Insurance companies grapple with question of picking up tab for customer AIDS tests.

Most insurance carriers have not adjusted health plans to cover AIDS testing, leaving those wishing to be screened for the virus with the possibility of having to pick up the tab for the test themselves.

There is no standard policy in the industry for payment of regular diagnostic and preventive screening tests, such as AIDS, said Michael Chee, senior public relations director for Blue Cross of California.

Linda Ambrose, director of media relations for Aetna Life & Casualty Inc., said her company treats AIDS like any other medical condition that requires coverage for services and treatments. Like other preventive procedures, insurers generally define their policy guidelines for preliminary testing on a case-by-case basis.

For large corporations that frequently self-insure, then contract with an outside agency to service and administer the policy, or have a group plan, AIDS tests are treated the same as any other testing or diagnostic procedure.

Under its Prudent Buyer plan, Blue Cross of California does not cover physicals on a routine basis and therefore the AIDS test would not be qualify for except as part of an examination ordered by a physician. But, according to the provisions of the CaliforniaCare HMO plan, the test is covered when pre-approved by the insurer.

About two years ago, Blue Cross amended its standard application form to ask for disclosure of previous consultation, treatment, advice or hospitalization for the AIDS virus. In cases where the disease has been diagnosed, it is treated like any chronic illness that requires medical treatment, such as cancer or diabetes, Chee noted.

Other insurers cover the AIDS test under the category of annual check-ups or physicals. But a blood test for AIDS may not be included in a regular exam because it is not considered a routine procedure, Chee said.

Prudential Insurance Co. of America's standard group policies allow up to one AIDS test per year, said Thomas Rodriguez, member services coordinator.

If care is provided through a primary care physician, charges are covered 100 percent, usually with a required co-payment of $10. If a person chooses to belong to a health maintenance organization, a list of doctors is provided and treatment is paid in full as long as the applicant stays within the coverage network.

A major medical plan gives the individual the option of seeking treatment from his own choice of doctors. If the doctor charges above the allowable amount, the policy holder will be required to make up the difference.

The California Department of Health Services' Office of AIDS gets requests from private insurance companies to train counselors for customers. A three-day HIV program offers guidance on individual risk for infection, transmission mode and testing procedures, said Mary Huttner, chief of the HIV testing unit for the Office of AIDS. This is the administrative arm for state-funded testing sites throughout California. A total of 110,000 people went through the program from June 1990 to December 1990, up from about 22,000 when the centers first opened in 1985.

But some people are reluctant to seek the services of the state-funded clinics, because they are afraid of having their identities revealed. The state has addressed that concern by providing testing services in an anonymous or confidential manner. In the case of anonymous testing, the identity of the individual is not known. With confidential testing, however, the name and identifying factors about the applicant are recorded.

The option of anonymous testing is exercised by 53 percent of the more than 200,000 people screened annually at state-funded testing sites, Huttner said. About 2.7 percent of the 50,000 people examined in the first quarter of 1991 showed a positive result. Although the state does not compile statistics on private insurers, Huttner said an equal number of people are probably being tested in the private sector. Any doctor's office or medical clinic can administer the procedure.

"Our goal is to make standardized testing a basic feature of care in all clinics," she said.

But, state-run programs have also elicited concern from some participants, said Suzanne Rivera, executive director of the South Bay Free clinic. She said she has received complaints from people whose HIV test results had been given to insurers, and this, in turn, had affected their ability to receive or maintain coverage.

People treated at large health maintenance organizations also complained about the confidentiality of their test results being compromised, because their records had changed hands so many times, Huttner said.