MediCal pissing in our cornflakes.

I’m sure this post is full of grammar and spelling mistakes. To all the people who like to point them out, go fuck yourself.  I’m a pharmacist, not some soft-science English major douchebag.  If you are the type who likes perfect English and grammar, then go to a squishy website that reeks of deep literary self-masturbation.  If you are the type that wants to see the ‘real story’ of pharmacy, read bad words, have dirty sex with multiple Thai hookers while drinking Jack Daniels from their unwashed hoo-hahs, welcome to the party and ignore the shitty grammar.  Remember, PHARMACIST not PROFESSIONAL WRITER.

As of the first of February, MediCal (that’s California Medicaid for those out of state) decided to take a big steamy dump on the faces of pharmacies/pharmacists.  No, these are not the 10% cuts that I wrote about before, but something equally as stupid.

Before 2/1/09, if you had the patient’s Social Security Number, you could query either by POS device (a little credit-card looking machine that dialed into Medical) or their phone Automatic Eligibility Verification System (AEVS).  The little tape/magical voice on the phone would tell you the patients MediCal ID number (because we cannot use the Social for billing anymore).  Took about 1 min to do, and saved a bunch of time/trouble when the idiot forgot his/her card (or lost it (surprise)).

Now everyone who deals with Medicaid patients realizes that these people can’t even manage a $5, let alone be responsible enough to carry their MediCal card with them.  I mean shit, their Vicodin and Soma get lost every other week!  The POS/AEVS system made it easy.  They tell you their SS#, you get their MediCal number, no card required!

Well, they shitcanned that service.  That’s right, if you do not have the patients MediCal number you cannot get it via their Social Security number.  Let me tell you why I’m writing about this.

See that patient coming in the pharmacy at 6:30pm on a Friday night with that Rx for Levaquin?  He can’t get that because he doesn’t have his card on him (and he’s not in your system).  Doesn’t matter if you call MediCal and talk to a person, they refuse to give out MediCal ID number over the phone INCLUDING TO THE PATIENT THEMSELF!!!  This means the patient must GO TO THE SOCIAL SERVICES OFFICE and get a paper printout with their ID number on it.  Since MediCal is a government operation, lets put money on their hours of operation including weekends and all major (ie: every damn made up) holiday off.  Their social workers (for having ‘worker’ in their title, I have yet to see one actually ‘work’ or is worth the air they breathe)  can also provide them their number.  Yes, entrust someone with a few semesters of useless squishy classes with access to their ID numbers, not their pharmacist.

Now here we are at the rubber meeting the road.  You have a teenager or child with expensive antibiotics/medication that MediCal usually covers but they have no card (and obviously are not in your computer) Are you going to trust a MediCal patient with $200 of antibiotics to come in Monday morning with his card so you can bill for them?  Fuck no!  They have no incentive to help you out even though you helped them out.  Face it, its a fact.  Laziness beats ‘whats right’.  Fuck this ‘give some now and hold the rest’, you wont see them again!  Most of these people need to prepay for their Soma that is due TOMORROW because they don’t have the self control to keep that money in their pocket UNTIL TOMORROW!!  For the majority of them, if they had any ounce of responsibility in them, would they be in the situation they are in now?  I know I’m infamous for making blatant blanket statements on here, but how many hundreds of dollars must be lost on “whats right” before you put your foot down?  Why don’t you just dispense #100 vicodin/soma every other day because the patient is “in pain”.

You want to complain about this? Good luck, the MediCal office hires the most stupid, ignorant, minimum wage retarded dropouts on the planet.  You know all the “stupid people” in the Health Care profession I rant about?  Yeah, all of them are GENIUSES compared to MediCal phone operators.  It took 4 (FOUR!!) people to try to get the idea across how much of a BAD IDEA eliminating this service is for not only the patients but the pharmacies that service them.  They just didn’t get it.  One of which told me “I don’t see why you pharmacists make a big deal about this, just ask them for their card”.  *sigh* I almost died.  In fact, as I type this my soul died.

Requests for a complain phone number/email gave me a “There is none”.    I guess MediCal patients have no rights to voice a complaint about the care they are getting (but to be honest, why would a MediCal patient complain?  Their formulary is beat only by the magical CASH insurance).

