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 Post subject: Medicaid Horrors
PostPosted: Sat Jan 30, 2010 3:49 am 
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So recently after my visit to my Dr. which is every 2 weeks, I continue on to my pharmacy where I was then told I needed a PA Pre Authorization or Prior, whatever they call it. Now being that this had happened before I wasn't too upset and it was too late to get my Dr. to do anything so I just pay for a few under the impression that once my Dr. filled this out I'd be reimbursed the amount.
Fast Forward to the next day.
I go to my Dr. and he's already left early, and the receptionists are acting like he wouldn't fill out a PA! Are you kidding me? They then said that medicaid wouldn't cover the program, NO SHIT! I have to pay cash for the program in the amount of 300.00...SO i tell them that, and they still pretend he won't do it. So I call the pharmacies in the area and ask them what the Dr's have been doing for those patients and they say he has to fill out a PA and al the DR's they know have been doing so and out of all the pharmacies I called they said that maybe 1 person within the last few months has had to get a PA faxed in to medicaid from their DR because the pharmacy can no longer do it, and it's only because medicaid wants another hoop for patients to jump through. I also called other DR's and the price was the same, and they do fill out the PA for their patients so that medicaid will cover the medication but it's a longer drive for me....

I know I need to get ahold of my Dr. but no one could understand the hassle created by their reception area. It's impossible to see or talk to him w/o an appt, and apparently they're retarded, seeing that they kept insisting I was trying to have the card cover my office visit!

Any suggestions on how I can get this taken care of? Is there something I myself can get done or am I doomed o pay for them until my next appt and spend the money that'd be used for living expenses?


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PostPosted: Sat Jan 30, 2010 12:00 pm 
What a mess! It's not just Medicaid that's that way though. It's most insurance companies.....try getting something other than a well visit on an HMO! You'll die before they get you in!! That's an exaggeration, of course. But for the most part, insurance is a total pain. Doctors office staff people are generally not well-trained in all the ins and outs of all the various insurance plans (there are hundreds of different plans). Therefore they don't know what they're talking about a great deal of the time. It's highly frustrating. These are generalizations.....some insurance plans are easy to deal with and some doctors offices are knowledgeable and easy to deal with. If you're lucky enough to have it like that....count your blessings.
What should you do? Take a deep breath and then start over is what I would do. Go back or call the pharmacy - maybe the staff that's there today will be different and won't insist on having the pre auth form. If they still need the form, I would call your doctor's office and ask to speak with the doctor's nurse or medical asssistant. (they will usually know a lot more than the receptionists.) If you can't get ahold of the nurse, try asking for the office billing or insurance person. If none of these avenues gets you what you need, ask to speak with the office manager. The reason I'm not suggesting you insist on speaking with the doctor is that you already said that ain't gonna happen and doctors usually don't want or need to deal with this crap. If you can get ahold of the proper person, they will fill out the paper and stick it under the doctor's nose and have him sign it.....simple as that!! Also, be very calm and non-demanding when you talk to these people. I know it's frustrating and may not be right....but you will definitely catch more flies with honey (so to speak.) Like you, these are busy people, they hear people complaining about something all the time, so if you'll stay calm and just get ahold of the right person, tell them what you need....that you're Medicaid has always paid for your meds, that you've had a pre auth filled out before, all you need is the form signed by the doctor and you'll be on your way......surely they will get you taken care of.
Let me know what happens. Hope that helped a little.


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 Post subject: Good god
PostPosted: Wed Feb 03, 2010 4:57 pm 
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WHAT A LOAD OF RUNNING AROUND YOU HAVE TO DO IN THE USA!!!!!
In the UK, if you are employed you pay £7.20p per prescription, and if you receive unemployment/disability benefit the medication is free! All you need to do is tick the relevant box on the script and show proof of being in receipt of welfare.
Our National Health Service isn't what it once was, but we are still so fortunate to have it. Would it take an Act of Congress or whatever to make things simpler for American patients? When you're trying to get clean and reclaim your life, the last thing you need to worry about is damn paperwork.


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