HIV and health Insurance

Apr 30, 2007

  1. Golddoor
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    I had a lead that I met with whom is the office manager at a Doctors office. The office employees(6 total) are paying on an Aetna group around 7-$800.00 dollars per month each, even for single young and healthy employees. He claimed that they were paying so much because they had an employee that was HIV positive. The renewals were coming up next month and I showed the office manager what I could do on an individual basis for him, and he was in shock about the difference in an Ind versus a group. He said he was going to be leaving the job soon and needed some coverage that he could take with him. I thought well he is the perfect candidate for a Ind plan. He told me he was totally healthy other than some mild HBP. He was so over joyed he started telling all the nurses and the Doctor about what he would be saving. They then all wanted to get quotes and fill out apps. They asked if I could leave the apps and they would complete over the weekend. Well today I receive the apps from the office manager and the six employees, and the office managers apps health history questions, he answered that he had HIV. WTF? I called him and told him I couldn't help him other than getting him quotes with other companies on a group basis. I didnt ask why he didnt tell me, during our hour long meeting discussing insurance, that it was him that actually had the HIV. Now with the rest of the employees how would every one else handle this situation? Should I leave them alone? or submit them all incuding the office manager for group quotes to see if I can beat the high premiums they are paying with Aetna?
     
    Golddoor, Apr 30, 2007
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  2. senior-advisor-indiana
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    I would leave it be until that office mangaer leaves. I do not do major medical but thats what I would do if i did. Thats reall crappy he didnt disclose that. Some people still amaze me. Can you get a group to cover someone with HIV?
     
  3. K-Dub
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    K-Dub Super Genius

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    I thought you were going to say, "They filled out all the applications and the owner saw which employee had listed the HIV, then fired that person who is now starting a law suit!"

    I really thought that's where you were going...thank god it didn't!
     
    K-Dub, Apr 30, 2007
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  4. SME
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    The difficulty now is that the other employees are expecting thier rates to go down and are going to jump ship for individual policies. If they all leave you may not have a group left to deal with. Are you allowed to have a management carve out in your state? You might be able to write the doctor and the office manager on a group by themselves and write individual policies for the other employees. Just a thought.
     
    SME, Apr 30, 2007
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  5. Golddoor
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    No the Doctor knows about it because he treats him for it.
     
    Golddoor, Apr 30, 2007
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  6. Golddoor
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    I thought about that. If a group is already established can employees that are on the group drop off if they are still employed with the company?
     
    Golddoor, Apr 30, 2007
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  7. salpro22
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    I am not an expert in group, but it would seem that you might be able to take the gentlemen with HIV and put him on a state plan (if one exists in your state) and put the rest on individual plans.

    If the group is under 20 employees and the employer cancels the group plan, the employees become HIPAA eligible and should be able to obtain a GI plan. Your in Texas right? If so, I would be on the phone in a minute contacting Sti and offering to buy him some steaks for assistance...
     
    salpro22, Apr 30, 2007
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  8. Dave020
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    Dave020 Super Moderator Moderator

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    Become HIPAA eligible as long as they've had 18 months continuous coverage with no gaps greater than 63 days between any of those coverages and last coverage being group (which this is).

    Dave
    www.davefluker.com
     
    Dave020, Apr 30, 2007
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  9. taterpeeler
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    I would cover the othe rhealthy people, if u dont someone else will... and tell the dude with the aid to piss off.... or write it and let the chips fall where they may.... god i love internet apps... then i'm out of that loop
     
  10. leevena
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    This appears to be what I call a "drive-by" insurance attack and could be a good learning moment for everyone. And I am sorry, but from what you outlined here, this could have been avoided.

    Did you not think to tell that person that this was just an illustrative quote? And I will assume that you did caution him, but you should have told the employee not to speak with the others yet. What did you think was going to happen? At least one of those apps were going to come back with HIV.

    Difficult to say what you should do, but this group needs to stay with a group plan, at least for the short-term. If your relationship with the physician is ok, I would go back to him/her, explain what happened, own up to the mistake, and see if he will allow you to go forward with group quotes.
     
    leevena, Oct 27, 2011
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