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Post by Denise110 on Mar 12, 2004 10:49:29 GMT -5
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Post by jdmom on Mar 12, 2004 11:57:00 GMT -5
I had this problem when I first had Jarrett. I was getting my formula through WIC, and the doctor had prescribed him Lactose-free Enfamil and WIC didn't want to give it to me. They said it wasn't approved. The doctor wrote a letter to the director of the program and sent a copy of it to the state! Let me tell you, he ripped them to shreds! He told them how he had gone to school for 12 years and had been in practice for 30+. He told them that they were second-guessing his competence. He felt that the baby needed lactose-free and by God, they were going to pay for it! Guess what? They did. I'm sure it doesn't always work, but it would be worth a try to ask your doctor to send a letter to the director of your county or state's medicaid program asking them to approve it. You never know.
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Post by Dad2Brooke on Mar 12, 2004 17:05:32 GMT -5
jdmom, good suggestion. Until I read your post that was exactly what I was gonna suggest.
Denise110, I would ask their doc to write such a letter. Have him tell them all the different meds it has taken to get your children to the point where they are successful in school. And how they are successful finally, and now medicaid will no longer pay for a successful treatment. It my not help, but it certainly couldn't hurt.
"The squeeking wheel gets the grease."
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Post by Denise110 on Mar 15, 2004 13:52:36 GMT -5
Just wanted to give you an update.
Finally after 2 weeks of trying medicaid has approved thier medicine.
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Post by finnmom on Mar 15, 2004 14:09:54 GMT -5
Goncratulation´s Denise!! Great new´s!
Marja
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Post by shelli on Mar 15, 2004 17:17:33 GMT -5
we are getting ready to go on medicaid and Brenna takes Ritalin La. What do I have to do and how do I get it started? What info should be included in the letter?
Shelli
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Post by Jorgy on Mar 15, 2004 18:01:29 GMT -5
GREAT NEWS! Way to go! ;D
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Post by Honeysmom on Mar 16, 2004 1:50:23 GMT -5
That is awesome that they approved it. We are also on a form of Medicaid, called Badger Care. DH doesn't get insurance at work so we can buy it throught the state. I call them so much I should have them on speed dial.
Right now we are going through a big to-do b/c dd, only 2 1/2, has to have oral surgery. She has had problems with teeth since the day they came in. Being as young as she is, try getting a dentist to see her, let alone try and fill a cavity. So I called the dentists office back (3 hours from home b/c none of the dentists here take the insurance) and demand that they see her, I said, "I can see the cavities, and I am not a dentist!". It took them so long to work her in she has a cavity in EVERY tooth, except her front 2 on top and bottom. She needs to have 10 crowns put on! They are going to put her under for it.
To make matters worse, we are in a an HMO, and the dentist is 3 hours away, and of course, the hospital that is doing it is not a covered provider. I am turning into the red-tape queen. I think I just about have it, now only 4 more months on the waiting list for them to do the surgery. I wish she would have gotten DH's teeth....
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Post by jdmom on Mar 16, 2004 9:37:06 GMT -5
Shelli,
you don't have to write a letter. We were just recommending that because medicaid had denied some of her claims. To apply for medicaid, you just need to go to your local office (here we call it DHS) and pick up the application. You fill it out, tell them your life history (j/K), submit it and wait for a response. Here in Arkansas, we have a website for our medicaid program that tells you all about it and gives you specs and reqs. Your state may have something like that. If not, your local office should be able to give you a rundown and let you know before you fill out all the tedious paperwork, whether or not your family would be accepted. Every state's program is different, so that's really all the info that I can give you, but if you have any more questions, don't hesitate to ask!
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Post by Dad2Brooke on Mar 16, 2004 16:01:33 GMT -5
Just wanted to give you an update. Finally after 2 weeks of trying medicaid has approved thier medicine. Good job Denise110. Did it take much to make the cave? |
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Post by shelli on Mar 16, 2004 20:34:29 GMT -5
We have aleady been approved for medicaid and I just have not had to have her ritalin la refilled yet. Are they going to deny it ? Should I call the Doctors office to have them start prior approval before I need it, or do I have to wait until they deny it? Sorry I was not clear in my earlier post.  Shelli |
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Post by jdmom on Mar 17, 2004 13:21:19 GMT -5
You can just ask your pharmacy if medicaid will pay for the Ritalin LA. Your pharmacist should know. If they deny it, then you will have to go through the hoops of appealing the denial.
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Post by Denise110 on Mar 17, 2004 14:52:50 GMT -5
Sheli
Your doctor has to fill out the form to send to medicaid for preapproval for the med. They want to know medical history, diagnosis, and what meds have been tried for teatment.
My son has been on Ritilan LA for the past 3 months and they didn't have a problem paying for it. They just started these new rules of certain meds being preapproved. I think it's mainly the more costly ones.
I didn't have to have thier Focalin preapproved. They paid for it no problem
Just make sure you have your doc fill out the form in plenty of time before your dd meds run out. It might take awhile to get it approved.
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Post by Denise110 on Mar 17, 2004 14:59:19 GMT -5
Dad2Brooke, I think the problem was mostly the doctors office didn't put all the info they wanted on the form. I called medicaid after the first denial when my docs office couldn't give me any info why. They said they needed some certain info thats why it was denied. So I called the docs office and told them why it was denied and stayed on them. You know I wish sometimes I could bypass the doc and do the paper work myself. That way I know the job will get done right. And thanks everybody for your support   ;D ;D |
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Post by Dad2Brooke on Mar 17, 2004 16:07:35 GMT -5
Denise, unfortunately sometimes you have to stay on people to get the job done right. It's not their children, so they don't quite have the vested interest that the parent does.
Good thing for your children that they have you as a strong advocate. ;D
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