update on thomas’ medications / medicaid

Okay so here’s the deal with Thomas’ medications.

This whole mess started when I went to pick up his Abilify and Citalopram from our local Kroger pharmacy at the first of the month.The lady at the counter told me the total was $700. I had a small panic attack and am glad I don’t have a heart condition! I took the Citalopram and came home and sat down to order his other medications from Transcript as is my monthly sop. We have the same csr every month, so if she doesn’t answer when I call, I just ask for her since she knows Thomas’ particular case. Then she tells me his Niphedipine currently has a copay of $60 and his Lipitor has a copay of $55. I had everything else shipped out – copay on one medication was $13 which I paid for out of my own pocket and not Thomas’; the rest have no copays.

So I managed to find out that because his three years was up, Thomas was dropped from Medicare. The charity or whomever it was who was paying for his Medicare coverage stopped paying. He had “Medicare Transplant” coverage. Somewhere somehow neither I nor Medicaid received this information. I had to start making multiple telephone calls – and if you know me, you know i loathe talking on the telephone; even more, I loathe initiating telephone calls. Social Security told me he wasn’t losing his Medicare coverage. The coverage he had was just switching over to a different type – from transplant disability to medical disability. I called Medicare. They told me that Thomas no longer had any Medicare coverage at all. I called Medicaid. They’re who told me about the charity or whomever it was. I called his local office Medicaid social worker to tell her about the Medicare issue. She told me to call Legal Aid (gave me the number and extension) to ask them to get me in touch with the proper prescription coverage help. I had no idea Legal Aid did this.

Now all this process took place over the last two weeks. I still need to call Legal Aid to see if they can find Thomas help with the Medicare. There’s no way he can afford the $150 a month fee, and I certainly can’t.

I went Wednesday of last week to talk to his therapist at CKBH about his Abilify issue. By then I’d found out that Medicaid would pay for it if I got a PA (physician’s prior approval). I went to CKBH to tell them to watch for the PA and to find out if I could pick up samples or whatever to do him through the wait and to dump Medicare off his record there. Robin is an angel. She did what she could that day. And Thomas’ therapist just happened to have one bottle of his prescription in her office. She called me this morning to let me know the PA went through and that the copay is $2.

I found out today that the PA for the Abilify went through and called Transcript back to see what we could do about the Niphedipine and the Lipitor. She dropped the Medicare from his account and ran those two prescriptions through Medicaid. I would have thought the Niphedipine, for blood pressure, would require a PA. No, the Lipitor does. The Niphedipine came through with a $1 copay and is on its way; it’ll be here via UPS Friday. Either she or someone on Thomas’ nephrology team call me back when the Lipitor PA goes through.

On Saturday, Thomas received a thick packet from Social Security. Disability review. Thomas had to sign one form. A records release. The rest is a twenty page review that I have to fill out – he wouldn’t know where to start and would be able to just get his name and address information (bear in mind it took him more than six months to learn his address after he moved in here). I’m almost finished. I just have to get the wording just right on how his transplant / medical disability has progressed over the last three years and then how his mental disability (which from what I’ve been able to gather isn’t documented with Social Security) has affected him over all this time and how it and his overall behavior has drastically degraded over the last six months. The wording on all of this is killing me. (Anybody have any thoughts? Any ideas welcome! Thanks in advance.)

I think that about sums everything up.

I want to go back to bed and have a very small, quiet breakdown now. I think I’ve earned it after all of this.

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Author: Mari Adkins

Appalachian gothic fiction writer - my works reflect a love of literature flavored by the darkness and magic residing in these ancient mountains. In my spare time, I'm a Simmer, I tumbl, I journal, but I always have a very strange sense of humor. I have lived away from the mountains and lived deep in the mountains. I currently live in Central Kentucky with my lifepartner and his cat. The mountains, their culture, their superstitions, their particular magics, will always be in my blood.