Positive Healthcare is leaving Florida, causing an insurance scramble for HIV/AIDs patients [South Florida Sun-Sentinel]

South Florida Sun Sentinel (FL)

Pete Povoli has more voicemails than time to respond and people lined up outside his Fort Lauderdale office seeking his help.

As a case manager at the AIDS Health Foundation, Povoli must work fast to find new insurance for Broward County residents whose low-cost health plan will be gone at the end of the year. Close to 900 patients in Florida are scrambling for insurance after Positive Healthcare, also known as PHP, has announced it will no longer offer coverage in Florida after Dec. 31. The insurer has been in the state for 15 years in Miami-Dade, Broward and Duval counties.

PHP is a Medicare Advantage health plan that also includes prescription drug coverage for people who have HIV or AIDS. The plan is backed by the AIDS Healthcare Foundation and members get all of the regular Medicare benefits and access to specialists at no additional cost. Their prescription drugs, especially HIV medications, are also covered at a low cost.

The insurer will continue to be operate in California, but a Positive Healthcare executive says Florida has become too costly to continue to offer its plan after changes to Medicare reimbursement.

“Florida hospitals would not allow us to pay a percent of Medicare like we do in California,” said Donna Stidham, chief of managed care for Positive Healthcare. “They wanted a stop loss and to be paid a percent of charges so that would mean a much higher rate.”

Stidham said PHP had contemplated pulling out of Florida for the last two years. “We couldn’t support the losses anymore,” she said.

For South Floridians living with HIV, the insurance plan has offered the rich benefits they desperately need. “The bulk of people in our plan have multiple co-morbidities and tend to have more hospitalizations,” Stidham said. “We started our plan because people with HIV and AIDS need a lot of support.”

The plan places brand name antiviral drugs on the lowest cost tier to avoid high co-pays. Its in-network primary care physicians are HIV and infectious diseases experts. The specialists in-network have HIV expertise regardless of their specialty. “It is not your regular Medicare Advantage plan for people who are retiring,” Stidham said.

As PHP leaves the state, the AIDS Healthcare Foundation has placed 10 case workers in its Florida offices to help patients find new plans and navigate the healthcare system with their new insurance. “We may be a Medicare Advantage plan but we are patient advocates first,” Stidham said.

Angelo, a Broward County PHP member, is undergoing cancer treatments, so losing his health plan has him concerned. “A doctor I just finished seeing told me he can’t take my insurance anymore. I have to keep going through my treatments. I don’t have a choice,” he said. He has asked not to use his last name to maintain his medical privacy.

Angelo says he sought help from a case worker in the Fort Lauderdale office of the AIDS Health Foundation and after three hours, they found a plan that had similar coverage and included most of his doctors.

“I will be spending more money though,” he said. With nearly 1,000 people shopping for new insurance with similar coverage, he urges PHP plan holders to get help with their search as soon as possible.

“My phone has been blowing up and I have been meeting with people left and right,” said Povoli with the AIDS Health Foundation. “There are alternatives for them. They just will have to know more about how to navigate the medical environment without incurring additional costs.”

Sun Sentinel health reporter Cindy Goodman can be reached at [email protected].