Perscriptions and insurance. Pharmacy problem...

[D L and K's Mom]

Long story
DH went to get DS perscription at pharmacy...I will not give name but it is not RITE to do this to people. I thought they were there to AIDE people . Perscription is supposed to be for 2 tablets once a day. They gave us 30? That is enough for 15 days. I call to make sure DR didnt write it wrong. I am told that my son's insurance will not cover the whole perscription. Ummm it did last month. I am told it changed in 2009. Ok so whom do I call, Dr. or insurance She tells me insurance. I ask which one denied it. She says there is only one Medicaid. I say no, there are 2 Blue Choice and Medicaid. I am told again no, only one. I tell her I was there last month and we had a problem...blah blah..I had to pay because other med was not covered. I ended up paying $35 just the copay. She says she has nothing. I ask her to check my DH account to see his number. Yup its there but nothing under DS. Ok can I please talk to pharamcist. He gets on the phone...blah blah...no number listed. Are you crazy we have been getting perscriptions for years and years. He asks again for DS info and then looks again. Oh there it is he tells me. Um no that is DH's soc security number. I have a card in my hand with DS name and number and it has a 2004 date. I tell him the number and he changes it in the computer. Then he tells me I never gave them the new one. I again say they billed DS perscription to it in Nov/Dec. He has no idea how that happened. I am done. I just say ok and hang up. I then call another branch of the RIGHT pharmacy hoping they can AIDE me. The man there looks up DS account and says the new number is listed with todays date. That they did have a different number but he cant access it because once a new number is in the system it wipes out the old but there is a key saying new number or changed number. I ask if someones account has been being billed for my sons persciptions. He does not see how that could happen.He then goes on to say BC has never been billed for perscriptions!!! There is only a record of one perscription being billed to BC They have all been billed to Medicaid. This is not right I say and he says, yup it is not right at all. I ask if this is something I can get in trouble for. He says that probably since it is on the reciepts and since I never corrected it It could be fraud. Well, I have to admit I never look at them. I dont pay a copay so I dont read them. Now what??? Do I call Medicaid and tell them? Do I just wait for next time and check and then go down if its wrong? Do I call BC?? Anyone????

 

[edwardsfire]

One thing i do and my Physician is this:
He writes the prescription for as many "pills" as you can for the daily dose..
Then he tells me how many to actually take.
This way, my monthly prescription lasts up to 3 months.
I.e, i take Prilosec (1) time per day.
On my RX though it tell me to take 3 per day.
Therfor, i get a 90 day supply for the 20.00 copay.
It is done alot but you need to let your Doc. know.
Remember, take what the Doc. tells you to take, not whats on the bottle.
We do this for antibiotics for our kids also, that way you have a full round next time the kids get sick. But only pay 1 copay. Again, your doc. will know exactly what to do.

 

[CathrynRose]

You have Medicaid and Blue Cross/Blue Shield?

 

[ClarabelleCowFan]

You have Medicaid and Blue Cross/Blue Shield?

Most likely a supplemental policy. My parents are on Medicare or Medicaid (the one for Senior Citizens) and also pay out of pocket for an extra policy from BC/BS that covers whatever the other doesn't. You can also purchase just a Prescription plan that covers your medications.

OP - switch to CVS.

 

[merekc]

Customer service can be lacking at the big chains. They are swamped. Consider using a local pharmacy where they have the time to provide better customer service.

But on top of that first of the year, lots of things happen because insurance companies suck.

Beyond that maybe someone here can tell you if it can be returned and reran through insurance correctly? I'd personally take the hopefully unused perscription back to the pharmacy with insurance card and try to deal with it one on one. Again, they are swamped and prioritizing their time to the customers instore.

 

[CathrynRose]

Most likely a supplemental policy. My parents are on Medicare or Medicaid (the one for Senior Citizens) and also pay out of pocket for an extra policy from BC/BS that covers whatever the other doesn't. You can also purchase just a Prescription plan that covers your medications.

OP - switch to CVS.

I thought Medicaid was the Public Assistance one?

ETA - I looked it up, it is: What is Medicaid?

Medicaid is a jointly funded, Federal-State health insurance program for low-income and needy people. It covers children, the aged, blind, and/or disabled and other people who are eligible to receive federally assisted income maintenance payments.


I dont think Medicaid pays if you have a separate insurance, do they? Maybe thats why you had the problems?

 

[mickeymedic]

I think the OP has Blue Choice Option. In NY, Medicaid subcontracts (for lack of a better term) some of their patients to Blue Cross and Preferred Care. I'm not sure all the ins and outs of this, but I'm pretty sure this is what the OP is facing. I can see why she's a bit confused as to who to contact at this point.

