Re: Fw: pharmacy billing 2 insurers

[Guest guest]

Sherri,

This is getting more confusing with each post. Pam just described the EXACT

situation that I find at my local Walgreens – they DO NOT bill the private

commercial insurance first (which I think is what you’re saying they are

supposed to do) and then the Medicaid; instead, to try getting the

cheapest meds, they try Medicaid first, if Medicaid pays, that’s all they do.

If Medicaid refuses the charge (not a generic, a non-approved formulary or

dose), then they put the charges thru to BCBS, who pays it, and incurs a

co-pay.

With our pharmacy it’s bill one or the other, not both, and they always try

Medicaid first. But if Medicaid is payor of last resort, shouldn’t the

pharmacies ALWAYS be billing the commercial carrier first, and then Medicaid as

a secondary if there are co-pays?

What Pam is saying her CVS pharmacy does sounds identical to mine – unless

I’m missing something. Trying to understand here. Especially if the state

Medicaid folks have to use precious tax dollars to go back & fight for

reimbursement from private insurance carriers who should have been paying for

the meds all along...that doesn’t seem to make sense!

L.

From: Sherri Schneider

Sent: Thursday, August 18, 2011 11:41 AM

IPADDUnite

Subject: Fw: pharmacy billing 2 insurers

----- Forwarded Message -----

From: Sherri Schneider <mailto:benefithelpss%40>

Pamela Caldwell <mailto:psc1106%40sbcglobal.net>

Sent: Thursday, August 18, 2011 11:38 AM

Subject: Re: pharmacy billing 2 insurers

You are correct.

By definition, Medicaid is ALWAYS the last to pay. Hospitals, doctors,

pharmacies, who are enrolled providers with IL Medicaid, are supposed to bill

the commercial insurance first and then bill Medicaid. What we are finding is

that the hospitals and the doctors are doing this but that the pharmacies are

only billing the commercial insurance - and not Medicaid - leaving us with the

higher co-pay. These are the pharmacies that I need to know about so the

Medicaid does not think that I am creating a problem that does not exist.

Thank you.

From: Pamela Caldwell <mailto:psc1106%40sbcglobal.net>

mailto:benefithelpss%40

Sent: Tuesday, August 16, 2011 4:12 PM

Subject: pharmacy billing 2 insurers

Sherri-

I saw your post on IPADD and am not sure I understand your question. (I have

two adult sons with disabilities who have both private insurance and Medicaid.)

Our local CVS pharmacy usually bills Medicaid first, since they have lower

copays, but bills our private insurance if Medicaid doesn't cover a certain

drug. So I think they are NOT an example of what you are looking for. Do some

pharmacies refuse to bill private insurance if medicaid doesn't cover a drug?

Let me know if you need more info from me, but I don't think we have the

insurance problem you are looking for.

Pam Caldwell