Question
I am 50 years old and have been on Soc. Sec. Disability since 1996. I receive Medicaid insurance though the SAGA program of the State of Connecticut. My problem is that I cannot find a doctor who will prescribe the medications I need (some are narcotics) who participate in the Medicaid/SAGA program. Further, physician who do not accept Medicaid/SAGA are prohibited by law from accepting payment if a person chooses to self-pay. Therefore, I have been seeing a physician who does not participate in these programs and simply not telling him that I am on Medicaid/SAGA and self-pay. The problem arises that if I
use Medicaid/SAGA to pay for my prescriptions, I belive they issue a report to the doctor several times a year, listing the medications he prescribed--at least the narcotics. At this point, he will find out my coverage and will drop me as a patient. Is it true that Medicaid/SAGA reports to physicians? If so, what do they report--all medications?; only narcotics?; tests and bloodwork? I am currently paying for the doctor and
the prescriptions, one of which is $400.00 per month. I simply can't afford continuing paying. My total prescriptions run about $900.00 per month. But, if there is no alternative and the
State does report to my doctor, I will have to continue to pay. Can you advise me on this issue?
Answer
Hi Nancy
This is too complicated to be done by e-mail. Also because the Medicaid regulations are different in every State, I am going to refer you to my counterpart in your State. Call 1-800-994-9422 and request to speak with a SHIP counselor. You will have reached the nearest office to you. They are Medicare and Medicaid trained counselors and will meet with you to help solve the problem you are having.
Go to Benefits.com, put in your information and it will screen about 400 programs that you might be eligible for.
Because of the disability rating, you should be eligible or have Medicare. With Medicaid, you would be a dual eligible and as such open for several options.
Check with the Social Security office and see if you are eligible for "extra help". If so. ask the SHIP counselor about LI NET, You should be getting your drugs for about $5 each.
In addition to that, ask about the Medicare Savings program. It will pay for the Medicare part B premium. If you have to do any plan changing, now would be the time to do so. The counselor can do a computer search and show you the best options.
Have a good Thanksgiving.
John
