My 16 month old son was taken by his dad today to urgent care and was diagnosed with a double ear infection. They sent a prescription over to CVS for his medication. When my husband went to CVS they denied giving him the medication because the system still showed that we had Medicaid, even though that insurance ended several months ago and we have new insurance, the information for which they have. Why would they deny giving us the medication if we have new insurance?
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Did you ask the pharmacy which insurance they ran? It’s very common for them to run incorrect insurance because they have the old one on file, or both on file, or they somehow never put your new insurance in the system.
It’s always a good idea to keep a copy of everyones insurance card either in your phone (photo front & back) or physically with you.
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My husband brought the insurance card and I called prior to him getting there with the correct insurance information. Even if they ran the wrong insurance why wouldn’t they just run the correct insurance afterward? And why would they need Medicaid to call them?
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If your husband had the card, they should have used that insurance information. Medicaid shouldn’t have been involved since it’s no longer your insurance.
Based on my experience with CVS, it could be a pharmacy staff issue. I’ve had strange refill rules from them, like insisting my primary doctor personally call to authorize a refill—not a nurse or nurse practitioner, only him talking to the pharmacist directly. Because doctors have so much extra time for that.
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That’s frustrating! Thank you for your help. I needed to hear that it was likely a staff issue and not that I was suddenly losing it.
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In this situation I’d opt to pay cash for the Rx and file a claim with your health insurance company afterwards.
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They think OP is on Medicaid so they won’t take cash from her. So this advice doesn’t help
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You can still pay cash for a prescription if you’re on medicaid. Source: been there done that
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I thought they were not allowed to take cash from Medicaid patients.
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Based on what others have said and my own experience, it depends on the medication and the state you live in. I have experience in Maryland. I was allowed to pay out of pocket while on vacation in Ocean City, and the closest pharmacy with the medicine in stock was in Delaware. In that case, the medications were liquid prednisone and liquid amoxicillin.
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Pharmacies can call a Medicaid help desk for support at (800) 310-6826. Go to the pharmacy and watch them call this 24-hour number. In the meantime, you can pay for the prescription yourself.
I once had an issue where they tried to charge me $1 for my son’s prescription, even though children under 18 should have a $0 copay. I paid cash for it, and later Medicaid sent me a $1 check. People and technology make mistakes. No one figured out the error, but it resolved itself in a month.
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Oh and they’re also telling me I need to have Medicaid call them to tell them that they don’t cover us anymore? That sounds ridiculous. I’ve changed insurances many times in my life and never have I asked an insurance company to call my local pharmacy to tell them they don’t cover me anymore.
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In some states, Medicaid will only fill a prescription if it’s written by a provider registered with Medicaid. If the urgent care provider isn’t registered, that could be why it’s getting rejected. Double-check that your Medicaid is actually inactive.
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Did the same to me and I’m 63!, went from my wife’s plan to myoen after retirement. CVS had the new insurance, but insisted on changing the old one, I had tonget the insurance to call the store directly.
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Did he have proof of the new insurance? Did he give it to them?
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Yes! Based on other people’s responses it’s a really inefficient system wherein I need Medicaid to call the pharmacy to tell them to remove that coverage from my list