Any info on medicaid portal?

[birchswing]

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I use Medicaid and I just had difficulty getting my most prescription filled. A message came back telling the pharmacist that my prescribing doctor (my psychiatrist) is not enrolled in a medicaid web portal. Apparently doctors who take medicaid had to sign up for a new medical portal as of February. Called my psychiatrist's office and have had a back and forth with the various office staff for several days, and the bottom line is that my psychiatrist is not going to sign up for this portal based on what the staff have told me. I don't think they know what it is, and I don't know what it is.

I had to pay for my prescription out of pocket which is almost all of my monthly income. Fortunately I can afford to do that for now since I live with my family.

I'm not sure what will happen when I see my psychiatrist in person at my next appt. She tends to do the least possible and charges for all extras. If she has to fill something out, she expects to be paid for it. She charges me $25 just to sign a form that says I've seen her (for my university). She won't talk on the phone between appointments so I have to wait until I can see her, but I don't even know if once I explain this in person if she'll agree to sign up for whatever this medicaid portal is.

Has anyone else heard of this medicaid portal? This is very frustrating.

 

[birchswing]

Wanted to add, from what the pharmacist said, this is apparently just a web-site the doctor needs to go to to enroll in something. It doesn't cost them money to do this. I'm in Virginia--not sure if it varies by state.

 

[PikminOC]

It takes time. All these things take time. We only have so much time. Your psychiatrist charges much less than I do. And changes of meds, etc between appts by phone etc is a legal morass.

 

[birchswing]

I think that all things take time so I'm not sure if that's the best explanation. From what the pharmacy told me (and they didn't seem quite sure either), it sounds like this is a new requirement for Medicaid providers and that the required sign up time was last February. My psychiatrist is getting paid by Medicaid for our visits. It seems that Medicaid wants her to do something she hasn't done for me to get my medications paid for.

 

[SmallBird]

I use Medicaid and I just had difficulty getting my most prescription filled. A message came back telling the pharmacist that my prescribing doctor (my psychiatrist) is not enrolled in a medicaid web portal. Apparently doctors who take medicaid had to sign up for a new medical portal as of February. Called my psychiatrist's office and have had a back and forth with the various office staff for several days, and the bottom line is that my psychiatrist is not going to sign up for this portal based on what the staff have told me. I don't think they know what it is, and I don't know what it is.

I had to pay for my prescription out of pocket which is almost all of my monthly income. Fortunately I can afford to do that for now since I live with my family.

I'm not sure what will happen when I see my psychiatrist in person at my next appt. She tends to do the least possible and charges for all extras. If she has to fill something out, she expects to be paid for it. She charges me $25 just to sign a form that says I've seen her (for my university). She won't talk on the phone between appointments so I have to wait until I can see her, but I don't even know if once I explain this in person if she'll agree to sign up for whatever this medicaid portal is.

Has anyone else heard of this medicaid portal? This is very frustrating.

This portal exists, its a hassle but not too bad.

Maybe this is state specific but I don't understand why the pharmacy should not be able to have your prescription covered because the provider isn't covered... they should still be able to bill your insurance/medicaid whatever the status of the prescribing physician.

 

[birchswing]

This portal exists, its a hassle but not too bad.

Maybe this is state specific but I don't understand why the pharmacy should not be able to have your prescription covered because the provider isn't covered... they should still be able to bill your insurance/medicaid whatever the status of the prescribing physician.

Thanks. I'll try talking with the pharmacy again.

 

[PikminOC]

This portal exists, its a hassle but not too bad.

Maybe this is state specific but I don't understand why the pharmacy should not be able to have your prescription covered because the provider isn't covered... they should still be able to bill your insurance/medicaid whatever the status of the prescribing physician.

Wrong. This is a new Medicaid rule. Coming soon to Medicare. This is to force docs into medicare\aid.

 

[PikminOC]

in private practice we don't get paid for all thus extra work. And the time adds up. It's not salaried work and its not income generating.

 

[TexasPhysician]

Just another reason why private practice docs should opt-out.

 

[Shikima]

Government does not manage anything well. This is one of the best arguments against single-payer. At least with insurance companies, if they demand too much, you can submit a bill back to them for wasting your time. The catch to this would be the agreement contract.

 

[PikminOC]

Just another reason why private practice docs should opt-out.

Yes. That's my point to the OP. He complains incessantly about his psychiatrist but has no idea how lucky he is.

 

[birchswing]

There are byzantine tasks at every job, and psychiatrists are well compensated for their work and have support staff. If Medicaid is your bread and butter, setting up an account on a web-site so that your patients can get their medicines covered seems like part of the job. I am going on the information I've been given so far. Neither my doctor's office nor the pharmacy seemed to know a lot about this. I can't confirm whether my doctor not setting this up is a legitimate reason for my prescriptions not being covered; I am speaking to this with the information I have been given.

I know that I am very lucky with the support I have from my family. I am not quite sure how a very mentally ill person without the family support I have trying to pick up their medicines would navigate these systems.

 

[birchswing]

Yes. That's my point to the OP. He complains incessantly about his psychiatrist but has no idea how lucky he is.

