If not, what are ISDH's recommendation to HIV Care Coordination Consumers in regard to receiving Swine Flu Vaccination?

At this time there has been no communication with how these vaccinations will be administered or distributed. [Consumers should] pay attention to local news.  Dr. Monroe [Indiana State Department of Health Commissioner] has been informing the public as she has answers regarding these matters and has been doing so with both television and newspaper media

This concluded the CAB Representative's questions regarding the Swine Flu vaccine.  What follows next are questions regarding vaccines in general and coverage offered by ICHIA.

Does Anthem (ICHIA) cover vaccinations for the flu [season] every year?

People [consumers] on Medical Services is [sic] covered by ICHIA, not Anthem - Anthem underwrites ICHIA, but it is NOT Anthem coverage, and yes ICHIA does cover influenza A (traditional flu) shots annually.

If not, will this be picked up by funds managed by ISDH to cover gaps [in coverage]?

...No, ISDH does operate additional coverage for those on HIAP/ICHIA - what is covered by ICHIA is what is allowed for those enrolled.  Those on EIP prior to full HIAP/ICHIA are covered for flu as well as those on HIAP/ICHIA.

If not, what are ISDH's recommendation to HIV Care Coordination Consumers in regard to receiving the Flu Vaccination?

The flu shot is an allowed service so there is no need to provide  additional recommendations.

Does Anthem (ICHIA) cover vaccinations for Pneumovax every five (5) years (as recommended
by physicians to HIV+ individuals).

ICHIA does cover pneumovax [vaccination]

If not, will this be picked up by funds managed by ISDH to cover gaps [in coverage]?

It is covered so no need.

If not, what are ISDH's recommendation to HIV Care Coordination Consumers in regard to receiving the pneumovax vaccination every five years?

It's covered so no need for additional information

This concluded the questions the consumer's CAB Representative questions requesting clarification with Neil on the most common vaccinations often received by consumers on a regular recurring basis (Flu, Swine Flu, Pneumovax, etc.). 

Part 2 next week will explore not only who is responsible for notifying client of changes in policy and which policy is changed (EIP, HIAP/ICHIA, Anthem), but also address the issue of vaccinations which are not necessarily so regular or recurring and only are received based on certain criteria as defined by a physician (i.e.  TB, Tetanus, Hep A & B, etc..

If you are currently enrolled in the Care Coordination Program and have questions regarding coverage or other questions regarding your ICHIA insurance, you may contact Neil by sending him an email at ncarnes@isdh.IN.gov.
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Jeff Wolfe serves as the Central Area Representative for the Indiana Consumer Advisory Board and Vice-Chair for the Comprehensive HIV Services Planning and Advisory Council.  Jeff holds a BA degree in Sociology with a minor in Medical Sociology from Indiana University.  Jeff has served also as the District/Region 4 Representative back in 2006. You can reach Jeff by sending an email to jeff.wolfe@indianacab.org. DISCLAIMER:  the information provided herein is for informational purposes only.  Consumers should always consult their physician regarding needed and required vaccinations to protect their health, whether or not such services are provided by insurance.   

One the Indiana Consumer Advisory Board's District/Region Representatives recently received a request from a consumer for help.  Apparently the consumer had been put on a "CASH ONLY" basis by his primary care physician's billing office.

The consumer found out that a bill for their 10 year tetanus vaccination, that the consumer received at the physician's decision because of a hand injury, was not paid by his primary insurance (medicare) nor his secondary insurance (ICHIA).  As a result the billing office put the consumer on credit hold.  The consumer contacted his Care Coordination provider and they stated that vaccinations were no longer covered by insurance according to a letter they received back in June of 2008. 

The consumer attempted to receive assistance from the Care Coordination provider who referred the consumer to the insurance company and/or the healthcare provider. Clearly the consumer was frustrated and stressed out that they could not keep their primary care physician's appointment because of the credit hold.  Who has $600 cash to pay for a standard office visit with their primary care physician (standard cost for this consumer's physician's charge for office visit).

The consumer contacted their CAB Representative for help. After a few phone calls to the billing office of the physician's office by the CAB Representative, the issue was quickly resolved and the consumer was released from credit hold. Once this issue was resolved, the bill written off, and the issue fixed and the consumer to reschedule their appointment with their healthcare provider.

However, for the CAB Representative, that did not resolve the issue that the Care Coordination provider stated that ICHIA would no longer provide coverage for vaccinations.  Was this all vaccinations? Did this only exclude certain vaccinations? Nor did it resolve the issue of notification to consumers of the change in policy coverage. Who is responsible for notifying consumers when changes to policy are received by the Care Coordination site?  Both of these issues bothered the CAB Representative. 

First, the CAB Representative thought that couldn't be right. How could an insurance company deny vaccination coverage to immune compromised consumers under the state's high risk policy?  Secondly, the CAB Representative wondered who was responsible for notifying consumers when the Care Coordination provider received notification of changes to insurance policy for ICHIA?

This story is a two part story and this week's article addresses the issue regarding vaccinations and what is covered under ICHIA.  Next week will be a continuation of this story addressing the issue of notification of changes when a Care Coordination Provider receives information regarding changes.

The consumer's CAB Representative contacted Neil Carnes, HIV Medical Services Program Manager for ISDH, Division of HIV/STD and asked the following questions to help clarify the first issue discussed in this article - are vaccinations covered under ICHIA. The CAB Representative focused on requesting information on the most common vaccinations (not necessarily tetanus, TB, Hep A & B, etc).  Under each question is Neil's response to each of the questions shown below.  These are published for the benefit of all consumers in case in the future consumers have questions regarding the most common vaccinations and what is covered.

The CAB Representative first asked questions regarding vaccinations for Swine Flu since this is in the news and surely a concern for consumers.  The second set of questions are regarding vaccinations in general and what exactly is covered under ICHIA.

Here are questions the CAB Representative asked Neil Carnes, ISDH HIV Medical Services Program Manager, Division of HIV/STD, about the Swine Flu Vaccinations:

Will Anthem (ICHIA) cover the cost of vaccination for Swine Flu?

This has not been decided - the vaccination is not available at this time so we do not anticipate a decision at this time.  When ICHIA makes a decision regarding coverage, I will let the CAB Representatives and Care Coordinators know the answer. I have asked ICHIA what is their intent regarding this matter, but no answer as of yet.

If not, will this be picked up by funds managed by ISDH to cover gaps [in coverage]?

No, HIAP follows ICHIA coverage.  We do not operate distinct coverage outside what ICHIA allows. We do not have the funds to operate such programming.