My Misadventures With Medicaid Continue

Ever since I started this series of articles, I received a few comments from people. Most of them are from people that I know, like some family and close friends. I have also received comments from some people in the health care profession. A couple of my doctors told me their horror stories about dealing with certain Medicaid insurance companies, particularly about Buckeye.

With that in mind, I encourage anybody to contact me and share their experiences, both good and bad, through the Medicaid system. I welcome everything – questions, compliments, and insults (I can take them; I’m not afraid to). I would love to print them with my articles, with your kind permission, of course.  I can be reached at this e-mail address:

bryanjr0131@yahoo.com

Please, don’t be afraid to say what’s on your mind. I have learned one thing from my personal experiences. Sometimes, being silent and not doing anything can do more harm than good. I ask of you, the reader, to aid me in making Medicaid a better experience for other people by getting involved somehow. If you wish to be anonymous, I am more than willing to do that. I can understand.

PART 3: ENDURING PRIOR AUTHORIZATION

This is part of the Medicaid experience that I don’t fully understand. It also frustrates me at the same time. The most basic definition of “prior authorization” is that if you need anything from the insurance company, you have to get some kind of permission from someone or somebody to receive it. On one website, it is defined as “an extra step that some insurance companies require before they decide if they want to pay for your medicine.” (http://www.consumer-health.com/services/cons_take51.php). That definition is so true.

For example, and I have been through this experience, if one needs a particular medication that they know it works, instead of some kind of some cheap knock-off, you need to get prior authorization from either a primary care physician or the health insurance company to get it. From my own experience, it feels like bureaucratic red tape. It takes a long time to get it approved, and you have to fight hard to get it. 

It is because of that experience that I cannot get Nexium for my acid reflux problem. I have to take some other version of it, like Protonix. What did my insurance counselor tell me why, when I asked her about the alternative medicine? Nexium was too expensive, because they were paying for the name. Yeah, that makes sense!

This is what tees me off. It is the government that pays for the medication or service, not the insurance company.  Corporations, like Buckeye and CareSource, are nothing more than the middle man to get that prescription or certain benefits. As long as the government is willing to pay for that necessary need, the insurance should let that person have it, no questions asked. It also begs to question why we, meaning Medicaid recipients, really need to go through an insurance company in the first place. I will further investigate that situation in another article.

I have stated it before. When something does more harm than good, it should be done away with. Prior authorization is one of those things. When a person has a life-threatening condition (they need a medication or a diagnostic test), they should not have to endure some time-expended executive decision by a health care organization. That is something that corporate health care does, not a socialized system, like Medicaid.  That is wrong, inhumane, and disgusting.  These Medicaid providers should be ashamed of themselves for allowing prior authorization to exist in their system.

I challenge anybody who works at such a company to argue with me why prior authorization should exist. Please, explain the logic behind it to me and the people who are reading my articles. Why do we need prior authorization? How does it serve me, or somebody else, as a Medicaid recipient? What exactly does it do for the patient that needs an MRI or chemotherapy? I want to see someone who has the courage to answer these questions.