Thursday, January 5, 2012

Costs Adding Up

Is it just my imagination or is Medicaid paying for fewer and fewer medicines these days? I know that each state administers Medicaid differently, but I have been surprised over the last 6 months or so at denial of medication payments. And these are meds that previously were paid for.

Because my children with the most significant special needs were adopted, they have automatically received Medicaid coverage. I have also added them to my work insurance policy, but it pays for very little. And, Ashley has reached her lifetime maximum under my work policy. So we rely very, very heavily on Medicaid to cover any medical expenses.

First it was one of Ashley’s medications, then another. Then this month alone, two of Ronnie’s which had previously been covered were denied. So far, the cost of those denied meds hasn’t been excessive if you look at them individually. But, when you start adding them all together, the budget takes quite a hit – a hit which will be repeated every single month.

I’m not sure if there is any sort of appeal process to get the medications covered again, but based on my past experience appealing another Medicaid-denied service, the process is difficult at best. And last night, well past 9pm, when I was at the pharmacy and the pharmacist was on the phone with the Medicaid office, there seems to be very little interest on my state’s part at even addressing this issue.

You know, this past summer, I worked really hard with Ashley to discontinue two of her medications. Perhaps that was a good thing considering this new lack of coverage. But, there are some meds, seizure meds for example, or life-sustaining kidney meds, that we just can’t discontinue.

One would think that between two insurance policies I could get medicines at least partially paid for, but that is not looking to be the case.

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