So I told them “I am going to turn away every new patient who does not have their card because you have forced me to make the choice to either take a loss on their Rx’s, or to not give them medicine.”  They just said “uh huh” a lot.  I must of used too many words too fast for their small brains to comprehend.

Now the ironic part of it is that I always bitch about how we need to make the Welfare folk more responsible, and them not having their cards (and thereby not having their medication and dying) would in fact pound some responsibility into their brains.  However what kills my soul (more) are the kids who really need antibiotics and due to mommy and daddy being ‘winners of life’ (by losing their ID card) get doubly fucked over by this change.  You are forcing their medications to ride on a card given to someone who can’t be entrusted to always have the card, however I guess that’s the same argument with a child isn’t it?

I’m hoping this is just a huge oversight that will be taken care of.  However if you, your staff, or your patients have been effected by this, please comment and maybe MediCal will get the idea (hah! right).

Comments #

Comment by Anon E Mus on 2009-02-03 20:57:01 -0800 #

I couldn’t agree with you more.
As a pharm tech, I FEEL your pain 110%.
Just reading your site pisses me off about work lol.

Comment by Jamie on 2009-02-04 00:01:32 -0800 #

My husband was on MediCal for a little while before he passed away. At first I made a point of having his card with me every time I went to pick up his medicine, but after not being asked for it so many times I quit bothering. I’d like to think that patients can be trained the other way, but I have a feeling that it won’t happen. And it sounds like your heart is too soft to train the parents about bringing their card by witholding medication. Good luck.

Comment by v on 2009-02-04 00:06:22 -0800 #

well, i know its frustrating but here in ny if a medicaid patient does not have the card we cannot process the rx. the reasons for this are people let others use their card, sell medication gotten on medicaid, call in fake pa’s, etc etc. we cant even call medicaid to reverse claims anymore or let alone call for id numbers. it gets even worse becuz nymed contracts out the benefits to third party insurances s sometimes its not even straight medicaid sighhh

Comment by welsh pharmacist on 2009-02-04 05:22:26 -0800 #

Why does government agencies do that? do they look at themselves every month and think, “right what is going well and how ca i fuck it up?”
I am so apreciative that we have the NHS, yes its obscenely wasteful and a completely unfair system, but at least its easy, do the script, send of the script, get paid for it.
I wouldnt normally complain about things in your rants, thats what this blog is for, to let you vent, but I must defend social workers, my parents are social workers and they work really really hard. They get an even worse time than us when a mistake is made. (eg. my dad works in london – gets abuse from people cos another completely separate london borough allowed a kid to die). medical error deaths rarely even hit the papers here. I know i am about to get flamed for complaining about your anger, but this is just something i thought i had to defend, like our own sit out the back counting tablets all day image.

Comment by RxDawg on 2009-02-04 12:16:55 -0800 #

Thats a pickle your in allright. I guess if I was in the same scenario, I’d tell the patients to head to the ER and explain the reason of not getting their meds. It cannot fall on the pharmacy to provide loans, no matter how much we might want to. At least the local hospital is backed up financialy by the government.

Comment by Ute Tech on 2009-02-04 16:00:09 -0800 #

Just wait until California moves to a 4 day work week, same crap you outlined above but now thursday’s your last day. Here in Utah, the change has been a pain in the ass over and over again. A pharmacist I know got burned on some lovenox cause of medicaid’s stupid 4 day week.

Comment by thank you for calling… on 2009-02-04 19:00:37 -0800 #

If it makes you feel any better, NYS Medicaid has the brilliance to assign Medicaid recipients cards with “sequence numbers,” so even if they, by some miracle of nature, have their card on them, if it’s not the most up to date card with the correct sequence number, you are shit out of luck. The only way to get it is to have the patient call the Social Services office because we aren’t allowed to give out sequence numbers at the billing helpdesk.
As the phone operator on the other end when you call the pharmacy helpline to bitch, I feel your pain. There are plenty of people at the State I would love to punch in the face for wasting everyone’s time with neurotic ideas like these.

