HIV Consultation Costs
The range or average cost for a standard or routine 30-minute HIV consultation for a patient with and without health insurance coverage could not be found. No specific details were found also on the typical portion of the consultation costs that would be out-of-pocket for those HIV patients that do have insurance. This could be due to the various factors that impact the cost of visits to the doctor’s office such as doctor’s preferences or prerogatives, state’s average, hospital’s mandates, specialization, and other factors. Based on the American Medical Association’s current procedural terminology (CPT) table, the average fee that an infectious disease doctor in California charges for a 25-minute office visit of an established patient is around $300. Some of the available estimated costs found on the consultation fees of doctors or specialists and the corresponding Medicare payment estimates were presented below.
Cost of Visits to the Doctor’s Office
- Based on the Healthcare Blue Book costs, doctor office visits for new patients with mild conditions that need counseling and treatment is around $68 for 10 minutes. This may include linking with other healthcare providers for the needed care.
- For patients with complicated medical issues that need a comprehensive diagnosis, the average cost is around $234 for 40 minutes.
- Nearly all private insurance plans need the insured individual to make a co-pay payment when going to their physicians or other health care providers. The co-payment cost is different under each insurance provider.
- The usual co-payment for going to a primary care doctor goes from $15 to $25.
- For specialists, the co-pay amount is around $30 to $50.
- The majority of insurance plans also need the patient to make a deductible payment prior to the insurance provider “taking over the payments” to a doctor.
- The deductible amount is different for each insurance plan. For some plans, the benefits may already be on-hand even before the “deductible is met.”
- Furthermore, co-payments are sometimes not “included in reaching the deductible” as co-insurance fees are usually indicated as part of the total bill .
- As an example, an 80/20 plan will require the insured to shell out 20% of the bill while the insurance firm’s share is 80%. This is applicable only after the plan holder has made a co-pay payment and reached the needed deductible amount.
- In most cases, the cost of visiting the physician’s office is usually negotiable. The cost can be negotiated prior to the visit and after it happened.
- Discounts are typically given for self-payers. Patients can also do their research to find the best deal for their planned consultations.
- Furthermore, some doctors have made a decision to be excluded from the prevailing insurance payment structure and have opted for a more administratively simple fee-for-service strategy.
- Other doctors also preferred not to charge fees for each visit, opting instead for an annual pricing plan for any service availed within a year.
- HIV treatment cost can range from $14,000 to $20,000 annually. This cost typically includes doctor’s visits, medications, and other treatment needs.
- Based on the Consumer Health Ratings site, a typical visit to the doctor’s office costs around $267 in 2017. This can be extrapolated to around $288 in 2020.
- In Vermont hospitals, the average cost for a doctor’s office visit is around $155 for established patients. As hospitals may have additional fees, the total bill may go up to $208 per visit.
- Visits to the doctor’s office in the state can range from $98 in the Northeastern VT Regional Hospital to $662 in North Country.
- In terms of Medicare payments, Medicare paid the following rates for an established patient: $49 for a 15-minute visit; $73 for a 30-minute visit; and $116 for a 45-minute visit.
- For new patients, Medicare paid the following: $73 for a 30-minute visit, and $116 for a 45-minute visit.
- Meanwhile, some sample data from the American Medical Association’s CPT payment data chart shows the following cost details for an infectious disease specialist:
Internists or infectious disease specialists are usually the types of physicians that handle HIV cases.
The following shows the average consultation cost in an accredited and non-accredited facility:
Emergency HIV Plans
While many private health insurance plans offered through employers or the Affordable Care Act (ACA) marketplace offer coverage for HIV and AIDS treatments, there are unfortunately others which don’t. The ACA, Medicaid, and Medicare have provided coverage to millions of Americans who were previously uninsured; however, there are still millions of Americans who remain uninsured, with many more being defined as “underinsured” (having a health insurance plan which does not provide substantial coverage options). Thankfully, for those individuals facing a diagnosis of HIV either without health insurance or with a plan that does not offer comprehensive coverage, there are a number of other options, such as Medicaid and the Ryan White HIV/AIDS Program. Several options have been discussed in more detail below.
- Medicaid is a federal health insurance program providing coverage for “people with lower incomes, older people, people with disabilities, and some families and children. It is a critical source of coverage for many people living with HIV/AIDS”.
- While Medicaid is a federal program, it’s administered at the state level, with each U.S. state issuing coverage individually.
- While eligibility guidelines for the program vary from one state to the next however, the ACA ensures that all states – and most take advantage – have the option “to expand Medicaid eligibility to generally include people below certain income levels, including low-income childless adults who were previously not generally eligible for Medicaid. As a result, in states that opt for Medicaid expansion, people living with HIV who meet the income threshold no longer have to wait for an AIDS diagnosis in order to become eligible for Medicaid”.
