My ds has been ill for about a week and a half. Long story short, he was pretty ill and ended up in the ER Sunday morning and then the dr again on Tuesday because he wasn't getting better.
So, one of the meds he was prescribed wasn't covered by insurance ($98). I sucked it up and paid for it. Then on Tuesday he was prescribed another med that wasn't covered by insurance
Another $70. DS has MEDICAID by the way, and these weren't some crazy meds... just strong antibiotics. I sucked it up and paid for it because, well, ds NEEDED it.
So I called the medicaid people to find out why the second one wasn't covered. I was told that it wasn't covered because "the FDA has issued a statement saying that this medicine is no more effective than others and we cover the other ones". Except the other ones were NOT working (and ds was getting worse). He NEEDED the stronger meds. I argued with the guy and eventually worked my way up the chain. They were trying to insist that ds didn't need the stronger meds. Ummm... excuse me? Are you a doctor? No? Then don't pretend to be! So I (not so politely) requested a letter stating that I should give my son the meds they cover and that if anything should happen to him (if he gets worse and has even worse consequences) then they will take responsibility. He refused and the call ended shortly after. This all happened in a series of calls over the last couple days.
Fast forward to today. The pharmacy I got the script filled at (who has been involved with me in trying to get the meds covered) called to say that Medicaid just "made an exception" and is going to cover it! WOO-HOO! It is SO WRONG that I had to do that and they were refusing to cover it. But I'm pleased that I got my $70 back
So, one of the meds he was prescribed wasn't covered by insurance ($98). I sucked it up and paid for it. Then on Tuesday he was prescribed another med that wasn't covered by insurance
Another $70. DS has MEDICAID by the way, and these weren't some crazy meds... just strong antibiotics. I sucked it up and paid for it because, well, ds NEEDED it.So I called the medicaid people to find out why the second one wasn't covered. I was told that it wasn't covered because "the FDA has issued a statement saying that this medicine is no more effective than others and we cover the other ones". Except the other ones were NOT working (and ds was getting worse). He NEEDED the stronger meds. I argued with the guy and eventually worked my way up the chain. They were trying to insist that ds didn't need the stronger meds. Ummm... excuse me? Are you a doctor? No? Then don't pretend to be! So I (not so politely) requested a letter stating that I should give my son the meds they cover and that if anything should happen to him (if he gets worse and has even worse consequences) then they will take responsibility. He refused and the call ended shortly after. This all happened in a series of calls over the last couple days.
Fast forward to today. The pharmacy I got the script filled at (who has been involved with me in trying to get the meds covered) called to say that Medicaid just "made an exception" and is going to cover it! WOO-HOO! It is SO WRONG that I had to do that and they were refusing to cover it. But I'm pleased that I got my $70 back
: Awesome!
