Fuck! Medicaid will not pay for my mom's $3000 meds

[EndersDame]

She is supposed to get some kind of injections for her bones . Everytime she trips she seems to break something and has to go to the ER and then physical therapy it seems to me it would be more cost effective to pay for the meds to strengthen her bones. Jesus fuck what I am I supposed do

[Hawkeye-X]

1. Appeal the decision

tell medicaid it is medically necessary.

Ask them what OTHER alternatives do they have besides heading to ER every time your mom is hurt?

[GreenPartyVoter]

7. Yes, appeal and get her doc to sign off on this. I often have to apply twice for meds through

the medicaid system, but having my docs back me up really helps. He or she usually just has to sign a form or something stating that I really do need the meds.

[nc4bo]

10. I really think good results would come from speaking to the doc about this

Might have to "insist" a wee bit harder with Medicaid than with Medicare but the oral medication does have some side effects that some patients can't tolerate.

My mom's doc told us this was one of the main reasons why the injection was created.

Hopefully the OP will have success.

[LeftyMom]

21. I've had to do this through private insurance.

I needed a medication that wasn't on their formulary. It wasn't terribly expensive in this case, but there were cheaper alternatives that work fine for most people, so it wasn't normally covered. None of the cheaper alternatives, for various reasons that don't really matter to this post, would work for me. So my nurse practitioner had to jump through a few hoops to get me approved, none of which tood any real effort on my part luckily.

If it's a drug with a cheaper alternative, probably the doctor just has to explain why the cheaper alternative isn't suitable in this case.

[PDJane]

2. My mother has had very, very good results

With Fossavance and Calcia three times per day...that's calcium and vitamin D, extra strength, and it has worked.

The injection works quite well, but our health care system won't pay for it unless the other solutions don't work.

[dugaresa]

34. coupled with strength training with a good PT/Trainer

and those same meds, my mother in law built back her bone mass and no longer needs the meds. I was reluctant to believe her but the combo of the meds and the PT made a huge difference.

[Justitia]

3. Also, contact the drug manufacturers directly (check their websites).

They may have links like "do you need help paying for your meds?"

Also, try this link: www.pparx.org

Check in with her pharmacist, let them know you are having problems, they may know of some way to get help.

I did all these things when my uninsured son needed chemo drugs.

If your mom is a senior, I suggest also contacting your county "elder services" dept.

If your mom suffers from a specific condition, (i.e., osteoporosis) try googling national advocacy organizations for those conditions.

All the best to both of you.

[EndersDame]

12. thank you so much for the info

[nc4bo]

4. Yearly osteoporosis injection? My mom's doc

said that her Medicare should take care of it as long as it's proven she can't sit up for certain period of time, is having bad stomach problems or if she's experiencing some adverse side effects (bone and muscle pain, etc.) from the monthly oral med.

Is your mom experiencing any of these problems?

[alfredo]

5. The Donut hole?

[rwheeler31]

6. Can someone stay with her?

[EndersDame]

11. I have moved back in

[bobbolink]

8. First, this is unspeakably terrible, and more so given this is the richest country in the world!

Obviously you're worried and she must be in pain and fear.

Second, this is part of the reason why people have concerns about a single payer system. There are problems with Medicare, although people are usually quite happy with it.

Medicaid is riddled with problems like this, and that doesn't do much to quell peoples' fears about a single payer system.

This needs to be fought.

I hope you are harassing your congresscritters offices!

[EndersDame]

18. I hadn't even thought about talking to them thanks for the idea

[mudplanet]

9. Medicaid is a state administered program so it might help if

you post which state you are in. Appeal sounds like the right path.

Get ready for this - Medicaid is usually much more comprehensive than Medicare.

Until you get this straightened out your mom should be in a wheel chair or motorized cart. It's a lot to swallow, but getting her to use the wheel chair will minimize the chances of a broken hip or wrist. Explain that the most important thing is to remain mobile enough to use the bathroom independently, and if she breaks her hip she'll be using a bed pan.

[inna]

13. Universal Health Care for All Americans, anything else is a distraction.

UHC, NOW!!!! it's OURS, if we DEMAND IT. it's as simple as that. wake up, people.

