Today at my work I stumbled upon a payment rejection for glucose testing strips. The reason was, “Quantity exceeds number of days duration.” So it pretty much says that Medicaid won’t make payments because it’s too many test strips in a day.
Patient is 16 years old and type 1 diabetic. He will have to prick his fingers 7 to 8 times a day to make sure the glucose in his blood stays within normal range because his body cannot make insulin. He will have to do this for the rest of his life. He will be at much higher risk for kidney failure. Without proper testing he could possibly develop DKA in as little as 24 hours which can be fatal. For this situation and many other type 1 diabetics we dispense meds for everything looks right.
Then I make the call to Medicaid and tell them about the situation of being a type 1 diabetic and they already have that in their system at the state because that is the sole reason the family asks for assistance. Medicaid knows he’s a type 1 diabetic, but I still get the whole speel that they will only pay for 3 test strips daily.
Bullshit. Absolute bullshit. Why can’t we all accept the fact I keep repeating that he has a condition where he has to test like that. Again, I get the same response that a “PA” needs to be implemented for the “increase in duration” (never has been an increase by the way). We all got lucky when I called back in again and managed to get a different person on the phone and I mentioned that he had primary insurance coverage from his parent’s work that was taking all but 45 bucks off. She put an override in under that condition that Medicaid would not be paying for all of it.
I get so freaking frustrated of the fraud and abuse the Medicaid system goes through where it comes to the point where people who actually need the coverage such as a type 1 diabetic now cannot get any help. It is a chronic health condition that was not preventable. It is an autoimmune disorder. There is no cure. Then I see the people who seem to be on so many medications (even getting their dang vitamins covered by Medicaid) then all of a sudden when they get caught abusing the system, then they only seem to get the essential meds. Then I am also frustrated at the patient’s provider for not taking the steps to put what proper implementations are needed to get things covered. The mother had spoke to me that she pays 300 bucks a month in equipment for his insulin pump. Medicaid won’t touch it and there’s no reason that they shouldn’t.
So guess who is going to call the provider’s office tomorrow and making some stuff clear that they need to get their shit together for the sake of the patient and his mother.