Socialized Medicine isn't so Social!

My family and I have always had the best of everything. I'm saying this to brag, I'm saying this to give you a brief background. We had what we needed, not extravegant items, but nice enough,  our cars were paid off, we had a nice house, clothes on our back, etc. But it came down to the fact that my husband was laid off and we were on COBRA Insurance http://www.dol.gov/dol/topic/health-plans/cobra.htm#.UOr6eqzheKw. This type of insurance only lasts for 18 months. If you're fortunate enough you'll have found a job by then that offers insurance and if not you're SOL or you have no other choice to sign you and your family up for Socialized medicine; otherwise known as Medicaid; http://medicaid.gov/. We weren't the fortunate ones and had to sign up for Medicaid/Socialized medicine.

One thing I found out fast about medicaid is that NOT all doctors are required to take Medicaid. The state(s) are trying to get all doctors to accept Medicaid, but that doesn't  mean they have to accept it.

When I was first on Medicaid and I went to see my neurologist, I presented my Medicaid card, I saw the look on the receptionist face. I explained to her that my husband had recently been laid off and we're no longer on BCBS/IL and we're now on Medicaid. She took the card back to the Insurance lady, they made a copy of it and that was it. My neurologist refused to see me after that. Based on the fact that my neurologist didn't take my new type of insurance he no longer would see appalled me. I needed a neurological team behind me due to my condition, yet he didn't even care to see if I could work out a payment plan with his office. I had been seeing this doctor for years. It wasn't like I was a new patient. I was hurt by this.

The rheumatologist I had been seeing moved to a new medical group so this was the first time I had been to his new building. I presented my Medicaid card to the receptionist and proceeded to tell me my rheumatologist didn't accept Medicaid. I asked if any other doctor within the group did and she replied,  "yes". I asked if she could accept it and bill it to Medicaid. I was told no. Once I got home I called Medicaid and was told by Medicaid the office in fact could have billed Medicaid under the medical group's name. 

During my next medical visit I relayed this information but was told I could either find another doctor or agree to pay out of pocket $100/per visit. Having chronic Lupus I had no choice to keep this doctor and pay $100 per visit. I didn't want to find another doctor since I already fired my previous doctor months earlier and had a great relationship with this doctor.

Then, August 1, 2012, the reality of it all hits with Medicaid! Medicaid puts a limit on how many prescriptions ONE person is allowed to have monthly! What this means is that if the patient has more than four monthly prescriptions, the patient has to get prior authorization from his/her physician to obtain more prescriptions then Medicaid will either approve or deny the "said" prescriptions.

I personally inquired within my states highest government chain of command and within Medicaid. I received an email back from the governors office and also received an email from the Director of Business Development Drug Information Group who is the Clinical Associate Professor in the Department of Pharmacy Practice /College of Pharmacy at the UIC; apparently she heads up the Pharmaceuticals for Medicaid because every email since this time has come from her. She explained the 4 monthly prescription limit as: 

"The purpose of the prescription limit program is to have physicians review maintenance medications and, where possible and clinically appropriate, reduce duplication and unnecessary medications.  There are exceptions to the limit for drugs for which a prescription limit isn't logical.  Examples are drugs such as antibiotics, which are typically not dispensed as maintenance medications, and products that require multiple prescriptions to be filled each month (insulin and insulin supplies). The program is being phased in gradually; the current limit is set at 9 prescriptions. The program is being phased in gradually; the current limit is set at 9 prescriptions."  

This email was dated October 23, 2012, so the limit of 9 is no longer in effect. 

There are currently 16 states that enacted this policy. http://www.thenewamerican.com/usnews/health-care/item/12274-states-enact-prescription-drug-limits-on-medicaid-patients

The good news is that my husband was able to find a job, it's with a temp agency but it's with a good company. The down fall is that the health insurance they offer costs the employee $1,300 a month! Who in the world can afford that? Medicaid does have a stipulation that if you do have a full-time job and if the health care is not affordable you are eligible for Medicaid. Thank goodness because just having Lupus (which I have multiple other autoimmune diseases) can run over $12K a year in health costs!