerical insurance that Aetna is responsible for about 98 percent of the drug’s cost, and I can use Gilead’s co-pay coupon card to cover the rest. (Yes, this means I get this expensive drug for free.)

But every morning when I swallow one of these pills, I think about the possibility  there are people out there who can’t afford this drug that helps prevent against one of the worst epidemics to hit the LGBTQ community — my brothers, my sisters, my family.

Bless us all.