Academy Exchange

 View Only
  • 1.  PrEP for someone on parents insurance - getting around EOBs

    Posted 10-04-2023 17:48

    Hey everyone hoping you can help us out. I am actually a mentor for for the mentorship program and my mentee of course asked me something I DONT KNOW! For folks who are on their parents insurance, do insurance EOBs show information about medications/visits/labs and if so how does one get around it? We are in Pennsylvania which might change the answer. Are there any handouts on this for providers when learning about PrEP? THANKS!



    ------------------------------
    Angela Kapalko
    Physician Assistant Chairperson for AAHIVM
    Philadelphia FIGHT CommunityHealth Centers
    Philadelphia PA
    akapalko@fight.org
    ------------------------------


  • 2.  RE: PrEP for someone on parents insurance - getting around EOBs

    Posted 10-05-2023 15:09

    Not sure about other states but in MA we have something call the PATCH Act (= Protecting Access To 
    Confidential Healthcare) which allows patient to call insurers and not have EOBs sent to the policy holder.  Other options like using programs for meds or even paying out of pocket using goodRx for generic meds is an option but only solves the medication issue but does not address visit and lab charges.  It's a tough problem and even though we have a program like this in MA it's actually very cumbersome to try to operationalize it. 

    FINAL-CHLPI-PATCH-Act-consumer-script.pdf



    ------------------------------
    Jonathan Pincus
    Codman Square Health Center
    Milton MA
    ------------------------------



  • 3.  RE: PrEP for someone on parents insurance - getting around EOBs

    Posted 10-05-2023 16:36

    Unfortunately, the only option we have found is having people purchase generic Truvada with a GoodRx discount card. We overcome other costs by having people get labs at designated public health sites (Iowa HHS offers lab monitoring for no cost to the person), and our pharmacist-managed PrEP clinic does not charge for visits.

    Heidi Wood, pharmacist

    Iowa TelePrEP



    ------------------------------
    Heidi Wood
    North Liberty IA
    ------------------------------



  • 4.  RE: PrEP for someone on parents insurance - getting around EOBs

    Posted 10-06-2023 03:15

    Greetings, Angela-

    We deal with this all the time as I take care of adolescents, many are on their parent's insurance. 
    You can get around this 2 ways: First EOBs don't usually list specific services provided. It will list labs, office visits, or other diagnostics but won't show specific STI tests. Most EOBS list services billed based on codes. 
    1. We use a code our clinic enters that is used for general clinic visits, physical exams, etc. 
    EOBs are a statement that the insurance company sends to summarize the costs of services you received. An EOB shows how much the provider is charging your insurance company and how much you may be responsible for paying. It is not a bill.
    2. If an adolescent / young adult is on their parent's insurance, they may qualify for the Gilead assistance program and not use their parent's insurance at all. 

    Hope this helps! We haven't had any issues with our patient's healthcare being compromised by EOB. I usually tell my patients if their parents ask, say, they went to the doctor for a physical exam. 

    Michelle
    Michelle Collins-Ogle, MD, FAAP, FPIDS
    (she/her/elle/Ella)
    Medical Director
    Montefiore Adolescent & Youth Sexual-Health (MAYS) Clinic
    Division of Pediatric Infectious Diseases
    Children's Hospital at 
    Montefiore 
    Associate Professor of Pediatrics
    Einstein College of Medicine 
    Bronx, NY 10467
    T # 718-882-5482 Fax # 718-654-6692
    **
    "Of all the forms of inequality, injustice in health is the most shocking and inhuman" 
    Martin Luther King, Jr., March 25, 1966






  • 5.  RE: PrEP for someone on parents insurance - getting around EOBs

    Posted 10-09-2023 12:57

    Useful piece of information to keep in mind and to break down the barriers.



    ------------------------------
    Vivian Eger
    Martinez CA
    ------------------------------