The GREAT news after getting on the horn today with the State Medicaid office is that the retroactive Medicaid cards I was supposed to have gotten, weren't screwed up and I wasn't accidentally applied for not retroactive. They must have gotten lost in the mail. Even better than the 90 days retroactive before my April 13th surgery on my right knee, is that it goes retroactive all the way to January first, which covers the home physical therapy and home rental of the knee machine rental from the FIRST, left knee, surgery, too! I hadn't thought that most of January would be covered! And, after the orientation last week, I had thought that, since I had only received a card for June, it sounded like I might only get the cards for the 90 days prior to JUNE, and not prior to my SURGERY date, and had resigned myself to only getting the last month of my previous surgery's physical therapy paid for, as well as the anesthesia from this surgery, which is the first bill that came through for it and maximized out our deductible . . .
I am also unsure of how to submit pharmacy expenses from earlier in the year, if I even can at all, which I probably can't. That was one thing I forgot to ask the benefits lady at the orientation, but I've got her number, so I can call and ask.
They're sending me new retroactive cards going back to the beginning of the year, but said I can use the number off of June to give to providers. It's a good thing that retroactive expenses do NOT need to be on the provider list with the plan I picked for June and going forward, because the plans they had did NOT have my orthopedic practice (knee, hip doctors), nor my physical therapy place, etc. For retroactive stuff they just pay it straight from the state, without going through a plan.
Anyway, now to the pharmaceutical stuff, which I was looking at today. There was NO NO NO mention in the orientation about something that happened a year ago, in our state legislature, but THAT's no surprise since they are working with printed books that are from 2008!!!! UGH UGH UGH UGH!!!! I mean, REALLY!!!
What happened in 2009, was this:
Preferred Drug List
During the 2007 legislative session, the Utah State Legislature passed Senate Bill 42 allowing Medicaid to adopt a preferred drug list (PDL). During the 2009 legislative session, the State Legislature approved SB 87, which authorizes Utah Medicaid to require a Prior Authorization for non-preferred drugs. The PA requirement became effective May 18, 2009.
Direct from the horse's mouth, as it were. After looking through the two lists, there's only ONE of my medications on the "Preferred" list, and that's generic omeprazole. My other meds are Vyvanse, Geodon (still ramping this up), Lorazepam, topirimate (generic Topamax), and, not prescribed yet by the new psychiatrist but part of an as needed basis prescribed by previous psychiatrists and listed to the new one, and not told to stop, taken as needed when I remember which I usually don't, alprazolam, the generic for Xanax. The Lorazepam is also as needed, which I've only needed it once for agitation in the two and a half weeks I've been on Geodon now, and I suspect that that situation would have aggravated me Geodon or no.
Anyway, so I'm not concerned/worried about the Xanax, since I forget about it most of the time. That leaves four medications for my psychiatrist to get approved by Medicaid. Now, she doesn't TAKE Medicaid so she probably won't be used to this; Medicaid is contracted with Davis Behavioral/Mental Health, in Davis County, where I live.
I wrote once or more about how I had, once upon a time, seen them in the mid-90's for counseling; in fact, the time I tried to kill myself, was the week my counselor went on vacation, although there were MANY other factors at the time as well; THAT, though, was one of them - Having my ear to talk to taken away from me, when I was in the middle of so much . . . but that was a difficult time, when I understood so much LESS . . . I wrote, once or more, about how I had used their services, and then, several years later, tried to turn to Davis Mental Health again, and was told something like, unless you are funded from a certain source (I assumed, Medicaid or Medicare), we can't see you . . . funding cuts . . . They had previously seen me on a sliding scale, but couldn't see me at full price even, at this subsequent time. I then left, disbelieving, that society didn't even care if its citizens had any kind of mental health services . . . .
I eventually related that story, with assurances that I was now currently in treatment with a psychologist and psychiatrist, to my state's then-governor, Jon Huntsman, over the radio, KSL 1160, on a radio call-in show with Doug Wright as the host. I brought the issue of mental health issues and funding up, since it was the fact that the state hadn't picked up the slack in funding brought about by the federal dropping 7 mil in funding; the state had only picked up $2 million of it, and needed to pick up MORE of it, because people like ME had fallen through the cracks, like the story I just illustrated. The responded kindly and nicely and seemed to understand my point. Let me tell you, I was scared to DEATH, lol!
Anyway, back to the stupid Medicaid drug approval process. This is ASININE that it wasn't a part of last week's orientation!!! And then, to have 4 out of 5 medications not on the list? Heck, there wasn't even a category for anti-psychotics, or for mood stabilizers, or for antidepressants, or for ANY kind of mental health medication!!! Probably because of the cost, and probably why they want them approved . . . . stupid bunch of red TAPE!!!
Even though my insurance doesn't run out until the end of July, I'm going to ask her at the early July appt. to work on it; I'll have to print out copies of the form at the library, as our printer recently died. I hope she doesn't say, YOU do it. SHE has to, if you click through at that page and read the form . . . she's supposed to include a copy in my chart, for audit purposes, too. Not that she takes Medicaid, but since I'll be getting the medications using the Medicaid benefit after July, she'd better fill out the forms, I mean, what choice does she have?
I am not sure how I'll pay her after the insurance goes . . . like I say, Medicaid is contracted through Davis, but I'm a little leery, because what if we suddenly don't qualify, like if my husband gets really lucky with the job search on the pay rate? Yeah, one can wish, but maybe the Lord will bless us. What if that happens, and then I'd have to drop THAT psychiatrist, too? So that's why I'm leery, for one reason, to switch, even though I haven't been THAT happy with this new psychiatrist. Plus, we're currently trying a new medication, and I hate to switch in the middle of a trial.
I REALLY hate red tape, though. I do feel for the extra time an already burdened w/paperwork doctor must feel, BUT . . . I don't have a choice, here. Medicaid ain't much fun for the patient, either, people. I feel like a show dog being led around by the nose - go here, do that, get this treat that tastes like crap, go do that, jump through this hoop . . . . yada yada, etc.
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