Beyond frustrated with State Medical

[amyrising]

A few months ago I lost my job. I have gone on state medical and all hell broke lose. Sure, I don't have to pay for anything...but they won't cover anything either. My PCP will not participate in the new healthcare "Obamacare". The new doctor they assigned me got her degree in the West Indies and is not board certified. I finally got to chose a Nurse Practitioner that I felt kinda comfortable with. They are denying ALL my prescriptions. They said they will not approve Ritalin for anyone over the age of 17. Thankfully I did get on a program for the Tecfidera so I don't go without that. The pharmacist told me that he is so frustrated with the whole insurance issue. He said everyone is having the same problems. My only option at this point is to pay cash...but I don't have a job so I don't have any cash!!

How are you all dealing with this? I'm going to end up with some serious withdrawls if I can't figure this out.

[22cyclist]

Amyrising: I am sorry you are having such difficulty navigating your state's system. Some states have set it up intentionally to make it harder for people to get access so people will dislike it. You have medicaid which is not Obamacare. Medicaid is state run program which is run by the state, not federal government. You can file an appeal through your state medicaid office.

I have BCBS through the ACA my costs are $0 because I have no job, and have not applied for disability yet. I have to wait 1 more year for my cognitive testing. Anyway, its great that you are on medicaid, it sucks that your state limits you to such few physicians. I would file a complaint. I am happy you got your MS meds. You might want to try having your neuro file a complaint that you need the ritalin to keep you more alert during the day, or you may want to try another drug for that. Have you neuro prescribe it.

Good luck to you. I sure hope things get better

Lisa

[laurasari]

I am shocked that the gave you a Dr not board certified. I am not surprised about the Ritilan cause even pay plans often deny that without a fight. My daughter just went on Medicaid though her GP is participating. They decided after 2 months her birth control pill is no longer on the acceptable list there are only 4 they will cover. ha I thought that was one of things Obamacare had to cover I wasn't aware only certain ones were. Acceptable Crazy but. She just started a new one 2 days ago though though Medicaid started Jan1 go figure I can't
Good luck Laurie

[Grace53a]

Hi amyrising & 22cyclist (Lisa),

Medicaid is jointly funded by both the Federal and State governments. The Federal Government pays the state for expenditures via the Federal Medical Assistance Percentage (FMAP). That being said, Lisa is correct that the program is administered by the individual state. Also, there are differences from state to state as to what services and medications are covered under the program.

Gracie

[its2much]

Generic Ritalin

is fairly inexpensive - have you priced that? Just trying to help. Also it might be cheaper to get a dosage higher and to cut the pills in half.

[amyrising]

Thanks guys. I am going to pay cash for what I can and my Neuro is going to fight with the insurance about it in the meantime. I guess I just don't handle the stress of change very well.

[amyrising]

I decided I should make an appointment with my new Nurse Practitioner and see if she could help push these prescriptions through. The one they assigned me works 1 day a month at the Urgent Care. They don't take appointments, it is a walk in.

So....I called another clinic who had doctors who were taking new patients. They said they would not even schedule an appointment until I provide them with all of my medical records. I asked did she want the last 5 years and records from the 10 different specialists I have seen. She said yes, because they need to look them over to see if I was someone they "even wanted to take on".

[onlyairfare]

Some states have requirements about necessary availability of participating practitioners (one day per month in urgent care is not really satisfactory for your PCP), and many health plans require board certification of any doctor who participates in the plan. Some states require 3 or more years of residency in order to be licensed to practice medicine, which is what is required for board certification in family medicine, internal medicine and pediatrics. You might want to check if you have any protection against the extreme limitations posed by your insurance. I am surprised that you might be required to see a non-board-certified physician.

You can also appeal any denials of prescription drug coverage. Many health plans do limit what drugs they cover, and have a narrow network of providers, in order to reduce costs. And some states pay so little for Medicaid doctors' services that many doctors decide not to participate.