 

[bigbabyblues]

I thought Medicaid was the Public Assistance one?

ETA - I looked it up, it is: What is Medicaid?

Medicaid is a jointly funded, Federal-State health insurance program for low-income and needy people. It covers children, the aged, blind, and/or disabled and other people who are eligible to receive federally assisted income maintenance payments.


I dont think Medicaid pays if you have a separate insurance, do they? Maybe thats why you had the problems?

I bill insurance for a hospital, and here at least, a lot of people have medical insurance with medicaid second (or third). I'm sure it varies depending on medical conditions, disabilities, etc.

 

[friendofgusgus]

If you have a primary insurance such as BC/BS or even an HMO, Medicaid is available for those who qualify to be used as a "secondary" insurance.

It covers co-pays, deductibles and other items not covered by the primary (private) insurer. In some states that includes dental services and eyeglasses, but those inclusions are set by each state.

OP, there is no intent to defraud Medicaid on your part and Medicaid paid, so I wouldn't lose sleep over the prescriptions that have already been filled. If Medicaid paid them, they didn't have a problem with it and it was the pharmacy that submitted them that way. If Medicaid had been unwilling to pay before BC/BC, they would have rejected the pharmacy's bill immediately. Really, don't worry about what's already happened

All pharmacies can have days where stuff like this happens, so I wouldn't think too badly of that particular chain. It is always worst right after the first of the year when deductibles reset and policies change.

I would take your business to another pharmacy but don't be discouraged if they are not much better. Pharmacies now are required to fill an immense number of prescriptions daily to stay in business (they lose money on many of them) so it's not unusual to have billing/insurance issues.

Your best bet is to find a local pharmacy if there's still one near you where they will get to know your family and your insurance situation.

For the prescription you have, you need to talk to Medicaid if they did not pick up the co-pay. In the future, do not pick up a prescription until you figure out the insurance - otherwise, you are on the hook for the bill.

 

[chell]

Get printed out receipts from the pharmacy with as much detail as you can have. I would get this from the one where you got the prescriptions filled.

Is there an advocate at the local Medicaid office you can go to? If so, I would make an appointment with them first and start there. They can walk you through whatever you need to do. They may need to do an audit of this pharmacy because they may not be handling the insurance correctly.

I would look for another pharmacy as well.

 

[Jsme]

We used CVS for years because they were the only pharmacy in our area without having to drive 15 minutes. Call it lazy but when you have small children it was easier to have the dr call it in and pick it up close by. Or drop off the prescription and let Dh pick up on the way home. They always had issues with the wait time and never having the medications.

Anyway then a Eckerds/RiteAide opens. They are not much better than CVS. Never have the medication and have to order it and wait.

Finally a family owned pharmacy opened. It is so wonderful. They are friendly. They have medications in. Prices are the same and I am happy. Plus I am helping a wonderful small business owner.

 

[daughtersrus]

One thing i do and my Physician is this:
He writes the prescription for as many "pills" as you can for the daily dose..
Then he tells me how many to actually take.
This way, my monthly prescription lasts up to 3 months.
I.e, i take Prilosec (1) time per day.
On my RX though it tell me to take 3 per day.
Therfor, i get a 90 day supply for the 20.00 copay.
It is done alot but you need to let your Doc. know.
Remember, take what the Doc. tells you to take, not whats on the bottle.
We do this for antibiotics for our kids also, that way you have a full round next time the kids get sick. But only pay 1 copay. Again, your doc. will know exactly what to do.

Is this legal? I thought that it was insurance fraud for a doctor to prescribe a medication or treatment that is not needed. Isn't that what the doctor is doing by prescribing a higher dose than what is needed so that the patient can have extras?

 

[Abbie]

Is this legal? I thought that it was insurance fraud for a doctor to prescribe a medication or treatment that is not needed. Isn't that what the doctor is doing by prescribing a higher dose than what is needed so that the patient can have extras?

It's probably legal but it's not good medicine. And if a medicine is labeled to have more taken than recommended, insurance will deny it anyway.

I can't begin to imagine having the label say one thing and hope your patients "remember" the correct dose! What a lawsuit waiting to happen.

 

[mum4jenn]

Long story
DH went to get DS pre scription at pharmacy...I will not give name but it is not RITE to do this to people. I thought they were there to AIDE people .
Pre scription is supposed to be for 2 tablets once a day. They gave us 30? That is enough for 15 days. I call to make sure DR didnt write it wrong. I am told that my son's insurance will not cover the whole prescription.

Ummm it did last month. I am told it changed in 2009. Ok so whom do I call, Dr. or insurance She tells me insurance. I ask which one denied it. She says there is only one Medicaid. I say no, there are 2 Blue Choice and Medicaid. I am told again no, only one.

