How can a negative HIV test affect a person's insurance premiums?

November 19, 2010 1:23 PM

I'm a health care professional, and I recently read on a physician's blog that a negative HIV test on your health record may affect life or health insurance premiums. I have a vague idea of why this might be, but if any infectious disease, insurance or other professionals could shed some light on this, please explain!
posted by cothebadger to health & fitness (16 answers total)

If you have taken an HIV test before, the assumption is that you engage in unsafe activities (unprotected sex, intravenous drug use) that can be considered proxies for other unsafe behaviors.

This is similar to the logic of charging higher premiums for people who list skydiving as a hobby.
posted by dfriedman at 1:26 PM on November 19, 2010 [2 favorites]

I hope not. In many states HIV testing of new mothers is routine enough to be nearly mandatory.
posted by tilde at 1:33 PM on November 19, 2010 [2 favorites]

Yeah, that doesn't make any sense at all. HIV testing is routine for lots of perfectly safe activities, including having a baby and helping other people have a baby through egg or sperm donation.
posted by Sidhedevil at 1:36 PM on November 19, 2010

Really? I'm kind of surprised by this, since an HIV test was an automatic part of my prenatal blood tests. And it was also an automatic part of my life insurance examination. I don't fall into any particular risk category which led me to believe these tests were given to every pregnant person and every person applying for life insurance.
posted by BlahLaLa at 1:36 PM on November 19, 2010 [1 favorite]

This is also part of why (as I mentioned in another thread recently), my state has made the tests mandatory and universal for pregnant women -- it helps remove the stigma of testing AND it makes it difficult for insurers to jack rates on pregnant women who get testing (as the ACOG recommends all pregnant women do).

There's a clear benefit to routinely testing pregnant women for HIV (very dangerous for infants, but excellent treatment options available if the HIV is known in advance of delivery), but with insurers raising rates on the theory that getting an HIV test was proof you engaged in irresponsible behavior, women were refusing the test. So as a public health matter, the state simply mandated it to prevent that kind of stupidity.

(In the last state I lived in, doctors usually suggested people go to the anonymous clinic for HIV tests rather than having it hit their health record, since rate-jacking for past HIV tests was common and legal, though testing for things like syphilis was apparently not a problem.)

But yeah, it's part of a larger problem where the health insurance industry's incentives do not remotely align with either patient health goals OR public health goals.
posted by Eyebrows McGee at 1:37 PM on November 19, 2010

If the insurance company's statistics show that people with a negative HIV test have, on average, been more expensive to insure than people who have never taken a test, they will put the premiums up. Doesn't matter to them whether that's because HIV tests cause your legs to fall off, or whether there's some correlation between risky sexual behaviour and deciding to take an HIV test, or between hypochondria and going for an HIV test, or whether taking an HIV test is just an indicator of a future desire to take more HIV tests and charge them to your insurance.
posted by emilyw at 1:38 PM on November 19, 2010 [4 favorites]

My (100% rumor) understanding of this is that your rates would go up if you had a lot (no idea how many) of negative HIV tests (on the grounds seen above), not just 1 or 2 ever.
posted by Phredward at 1:51 PM on November 19, 2010

The last time I requested an HIV test from my doctor through my insurance, he sat me down and told me directly not to do that. He told me that it would increase my insurance costs, and that I'd be better served to go to a free clinic, pay out of pocket, and avoid it being on my records.

Very sad. I did what he suggested. Negative, of course, and annoying, but I appreciated my doctors' candor.
posted by Invoke at 1:52 PM on November 19, 2010

As they consider it, the need to take the test indicates a riskier lifestyle. It's not logical, but probably statistically correct.
posted by Raichle at 2:22 PM on November 19, 2010

Related to your question, check out this article on how Capital One gives different prices for car loans depending what internet browser you use. The comments there are very insightful. Basically insurance companies and banks are in the business of risk management so if they see any correlation between an action and an increased risk (people who have negative HIV tests on average likely have more health claims than the average untested individual due to the few who have a risky lifestyle), they will use that information to better manage their risk (by increasing premiums).
posted by ajackson at 3:36 PM on November 19, 2010 [1 favorite]

The vast majority of women don't fall pregnant without having unprotected sex - which is a known risk factor for contracting HIV among other things. From a purely actuarial standpoint, having unprotected sex places you at increased risk of contracting certain diseases, as do certain other lifestyle choices, and premiums are often adjusted to reflect increased risk.

Many people in health related fields are required to be tested for certain transmissible diseases periodically as well - their occupational exposure puts them at increased risk of acquiring those diseases.
posted by Lolie at 4:11 PM on November 19, 2010

CDC's recommendations urge providers to include HIV testing as a routine part of their patients’ healthcare. Routine HIV testing ensures more people learn whether they are infected with HIV, allowing them to benefit from earlier access to treatment and reduce the risk of infecting their partners.

I work in an ED, and we offer tests to every single patient who comes through the door, no matter what the complaint.
posted by gramcracker at 4:44 PM on November 19, 2010

Really, if you can afford to go out of pocket, you should do as many routine tests as possible out of pocket. Someone I know got a test for his heart -- just to be safe -- and though the results came back as normal, his insurance rate soared. In contrast, someone else I'd heard of went to a doctor for the same test, said "I want the test", refused to disclose his information, and paid cash. He saw no change in his insurance rate.

As I understand it, if you're not using insurance money to pay for it, and if the results show that you have no health problems, it's really not any business of the insurance company to find out. If something does come up, you will have to disclose it, obviously, at which point you might as well send in the paperwork for reimbursement as well.
posted by Deathalicious at 3:12 AM on November 20, 2010

Remember, though, that (1) this is a US-oriented discussion, and (2) most USians with health insurance have group insurance, and as I understand it, their individual testing records will be irrelevant to their health insurance costs. So even if this is all true, it's relevant to you only if you are now or expect in the future to have to pay for an individual policy. Don't go paying for all your routine tests out of pocket if you have a group-based policy and reasonably stable employment prospects.
posted by Jasper Fnorde at 8:27 AM on November 20, 2010

I'm not sure that this is always the case. Aren't the insurance rates different for each person at a company based on their prior health and factors like age and gender? So surely they would keep things like testing records in mind when determining the insurance rate? Or do they seriously charge everyone the same amount regardless of age or health condition?
posted by Deathalicious at 7:59 PM on November 20, 2010

"Or do they seriously charge everyone the same amount regardless of age or health condition?"
Yes, that is exactly what group insurance is.
posted by soelo at 9:14 PM on November 20, 2010