Fw: pharmacy billing 2 insurers

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

From: Sherri Schneider <benefithelpss@...>

Pamela Caldwell <psc1106@...>

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 <psc1106@...>

benefithelpss@...

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