Medicaid frustration

By butterflydreams Latest Reply 2010-03-23 13:08:05 -0500
Started 2009-12-29 10:33:55 -0600

Ok, so first off let me say, that I am very grateful to even have coverage, but that aside I am very frustrated.

I was working up until the end of August and had private insurance through my employer. After I wasn't working, I applied for Medicaid for myself and my children. Medicaid finally kicked in at the beginning of November. I went to my internist because I needed refills on my meds and they wouldn't fill them without an office visit (it had been since July since I had seen him). Anyway, because my weight was up (which he has always been on me about my weight) and my BS numbers weren't where he wants them (my fastings were in the 140's or so) he took me off Janumet - which I had been on for the last 2 years and put me on Actosplus Met and Byetta. He also prescribed me Metanx because I was complaining about some pain in my right foot and he did a tuning fork test thing and said I have peripheral neuropathy starting. (I was shocked at this because I haven't had real high blood sugars, the highest I have ever had was 205 when I was diagnosed in 2007).

Anyway, on to my rant. Medicaid covered the Actosplus Met and the Metanx. He didn't give me a prescription right away for the Byetta because he wanted to see how it was going, plus I had a months supply with the sample he gave me. Anyway, he finally a few weeks later his office called in a prescription for the Byetta for me and low and behold Medicaid said that it needed pre-authorization. That was 3 weeks ago. I called the office again yesterday and asked how the preauthorization was going. I was told that Medicaid keeps denying it. I asked why and was told that they said I needed to try other meds first. Umm, I have been on Metformin, I have been on Janumet and now Actosplus Met (which I am not crazy about) what else do I need.

To add to this, I also have been on Cymbalta and Protonix (for acid reflux) for several years. Now when I am not on Cymbalta I am not pretty to live with. Medicaid will NOT cover these. So my doctor wrote me a prescription for Effexor and Prilosec. They are denying these too. I told the nurse I talked to yesterday that the only reason that the doctor changed to these was because they wouldn't cover the Cymbalta or the Protonix. Now I have been without Cymbalta for a month and I am a complete mess. I am so depressed and irritable it isn't funny.

I am so frustrated!!!!

8 replies

texasdorkprincess 2010-03-23 13:08:05 -0500 Report

I feel your frustration. My insurance denied the Byetta due to not meeting the step process. I was like i can only do what the doctor puts me on. I've already done a few medications and i am still on Metformin. The freaking Byetta is $278 for a month for a MONTH. I can't afford that.

Stinastina 2010-01-25 10:16:18 -0600 Report

I just wanted to reiterate to ask your doctor for samples. I am on Januvia and it really works for me. Metformin made me sick as a dog. Mediciaid does not cover Januvia. I have been surviving off of samples for almost a year. Check with the company who makes the medicine directly on their website. Most have a program to give you the meds for free. I just signed up for it myself.

Anonymous 2009-12-29 22:25:56 -0600 Report

Find out who administers the Medicaid program where you live and what the appeal process is for denials. Then follow the appeal procedure to the letter. There is usually a Medical Director who makes final determination and it sometimes takes a doctor talking to that Medical Director to get a denial reversed. Good luck!!!

butterflydreams 2009-12-30 06:47:44 -0600 Report

thank you all for your replies, everyone is so very helpful. I will definitely look into checking with medicaid and also with my doctor.

ginarb37 2009-12-29 15:07:23 -0600 Report

I used to work for doctors offices and delt with medicaid alot. You will have to stay on top of them on both ends. For they will just keep kicking it around. Contact the doc office and see about samples. they usually will have some if they are wanting you to try them. Doesnt hurt to ask. I myself is a one income family barely making it. Im having to call the docs office and go throu some programs. Also ask on here if you need something, sometimes ppl have supplies or such. I found someone that was very kind to me to send me some supplies. lm so gratful to him. ;)
Best of luck and if u need anything please feel free to add me. The more friends the better network. ;)

salmanda 2009-12-29 10:52:52 -0600 Report

I am so sorry you are having such a time with medicaid. I feel like that is par for the course with medicaid. Many folks have to jump through hoops just to get what they need.
Can you call the folks at medicaid and talk directly to them and find out why? Perhaps telling them what you have tried so far will help. It might be worth a try.
Also, I took Effexor a number of years ago, and I did not like the side effects. It made me sweat like crazy and also made my jaw quiver constantly. Thank goodness the jaw quiver wasn't noticable! I now take buproprion which is a generic form of Wellbutrin. Wal-Mart and other pharmacies often have medication programs that you can use even when you have other insurance.My local grocery store has a program I joined. I get my generic drugs for $4.99 for 30 day supply or $10.99 for 90 day supply. My dog is on my "family" list, and she gets her BP meds there as well!
Good luck,
Sal :)

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