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[IP] Re: Insurance Issue

When JayJay was first dx'd, a local pharmacy (local to Children's Hosp.)
graciously donated all the things that we would need to go home since
we were uninsured. They gave us a meter, strips, alcohol wipes, lancets,
insulin, and syringes. All in all, quite a few hundred dollars worth
of stuff. 

We then quickly applied for Medicaid for him and were approved. When
we went to a pharmacy near our home we were told that insulin was covered,
but not the syringes neccessary to use it, lancets were covered, but
not the strips. We were dumbfounded but had no choice at the time but
to pay for the stuff out of pocket. Our son had to have them. No if's,
and's, or but's.

I called the Medicaid office and the person I spoke with told me that
this was correct, no syringes or strips. The pharmacy manager also told
me that this was right.

Two months went by and we were slowly running up our credit card to pay
for these things, when I happened to run into a friend of my mother-in-law
out one day. Her sister works for Louisiana Medicaid. We got to talking
and she said that she would ask her sister about the whole thing.

She got back to me and said that the people I had been speaking to didn't
know their butts from a hole in the ground. Those items were covered
for diabetics who are insulin-dependant.

Back to the pharmacy I went. The same pharmacist who had initially filled
our prescriptions said that he knew that they were covered for those
who were IDDM's. I asked if he had conveniently forgotten that he also
filled a scrip for INSULIN that day. He said that he did recall giving
us insulin, but that it didn't say on the actual prescription itself
that JayJay was insulin dependant. Hello!?!?!?

Anyway, I got our CDE involved and she called both Medicaid and the pharmacy
and chewed them all out. In the end I was refunded all the money I had
spent on syringes an strips. Thank goodness.

I have since learned, several times over, that Medicaid (and any other
Insurer, I guess) really doesn't care about the patients that it covers.
If they can get away with denying it, and pretending to be ignorant about
it, they will. The pharmacy was the same. 

I have also had other problems with this same pharmacy. I will be changing
to a new one the next time I need a refill. The last major problem required
getting my local Congressman's office involved. 

First I was told that they pharmacy had run out of strips and I would
have to come back another day. As I was leaving, I saw boxes and boxes
of strips on the shelf and asked why I couldn't have some of those. THEN
I was told that I had exceeded my limit on that scrip. I asked what limit
that was. Annual? Monthly? Lifetime? I never been told about any limit.
After days and days of leaving messages at Medicaid and being ignored,
my mom decided it would be a good idea to call our local Congressman.
When Medicaid got a call from the Congressman, you better believe they
sat up and listened. I immediately got a phone call from the regional
manager asking "How can I help you today Mrs. Rogers?"

The message I'm trying get across? Don't take their crap and avoidance
tactics! They will try to get around you any way they can. Go STRAIGHT
to the top, do not pass go, do not collect $200. Don't listen to the
underlings. They are there just to put you off and talk you out of being
the squeaky wheel. If you get to the top and still have problems, go
even higher. Call your Congressman if you have to. S/he is there to serve
you. It was especially effective in my case since Medicaid is a government
type agency.


Mom to JayJay
born 2/13/98, dx'd 1/31/99
...sweet as ever

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