I tell her I was there last month and we had a problem...blah blah..I had to pay because other med was not covered. I ended up paying $35 just the copay. She says she has nothing. I ask her to check my DH account to see his number. Yup its there but nothing under DS. Ok can I please talk to pharamcist. He gets on the phone...blah blah...no number listed.

Are you crazy we have been getting prescriptions for years and years. He asks again for DS info and then looks again. Oh there it is he tells me. Um no that is DH's soc security number.

I have a card in my hand with DS name and number and it has a 2004 date. I tell him the number and he changes it in the computer. Then he tells me I never gave them the new one. I again say they billed DS prescription to it in Nov/Dec. He has no idea how that happened.

I am done. I just say ok and hang up. I then call another branch of the RIGHT pharmacy hoping they can AIDE me. The man there looks up DS account and says the new number is listed with todays date. That they did have a different number but he cant access it because once a new number is in the system it wipes out the old but there is a key saying new number or changed number.

I ask if someones account has been being billed for my sons presciptions. He does not see how that could happen.He then goes on to say BC has never been billed for prescriptions!!! There is only a record of one prescription being billed to BC They have all been billed to Medicaid.

This is not right I say and he says, yup it is not right at all. I ask if this is something I can get in trouble for. He says that probably since it is on the reciepts and since I never corrected it It could be fraud. Well, I have to admit I never look at them. I dont pay a copay so I dont read them.

Now what??? Do I call Medicaid and tell them? Do I just wait for next time and check and then go down if its wrong? Do I call BC?? Anyone????

Hope this helps!!

 

[cruisnfamily]

It's probably legal but it's not good medicine. And if a medicine is labeled to have more taken than recommended, insurance will deny it anyway.

I can't begin to imagine having the label say one thing and hope your patients "remember" the correct dose! What a lawsuit waiting to happen.

I agree completely! Especially with the part I bolded....I would never do this to save a buck, I'd rather have the correct instructions on the bottle!

 

[CPT Tripss]

One thing i do and my Physician is this:
He writes the prescription for as many "pills" as you can for the daily dose..
Then he tells me how many to actually take.
This way, my monthly prescription lasts up to 3 months.
I.e, i take Prilosec (1) time per day.
On my RX though it tell me to take 3 per day.
Therfor, i get a 90 day supply for the 20.00 copay.
It is done alot but you need to let your Doc. know.
Remember, take what the Doc. tells you to take, not whats on the bottle.
We do this for antibiotics for our kids also, that way you have a full round next time the kids get sick. But only pay 1 copay. Again, your doc. will know exactly what to do.

Over on another thread, (http://disboards.com/showthread.php?t=2054944&page=3) you say:

"1. End welfare
2. End medicaid...and Hud housing. (mediCARE is not welfare)
3. End Food Stamps
Then maybe some folks would get off the duffs and actually provide for themselves.
Alot of folks like to be on the wagon, few seem to be pulling it."

Over here, you seem to think it's OK to game the system and cheat the insurance company for your benefit. Sure seems like a big contradiction in ethical standards to me.

 

[Mish19]

I've had a problem with that pharmacy before. The pharmacist pretty much has told me I'm lying when I say there is a prescription for me (they called me to pick it up!) I called the med by it's pharmaceutical name (which a pharmacist should know!) and he found it under the retail brand name. How about finding it under patient name?

 

[allison443]

I can't begin to imagine having the label say one thing and hope your patients "remember" the correct dose! What a lawsuit waiting to happen.

I agree! That could quite easily be construed as malpractice

 

[edwardsfire]

Is this legal? I thought that it was insurance fraud for a doctor to prescribe a medication or treatment that is not needed. Isn't that what the doctor is doing by prescribing a higher dose than what is needed so that the patient can have extras?

No, actually it is common. The dose IS a legal dose, im not taken that much though.
Its a common loophole.

 

[edwardsfire]

Over on another thread, (http://disboards.com/showthread.php?t=2054944&page=3) you say:

"1. End welfare
2. End medicaid...and Hud housing. (mediCARE is not welfare)
3. End Food Stamps
Then maybe some folks would get off the duffs and actually provide for themselves.
Alot of folks like to be on the wagon, few seem to be pulling it."

Over here, you seem to think it's OK to game the system and cheat the insurance company for your benefit. Sure seems like a big contradiction in ethical standards to me.

Ask a pharmaceutical salers rep. It is not unethical. It IS a loophole that is left there for a reason, and that reason is for a physician to use his/her descretion as to what is best for the pt.
It takes the red tape out of the pt. doctor relationship.
It IS NOT unethical, it is a way for pt's to overcome an insurance companies rule that was put in place not looking out for the pt.