Today I called Daughter's medicaid plan about the ongoing problems with needles for her insulin pens. The woman told me (again) the pharmacy was billing it wrong, and weren't billing my insurance first. I had the denial in front of me, and informed them that the pharmacy was billing my insurance company first. Then she tried to tell me I needed to change pharmacies because this one didn't know how to bill. I informed her they were handling all of Daughter's other prescriptions without a problem. Then she told me that they needed to call in. I explained they had called in, and was told they weren't covered. Finally she put me on hold to make some calls.
I finally got an answer. It seems that they don't want to pay for pen needles unless they are billed with the insulin pens. I explained to her that there are 5 insulin pens in a box, which lasts for a couple of months. She goes through a box of needles in a month's time. That doesn't make any difference. I told her it was a waste to stockpile pens we weren't going to use so they'd pay for the needles. They put in an override to pay for the needles this month. I picked them up this evening, and they had removed the $20 co-pay from my insurance company.
I find myself asking if all the trips to the pharmacy and all the phone calls weren't worth more than the $20 I saved. More importantly, though, I wonder what happens to people who don't have a strong advocate, or someone who will pay for the prescription rather than go with out while fighting for payment. It's no wonder people stop taking their medication. I think it would be much more cost effective to pay for the medication than to pay for the hospitalization. But then, I'm not an insurance company.