Comment by intern2010 on 2009-02-04 23:24:07 -0800 #

I was lucky one of the pharmacists last night managed to guess the next sequence number for a medicaid patient to get it to go through, of course in NYS. I’m just waiting to see the state outsource it to some company or start giving the more and more holidays off. I’ve learned to really hate anyone who comes in with medicaid and does the whole “I forgot my card” routine only to come back 2 days later with the “missing/stole” card suddenly in hand. It probably has to go without saying the first script is either some antibiotic they probably don’t need but badged the doc into writing but have it when they need their (lortab/ambien/benzo) script(s) filled.

Comment by rph3664 on 2009-02-05 08:17:23 -0800 #

Back when I worked retail, there was an employer whose Blue Cross cards ALWAYS had two numbers transposed. It was way too common to be a coincidence.
This didn’t last long, so the suits must have realized that it was costing more money for customer service and they still had to pay the claims anyway.

Comment by http://openid.aol.com/myztic7 on 2009-02-05 10:01:16 -0800 #

I’m a CPhT from Florida and listening to your rants makes me feel better every day because I know I’m not the only one out there having to deal with this shit on a daily basis. In Florida, Medicaid doesn’t open until 9am and closes after 5pm. God forbid a medicaid patient comes in after work to fill their rx’s with no card. You can’t get anyone on the phone after 5pm here, and good luck getting through unless you have the time to hold for 45 fucking minutes with the xanie addict breathing down your neck on why you can’t just put his damn pills in a bottle and hand them the fuck over. My pharmacist LOVES to give out loaners to people and waive their copays if they bitch enough and we are loosing big bucks over it. I can’t wait until I’m a pharmacist and can have more control over what goes on in my pharmacy because I am not going to be giving away freebie pain pills to every moron who walks off the street and is supposedly in pain even though he’s on three different strengths of oxycontin that were just filled by ANOTHER pharmacy 5 days ago.

Comment by Shalom (R.Ph.) on 2009-02-05 13:58:58 -0800 #

One of the few things the State of New Jersey got right was to implement an on-line lookup for Medicaid patients. If you have any two of the following: name, date of birth, SSN, you can get the ID, along with what other insurance they have. Sometimes you get lucky and it even gives you the IDs for those insurances. For obvious reasons this website is limited to those with Medicaid provider numbers. (Shame MediCal doesn’t seem to have a similar service. I note that their FAQ page still says they’ll verify by SSN. ( http://files.medi-cal.ca.gov/pubsdoco/faq.asp#L3 ))
They stopped putting the ID on the Medicaid card, though, replacing it with a Card Control Number (CCN). You then have to go to the above website, plug in the CCN, and it spits out the same information as above. Of course if you don’t have web access in your store, you have to go through the automated phone system, which is an enormous pain in the tuchus.
New York is interesting. NY Medicaid cards went away sometime around 1998. Now the patient gets a card that says “BENEFIT” on it; this becomes their Medicaid ID, their food stamps (swipe it at the register), their welfare check (withdraw it from an ATM), their collateral at the neighborhood loan shark, and I don’t know what-all else. If a card is lost, or if anything changes in their benefit package, a new card is issued, with the same ID, but a new sequence number. The old cards may still work for the other stuff, but are useless for prescriptions… this leads to all sorts of amusing arguments like “It worked at the doctor’s office!” (Sure, because they don’t bill online.) I used to have a Verifone card swiper at my drop-off area; if it said “Card Not Valid”, buh-bye. Go argue with them, not me.
(Sometimes you get an idea how long someone was on Medicaid by how high the sequence number is. One patient of ours, who was probably somewhat developmentally disabled, kept losing her card… she had a seq no of 26 or something.)

Comment by David on 2009-02-05 15:20:53 -0800 #

TAP: “You want to complain about this? Good luck, the MediCal office hires the most stupid, ignorant, minimum wage retarded dropouts on the planet. You know all the “stupid people” in the Health Care profession I rant about? Yeah, all of them are GENIUSES compared to MediCal phone operators.”
And these are the morons that the libtard electorate in Amerika have decided will run the healthcare system for all of us. The model you see being demonstrated in Cali will be the one we all have to suffer under once the government takes over and imposes a one-payor system on the rest of us. Sorry TAP, this is your future. You will wish for the “good ol’ days” of only having to deal with this crap on MediCal patients, not for every swining dick (or dickette) that walks through the door.

