Medicaid has denied ritalin. They have tried 2 different diagnosis codes. We can continue paying cash for it. I am applying for a hearing with medicaid to try and get them to approve it.
I asked the person that called from the Dr.'s office if other kids get ritalin covered and they said, well it just depends on what their insurance is. No duh! I meant through medicaid. The girl didn't know. She was non-helpful overall.
I asked the person that called from the Dr.'s office if there were other medications that would have the same effect that we could substitute, they said no.
3 comments:
IDK if this helps but from the Dr. end Molina and Healthy u are the two worst types of Medicaid as far as requiring pre-auth for different things. We have a lot harder time getting things approved with them and it requires a lot more time and paperwork. Traditional medicaid and the new Select health medicaid doesn't make us jump through as many hoops. Is there a possibility to switch types if another one covers it. Also have you checked the cash price at Costco? You don't have to be a member to use the Pharmacy. We have crap insurance and have found that it is cheaper to pay cash at Costco than to use our insurance elsewhere.
Other thoughts...
Will it cover the generic version?
Have you contacted Novartis (the co. That makes it) to see if they have any patient assistance available?
Taking any trips to Mexico soon? It's OTC there. (Kidding) Although I can't tell you the amt of pts I had in Texas that hopped the border for meds. Sad but true.
Chantel---
We were able to run it through our other insurance and get it for $15 per month instead of $45 with no insurance. So that helps. We cannot use traditional medicaid. We can use select health...however through Jason's private insurance you have to choose to go through U of U hospitals (ie:Ogden Regional) or through IHC facilities. The U of U plan is A LOT cheaper so we go with that plan. That is why we choose to have Healthy U...so that they correspond with each other. If we switched the private insurance to the IHC version, then we would also switch the Medicaid to the IHC version...but it is not worth the expense to us. We used to do the IHC version of both...and it was a lot better...but it ended up costing us a lot more. I am still going to file an appeal...but even if we lose...$15 a month is not terrible. But free is better.
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