THE RYAN WHITE HIV/AIDS PROGRAM
- The Ryan White HIV/AIDS Program is a healthcare treatment program offered to patients diagnosed with HIV or AIDS and who do not have health insurance, or who are enrolled in a healthcare plan that doesn’t cover treatment options for HIV and/or AIDS.
- Currently, the program provides coverage to “more than half a million people living with HIV/AIDS each year”, and has been in effect since 1990. It “is the largest federal program designed specifically for people with HIV, serving over half of all those diagnosed”.
- In order to be eligible for coverage under the Ryan White HIV/AIDS Program, a patient must be diagnosed as HIV positive; have a household income under 500 percent of the federal poverty line; and either be uninsured, or be insured through a plan that doesn’t offer coverage for HIV/AIDS treatment.
- “The Ryan White Program covers the costs of medical care and support services for both uninsured and insured eligible individuals. If you are uninsured, the Ryan White Program will cover the primary charge for the service and you may be responsible for a small copay. If you are insured, the Ryan White Program will provide assistance with your copays, coinsurance and deductibles for eligible services.”
- Program coverage is issued at the state level, and individuals can be enrolled with the help of a social worker.
THE HEALTH CENTER PROGRAM
- The HRSA Health Center Program is a system of healthcare centers which provide both primary and preventative healthcare to 1 in 11 Americans, regardless of whether they have health insurance coverage and/or their ability to pay.
- Centers provide a variety of care, including “access to pharmacy, mental health, substance use disorder, and oral health services in areas where economic, geographic, or cultural barriers limit access to affordable health care services”. In addition, the Health Center Program provides HIV and AIDS treatment to millions of patients throughout the United States.
- “Some patients receive services directly at the health center itself, while others are referred to an HIV specialist in the community.”
- In addition to the above-referenced programs and resources available throughout the country, there are also a number of emergency healthcare resources for individuals diagnosed with HIV at the state level.
- For example, the Uninsured Care Programs “provide access to free health care (Drugs, Outpatient Primary Care, Home Care, Insurance Premium Payments, and Pre-Exposure Prophylaxis to prevent HIV infection) for New York State residents who are uninsured or underinsured”.
- Similar programs also offered in New York State include the AIDS Drug Assistance Program (ADAP), ADAP Plus, and the HIV Home Care Program.
HIV Support Groups
Positive Link, HERR Day Out, A Girl Like Me, HIV/AIDS Tribe, Grupo Familiar, Bebashi Support Group s, and POZ Community are support groups that are available to HIV patients that don’t have health care coverage or insurance.
1. Positive Link
- Positive Link by JustUs Health is an HIV support group for gay, bi, queer, pan, and same-gender-loving men and non-binary people. The program is held monthly and involves social outings, support groups, discussions, connecting people living with HIV to local resources and clinics, and health education presentations related to living with HIV.
- Attendees get the “most current and scientifically accurate information about living with HIV and other aspects of physical, mental, chemical, and sexual health”.
- The program is free and open to all people living with HIV.
2. A Girl Like Me
- A Girl Like Me is a support group by The Well Project, a non-profit organization recognized as a leader in the fight against HIV; providing meaningful and relevant information designed specifically for women living with HIV.
- A Girl Like Me provides a support community, creating a safe space for women living with HIV to speak out and share their experiences.
- The community is free to join.
- Therapy Tribe’s HIV/AIDS support group is a peer-to-peer support group for individuals or family living with HIV/AIDS. The group provides an environment for members to share stories, offer encouragement and friendship.
- The support group also helps to connect HIV positive individuals in order to positively affect their mental health and emotional well-being.
- The group is free and accessible upon registration.
4. Grupo Familiar
- Grupo Familiar is a Spanish speaking family support group for people infected or affected by HIV/AIDS by Christie’s Place, a nonprofit social service organization providing HIV/AIDS education, support and advocacy.
- The support group is led by people who have experience with HIV related topics or who are living well with HIV/AIDS.
- The support group is free and open to everyone.
5. HERR Day Out
- HERR Day Out is an HIV support group by JustUs Health for women living with HIV. The group aims to provide a safe place for women to share their experiences of living with HIV thus, increasing their emotional well-being.
- HERR Day Out encourages women to create their peer support network that offers a daily connection.
- Attendance is free and open to all people living with HIV.
6. POZ Community
- POZ Community Forums is an online support group for HIV/AIDS-related discussions for family, friends and caregivers. The community was voted the “Best HIV Support Groups of 2020” by Verywell Health.
- POZ provides a platform for people living with HIV to speak to one another, and is available for newly diagnosed, long term survivors, and people of all ages.
- Registration for the community is free.
7. Bebashi Support Group s
- HIV Co-ed Support Group and HIV Women’s Support Group are groups by Bebashi to “help HIV positive clients stay connected to care, adhere to treatment, and deal with the emotional and physical challenges related to their diagnosis.”
- The support groups provide participants with the opportunity to learn about new treatment options, dealing with side effects, and strategies to improve their health and wellbeing.
- The programs are free.