Comment by LifeandtimesTech on 2009-02-05 15:28:22 -0800 #

Yeah, and even better are the BlueChoice Option cards, that up until October or so worked under Blue cross. Now they get billed to NYMED, but the BCO cards don’t have a sequence number on them, just the ID.
You know how hard it is to convince a person that their insurance card isn’t their real insurance card?
Oh and lets forget that NYMED forgot to send half these people cards….

Comment by tech girl on 2009-02-05 20:32:28 -0800 #

In my store ( a Walgreens ) in Washington state, we do not give out medication for insurance problems…EVER. If it’s coverage no longer active…then you pay for it. We reimburse, the end.
If your medicaid is fucked up for some reason or a drug is not covered, it is part of our contractual obligation to WAMED to refuse you the medication even if you OFFER TO PAY out of pocket. The idea behind this being that if you can pay over 800 dollars for that Oxycontin, you need to not be on fucking Welfare.
I love this rule, and employ it often.
Blame the docs who keep on writing for Coreg CR for Medicaid patients. Patients never learn…sadly…neither do the doctors.

Comment by diana on 2009-02-06 12:41:27 -0800 #

they pulled that shit in kentucky, too. now we can’t call in with their SS# to get their ID#, and SS#s don’t work anymore. pain in everyone’s ass. AND, kymed contracted out the pharmacy to a PBM, so when somebody gets reinstated, but the state hasn’t told the PBM…we’ve all seen that.
i like that idea of ‘if you can afford your percocet or oxycontin b/c medicaid won’t cover it, why are you on medicaid?’ and refusing to fill…wish we could get away with that. we have a doc in town who doesn’t take insurance, cash only, but has tons of kymed patients, who then come to us for their methadone and valium and lortab etc etc and bitch about needing a PA. they don’t want to pay $45 or whatever for their drug, but they are willing to pay $150 to see the doc for 5 minutes to get the the green piece of paper…

Comment by MedBiller on 2009-02-06 13:17:38 -0800 #

Have the patient call the physician’s office who wrote the Rx. The physician’s office will have the medical number.

Comment by Charles Darwin on 2009-02-06 13:56:56 -0800 #

Medicaid destroys everything I believe in.

Comment by Ariella on 2009-02-07 20:10:21 -0800 #

This is an Email i sent to TAP about a year ago. I never got an answer. He is probably really busy, but i felt like sharing this so the Pharmacists feel appreciated. I very much love this blog, and it is nice to take a look into another occupation. I love you guys. it is because of you folks that i function. not all of us medicaid folks are bad, but there are too many that give us a baaaad name.
**
I could not find an E-Mail Address, so I hope you don’t mind an off topic comment. I find your blog brilliant and funny.

Comment by TAP Lover! on 2009-02-07 20:53:33 -0800 #

TAP YOU ARE DA BOMBBBB! Oh my god I am a clerk at a Walgreens and i hate Medical. I cant stand it, but reading your posts makes me feel so much better about myself knowing that there are others who share my feelings. Without you and this site I think i would die from all the stress
From now on, ill be telling those medical fucks that I dont want no scrub, a scrub is a guy that cant get no love from me, hanging out the passenger side of his best friends ride, trying to holler at me!

Comment by FillMaster-5000 on 2009-02-08 00:43:12 -0800 #

Considering that the entire state of California is broke, I really wouldn’t count on reimbursement for any Medi-Cal claims.
I think you can still verify eligibility using the patient’s social online at http://www.medi-cal.ca.gov , click “transactions,” log on with your NPI# and PIN#, then go to “single subscriber” use their SSN as the ID#, enter their birthdate, and use todays date as the issue date and date of service. I think that still works, but I might be wrong.
I work in Orange county, so most of our Medi-Cal patients are on CalOptima which is handled by Wellpoint rather than EDS, which I prefer, since they have a 24 hour pharmacy help desk and it is fairly easy to talk to a real fairly competent person. The EDS phone system, however, is a nightmare to navigate, and the people you talk to are never of any help and they always close promptly at five.
And I didn’t notice any mistakes in your grammar, BTW.

