Wednesday, January 20, 2010

Trying To be Positive, But....

...sometimes it's SO hard.
Cameron has been doing different doses of his meds lately, because we're trying to see if he actually NEEDS more or if he's okay on a lower dosage. (Personally, I saw a HUGE difference once we bumped up the dose.) Bumping up the dosage, though, causes HUGE problems with Medicaid.
I don't know if it's bad that I fully admit that Cameron is on Medicaid, but truthfully, if he wasn't on it, we would NOT be able to afford his many therapies or doctor appointments. It's a necessary evil.
Anyway, every time we tweak his doses, the doctor's office needs to contact Medicaid and get a "prior authorization," or in other words, get permission to raise the medication. The thing is, Medicaid only distributes ONE month's worth of meds at a time. So, if he's taking one pill a day, they'll only authorize the pharmacy to give him 30 pills per refill. Well, right before Christmas, we were waiting for prior authorization for doubling his dose (60 pills per month...) and got a HUGE surprise when we found out that even after being approved for the medication, we still had to wait 24 hours for it to get into the system. (I had gone TO the pharmacy, all prepared to get the meds, and was denied once again, and I literally was in TEARS. Cameron had run out of meds THAT day and with vacation I KNEW I was going to go crazy with an unmedicated child. Seriously, TEARS!) Thankfully, after learning the 24 hour rule, we got the medicine quickly. I think Cameron was unmedicated for a whole 3 hours that he's normally medicated.
Things are a lot different this time.
Cam was going to be out of medicine on Monday, so I called for a refill on Friday. The nurse called me back to tell me that the doctor wanted to raise the dosage, yet again, to THREE pills per day. I didn't think to make sure she'd get the prior authorization done (mostly because I was overwhelmed with my kids at the time...) and went to pick up the prescription on Monday. Now, remember, Monday we were OUT of more, nada, ALL GONE! I took the prescription to the pharmacy, and the tech looked a little confused. I asked him if Medicaid was having issues with the prior authorization again, and he said that was what it looked like. He said that lately, even on GOOD days, it takes about 3 days for the prior auth to go through. I was frustrated, and told him so, but I left trying to keep my spirits up. It helped that my sweet Cameron was in the back seat of the van consoling me, "Mama, that man was just doing his job. It's going to be okay..."
I quickly called the doctor's office to find out what was going on with the meds, and found out that the nurse had left for the day. *Great!* I left her a message, and told her that we were literally OUT of meds, and I was worried about sending him to school without any medication, and then I waited.
Tuesday, I wrote Cameron's teacher a note, explaining what was going on, and just as a warning that he wouldn't be his *usual* self. That morning I took what little of the quick acting, short-lasting, miniature dosage pills that I had left-over and tried to dose up the kid, knowing it wouldn't last.
At the end of the school day, I asked his teachers how it went and they said that because they knew what was going on, they understood, and noticed, but gave him a little bit of wiggle room. For the most part he was good, but did have his completly distracted moments.
I had called the doctor's office again that day and asked if we could possibly get a smaller prescription written to cover the few days that we'd have to wait for Medicaid, but my begging was only heard by the voice-mail, yet again.
Today, I called the doctor's office, yet again, and actually talked to a FEW people before getting to talk to the nurse I've been leaving messages with. She said that on Friday, when she'd written the prescription, she'd called Medicaid to get the prior authorization going. But because Monday was a holiday, she didn't expect to hear anything from them until at LEAST today. (*grumble grumble*) She said that, actually, she'd have a few minutes right then and she'd call to get things moving a little more quickly.
I've heard nothing.
Cameron is still on the itty-bitty pills, and they're not QUITE cutting it, but they're better than nothing. He's very confused about why he's had to take SO many pills and I told him that they help him so that he can concentrate when he goes to school and therapy. He seemed to understand that.
There are times I am SO grateful for Medicaid, but when I'm getting the "prior authorization" run-around, I don't love them so much.
Just so you don't think I truly have a hate/hate relationship with Medicaid, I will share one more recent Cameron/Medicaid story.
Sunday night, Cameron was arguing with his dad. (This happens a LOT. They're too much alike...) Because he was angry, he went up to his room, stomped around for a while, and then he "squeezed" his glasses. He must have REALLY been mad, because he BROKE his frames. (We've had this particular pair of glasses for ALMOST 2 months....) He came downstairs and immediately apologized and cried. I consoled him, and told him that we'd take care of it later.
Monday, the same day I tried to get the meds, we took the broken glasses to the eye doctor. They looked at them, said, "Oh, we can't fix these" (DUH!!) and then said, "Medicaid will replace this frame, easy."
Oh, what a weight was lifted (just before another was dropped...)
Being the mom to this boy is quite a job. Who knew I'd be so elated one minute and so bummed the next? BUT, after everything, it is DEFINITELY worth it. The fact that he tried to help me from getting VERY upset and crying again shows me that I'm doing a good job raising a concerned child! I can do this, but I will get frustrated from time to time...


stevie kay said...

Both of my kids are on medicaid and I cry every time I have to contact them. It's gotten a little better in recent years, but seriously it's a good thing we need it so bad because they make me want to shoot myself!

Jewelle said...

we were on medicaid when we lived in Idaho. It saved us so many times! We never could have paid for Lily's tonsil surgery, my surgery, or other things with out it. There is nothing wrong with getting help when it is needed. The Idaho Falls Medicaid office is horrendous! I've had similar problems with them. I know it is THEIR problem because when living in Rexburg we NEVER had a problem with Medicaid. I hope the meds can get all figured out so you don't have deal with medicaid for awhile.

Deanna said...

I'm so sorry Dawnyel!!!

I hope things start to look up, and soon!

P.S. - Scouts is Saturday, at 2, I think, so I'll pick Cammeron up about 1:50ish. We're staining and assembling the stands for their derby cars in Karen's garage, again. :)