I was RXed Soma & Lidoderm patches about 6 weeks ago by my RD. I am on medicaid along with BC/BS. I tried to get the soma and lidoderm patches filled, but they need to be prior authorized theu medicaid before medicaid will pay the co-pay left over from BC/BS. I normally would not worry about if Medicaid paid the co-pay or not, but the co-pays on these are in the highest tier - . And I do not have 0 to pay for just 2 meds.
I had been trying to get RD's office to send in PA forms to medicaid and even my pharmacy faxed my RD's office informing them I need them to be PAed before they fill them.
So... here it is Remicade wearing off, no infusion any time soon. And I am hurting and need pain meds and muscle relaxers.
I find out today the Ultram ER RD just RXed me today... needs to be PAed and of course is in BC/BS meds tier.
So... tonight... I faxed my RD's office a letter explaining that I need PA's for those 3 meds, before I can get them filled. And explained how much pain I have at night while trying to go to sleep and how I will not be getting another Remicade infusion any time soon.
HOPEFULLY... that fax will get them to send the PAs in to medicaid and they can finally get filled. All I have is the 5 dose Ultram ER sample, my RD gave me today, for my pain. I have no other pain meds. Had Darvocet, but I only has a few of those left and was only taking half of them to help me sleep thru my pain.
The pain is just getting worse and the swelling is getting worse again. I miss the Remicade already.
Let's hope the fax I sent gets the ball rolling!
Getting authorizations can be a pain in the patootie, good luck!Hi Joonie, I can't believe your system over there!!! You have to go thru so much to try and get help, I wish you all the best for the weekend and really hope you can pick up your scripts. Hugs Janie.
Sorry you're having so much trouble with all that. It's obviously the medicaid that causes the delays. I have BCBS and don't have any problems with them at all. My doctor prescribed Humira on Monday and the pharmacy had already called the house before I got home to see when I wanted it delivered. I've been real lucky.
I use the lidoderm patches and really like them. Hope they help you too. Good Luck.
I know it is the Medicaid that is casuing the delay, but only because I have BC/BS along with the Medicaid. If I had just medicaid only, I would not have this trouble, because the doctors office would be on top of the PA's. But they see my Primary is BC/BS so they do not think I need PAs sent in.
I was just really hurting last night. My knees decided they were going to start the swell more business and then I guess that triggered the fibro, because there was even more pain and for some reason stiffness. It was the beginning of the beginning last night, and well... I did not really care to be in that kind of pain again.
Why is it you have both? The medicaid covers your co-pays and anything your insurance won't? I don't know much about Medicaid.
I have both because that is what you get when you are disabled, and low income and do not have enough work credits. I can drop BC/BS and just make it straight medicaid, but I do not want to do that. Even a worker at the SS Office told me I could do away with BC/BS and just make it straight Medicaid, but I do not feel like I should. I know hubby pays a lot more out of his check to keep the BC/BS we do have, but I just like having it.
Yep, Medicaid pays for co-pays, but I have co-pays with Medicaid just they are not as high as BC/BS co-pays, and they pay for anything my insurance will not cover.
I don't have enough credits to get disability either. My hubby makes to much money for medicaid but we pay out the wazoo to have insurance and then have tiered copays. My meds and ins. premiums are breaking us. Over 0 a month that's our copay. I am getting free enbrel for 6 months then have to pay for 6 more months but won't be able to afford the when the time comes. We have 4 more years to pay then our house will be paid off and that will be a huge relief!
Joonie: You qualify for medicaid while having coverage through BC/BS though you aren't even close to the age of sixty-five? In my state if you have insurance coverage you cannot receive medicaid.
The exception is if you are old enough to receive social security then you need to carry additional insurance to cover expenses not covered by govt. insurance.
watchingwolf2008-04-19 22:25:21Joonie: I see where your RD prescribed Ultram ER for you on 4/17/08. Were you having more health issues and had to go in? Take Care.
In Wisconsin, you can both as well. I have to requalify for my Medicaid every year because my husband is self employed. I also get SSDI because I had plenty of quarters in. There was about 6 months that I had my primary insurance and Medicaid paid any balances- my co-pay which is .00 a visit.
Joonie, aren't you in IL? Seems you are always having medical problems. You should move north. We have the best health care in the US I believe.
Wish I was as lucky with BCBS - My Humira and Leucovorin have to be mailed from a specialty pharmacy and they haven't done one shipment right. I always end up in tears without my medication begging them to ship it fast. Plus, my copay for Humira is 0, and the Leucovorin is in the 's....toss in everything else and it is killing us. We make too much for help, and yet it is draining our retirement.
As for Lidoderm patches, I liked them until I became allergic to the adhesive. I had massive itchy red bumps that took forever to go away..............wah.
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