Comment by jacob on 2009-02-09 07:55:21 -0800 #

Don’t be surprised if you need a PA from welfare for levaquin. Cipro is much cheaper.
I had to recently deal with a PA for a welfare patient on Lexapro. It turns out that one tablet of lexapro is more expensive than 30 tablets of generic celexa.
I think there should be some sort of mandate that welfare patients are only allowed to get generic when there are two comparable drugs (one is brand and the other is generic) on the market (lexapro/celexa, levaquin/cipro). It’s crazy how the poorest and irresponsible people in our country have by far the BEST insurance plan possible.

Comment by Dee on 2009-02-09 07:59:53 -0800 #

I interned at a pharmacy with “free antibiotics” and had to deal with several upset customers who thought Levaquin was one of the free antibiotics. Dealing with welfare and people expecting free levaquin, augmentin, etc. was a double headache. I still remember a patient screaming “I’m going to sue for false advertising!!!”

Comment by http://openid.aol.com/Clckwrk16 on 2009-02-09 11:39:30 -0800 #

Medicaid is a crutch for the idiotic. I work in Nevada, and while our system doesn’t seem as annoying, we have plenty of people who really really really really enjoy their sami supplemental crap. It really helps that the Nevada Medicaid cards are recent ~30% of the time, and that I can understand the patient ~15% of the time. (I’m tri-lingual, none of which is spanish, or retard).
The whole welfare system needs to be reviewed. All it does is reward laziness (and rampant procreation). I can’t tell you how often in this town I see trailer-trash with a herd of retard babies, with their prized medicaid card hanging framed on their mantle-piece right next to that fucking singing fish thing.
I hate this town.
-An angry CphT

Comment by Anonymous on 2009-02-10 16:28:59 -0800 #

FillMaster-5000 is right. You can still verify eligibility at the Medi-Cal website. https://www.medi-cal.ca.gov/Eligibility/Login.asp
Follow FillMaster’s directions as they are spot on. Congratulations, now you can process as normal again. Unfortunately, that does not make your patients less idiotic.

Comment by PharmTechMidwest on 2009-02-26 23:57:09 -0800 #

What do you expect? You are dealing with a government run program. These are the same type of people who told my sister to divorce her husband. And leave my niece with him and then he would be able to apply for aid. The system is screwed up and it encourages all types of immoral behavior.
Stupid is as stupid does.

Comment by Sam I Am on 2010-05-08 10:07:12 -0700 #

I can’t wait till all americans are reduced to soilent green.

Comment by Monte on 2011-10-07 20:40:43 -0700 #

Wow… this is bs. Year’s later it just keeps getting worse. I have a 9 year old child who lives with me and I am on psychoactive drugs. My doctor changes the medications while her and I find the right one. We keep getting stuck because medi-cal will refuse to cover a new medication. This whole bureaucracy crap is affecting children. Medi-cal is not there to help, they are there to give you crumbs. Some of us need these medications to function normally. Or we live a life of horror. So if you hear a story of a man killing a 9 year old boy… It wasn’t me, I’m off my meds. Medi-cal denied them. Honestly, most of us have too much of a heart to do that but you wonder why we have random murders, rapes, and molestations… Ask the government. Maybe Kelly Thomas was acting a little aggressive because he didn’t get his meds.

Comment by Jenna on 2014-01-28 11:19:52 -0800 #

This is big-government for ya! Everyone wants equality here it is. Everyone will get crap equally distributed! ANYTHING government handles is just poorly ran and designed. Now you have to pay for more and get alot less!!! I can’t even get my children to see a pediatric dentist right now. It is taking way too long to get my child referred over to a orthapedic (he has scoliosis) the authorization is even difficult for the physicians to make in a timely manner.Thank you Medi-CAL. Good intentions do not always equal good results. Specially if it is by the government. They want want want money money money!! They waste it. Give you crumbs and they get more power.