[EndersDame]

16. I think this country just thinks of the poor as less than human

a

[timeforpeace]

14. Sort of the entire problem of paying for everyone's health care in a microcosm isn't it? Multiply

that times 330 million.

[EndersDame]

15. I would think that the amount would be cheaper than multiple ER trips + physical therapy

Do you suggest just letting the poor live life with broken limbs and hips?

I think it wouldn't hurt to divert just a little bit from the military budget into healthcare

[physioex]

17. Interesting....

The money seems to always be there to bail out Wall Streets and conducts acts of agression but mysteriously disappears when it comes to healthcare.

[marew]

19. Amen!

What a disgrace.

[HillbillyBob]

27. My other post was supposed to be a suggestion to appeal

to medicaid. The catholic charities may be able to help too.
I was diagnosed with hiv in 1985..I have been going through some of the same sh-- especially in the beginning. I had to be indigent, homeless, out of work, no car, no job for 2 years and land in ICU before I could get health care help. I would not have been disabled so early in the game if I had not had to come down with pneumonia and Cytomegalovirus solid organ that shut down my liver, kidneys, pancreas...Im doing ok because the dr that took care of me at that time threw away a lot of the bills, and raise hell with social security, medicare and medicaid as only an Irishman can.

I have been advocating health care and health education for all since then.
You should not have to be bankrupt and almost dead.
I m so sick of the assholes that call themselves Christian, but scream when social ills are addressed and it might cost them something
The only words that I think describe compassionate conservative christian are lying selfish hypocrite.

I hope you can get help for your mom soon.

[grasswire]

20. congressman

They can pull levers.

[Freddie Stubbs]

31. Medicaid is administered by each individual state, not the federal government

A state rep or senator would be more useful.

[grasswire]

33. doesn't matter

People often go to their U.S. Congressperson in matters of benefits for disabilities and health coverage. I've seen the leverage in my extended family.

[nosmokes]

22. You might try Canada. If they have the drug you need you can have it in hand

in about ten days. but your doc has to write out the scrip very specifically according to number of pills and dosage to fit pre-packaged specs.

[lawrencefox]

23. Take her off hartburn medicine about 10 years ago

not a doctor however I bet she was on some sort of acid reflux medicine and it made her body's bones.............. very brittle.

[Juche]

24. Forteo?

Contact Eli Lilly and see if they will offer it to her cheaply.

[rebel with a cause]

25. Is this possible Zemeta?

I get it to strengthen my bones and to hopefully stop my cancer from going into bone cancer. But it is not an injection but given intravenously.

Medicaid pays for this for me and I take it that your mom would be getting disability also. So I would speak to your doctor and case worker about it.

Medicaid is state ran, covers more things than Medicare but often it is hard to get some doctors, etc to accept it when the state gets really behind in their payments. Illinois was way behind at one point, but I am hoping that they have gotten better about it now.

[EndersDame]

32. I will have to ask her

[HillbillyBob]

26. Have you checked with your states Medicaid?

I have medicare, medicaid and ADAP (which I think is hiv specific)
Since I have never lived in Tx I have no clue what maybe available.

[1776Forever]

28. Have you spoken with her Senator/Congressperson office? They should be able to look into it also.

Some of the offices I admit are better then others but anything you can do might help. Also a lot of the pharmaceutical companies have programs now that will help out those that cannot afford their meds. Check it out, I know my son who has Progressive MS got his meds free for awhile when he didn't have any insurance.

Good luck!

[EndersDame]

30. Thanks for the info

[WVRICK13]

29. My Mother Had The Same Issue

You need to ask the doctor to get the injections pre-approved. The doctor needs to tell them they are medically necessary. Until that happens they treat them as a luxury. I know it sucks but the solution is in the approach. Good luck to you and your mother.

[rebel with a cause]

35. My daughter had this problem with her insurance.

She got a prescribed treatment and the insurance would not pay because they said it was cosmetic. The doctor's office had to send them papers showing that it was a necessary treatment and not an elected one.