If there were out-of-pocket providers that provided a more normal level-of-care, I would patron their business. I have limited income, but I am willing to and and am fortunate to be able to spend the majority of it on healthcare. Right now I pay nothing out of pocket to see my psychiatrist. There was a single psychiatrist who offered out-of-pocket care in my area, but he stopped after a few months and started working for an inpatient hospital. I am not aware of any other private-pay psychiatrists. I am happy to pay a considerable amount for good service and good care. That is not a service available for some reason. We don't have Uber either. I guess we're not metropolitan enough.

 

[PikminOC]

If there were out-of-pocket providers that provided a more normal level-of-care, I would patron their business. I have limited income, but I am willing to and and am fortunate to be able to spend the majority of it on healthcare. Right now I pay nothing out of pocket to see my psychiatrist. There was a single psychiatrist who offered out-of-pocket care in my area, but he stopped after a few months and started working for an inpatient hospital. I am not aware of any other private-pay psychiatrists. I am happy to pay a considerable amount for good service and good care. That is not a service available for some reason. We don't have Uber either. I guess we're not metropolitan enough.

The way you complain about your doc, you would not be one if my patients or in most practices I know of. And thanks for telling us how well compensated we are and how we have all thus support staff. You truly have no idea. We are psychiatrists on here, not patients, and we are giving you the same feedback about how crappy reimbursement is.
You ever wonder why that psychiatrist went to work for a hospital and closed up his outpatient practice? Because he was raking it in? No benefits and certainly no time for ungrateful patients.

 

[birchswing]

The way you complain about your doc, you would not be one if my patients or in most practices I know of. And thanks for telling us how well compensated we are and how we have all thus support staff. You truly have no idea. We are psychiatrists on here, not patients, and we are giving you the same feedback about how crappy reimbursement is.
You ever wonder why that psychiatrist went to work for a hospital and closed up his outpatient practice? Because he was raking it in? No benefits and certainly no time for ungrateful patients.

Your reimbursements are relatively low. The pay is still extremely high. But I'm not sure how we ended up talking about reimbursements, unless you're equating physician reimbursement with prescription benefits.

To be honest, your original reply to me in this thread did not indicate you understood my original post. I didn't want to point out that you have responses that are apropos of nothing.

It takes time. All these things take time. We only have so much time. Your psychiatrist charges much less than I do. And changes of meds, etc between appts by phone etc is a legal morass.

You immediately assumed this had something to do with needing a prescription between appointments (you can re-read everything I've written and see that it doesn't). It has nothing to do with what she charges. I was merely suggesting as an aside that if I ever can get her to sign up for this, she will probably charge me to do something that is considered customary as that has been a pattern. But the crux of my post was a specific inquiry about this Medicaid portal enrollment, which for some reason affects my prescription coverage. My prescriptions from my cardiologist are going through fine, and he is also a Medicaid provider. The ones for her are not. According to the information I have, even though she is receiving reimbursements for our appointments from Medicaid, she is not complying with some rule that required her to sign up for a portal. Why that has anything to do with my prescriptions from her being covered, I don't know. But from what I've been told this is not a matter of psychiatric reimbursements being out of par with other reimbursements; from what I have been told, this is a case of not being able to get prescriptions benefits if your doctor isn't signed up for this portal. And my comment about the salaries of doctors is that it seems they are paid well enough to stay on top of signing up for things they are required to.

My complaints, when I've had them, are extremely specific. And yet you've painted me broadly as ungrateful and complaining.

It doesn't bother me that you hypothetically wouldn't accept me as a patient when you seem to have difficulty understanding situations described by others outside of the way you've experienced a completely different situation involving shared keywords that seem to light up your synapses and trigger reactive responses.

I am glad that you express your anger because I would never doubt there are stressful parts to your job that I don't know about or possibly couldn't understand. I also vent frustration. You might be surprised how copacetic I am in person. The things I complain about on the Internet are not things I complain about in real life. There are almost no psychiatrists taking new Medicaid patients (nor is my current psychiatrist taking additional Medicaid patients). I would be stupid to complain to my psychiatrist. I don't even complain when she takes social phone calls in the middle of appointments. The Internet is a release valve for a number of people.

 

[birchswing]

i am not sure if this differs by state but i have not signed up for either the medicaid or medicare thing despite being told my patients wouldn't continue getting prescriptions if i didn't and lo and behold they still seem to be able to manage to fill their prescriptions. presumably your psychiatry sees a lot of medicaid patients (or maybe even all medicaid as it would be unusual for psychiatrists with predominantly insured patients to take medicaid) so one would think this would be an issue for her other patients?

i am pretty sure it would be illegal for her to charge you to sign up to the portal. and i cant believe you're her only medicaid patient so either the pharmacist is making something out of nothing, or your psychiatrist will be having to sign up for this sooner rather than later in order for her patients to get their rxs filled.

Hmm, very interesting, thank you.

Yes, it is confounding, and I'm definitely not the only Medicaid patient. Makes me feel a little less crazy to hear you say what the pharmacy has been telling me (that apparently there is some policy in place where patients won't get prescriptions covered if doctors don't sign up for this). It sounded so random to me I've thought I must sound a bit mad. So it's something at least knowing this is a real thing. My dad has even been calling the office on my behalf because they are saying they're not going to do whatever it is the pharmacy wants them to do. I can't get in any sooner than I'm scheduled to sort this out. Could be that the pharmacy is mixed up somehow, as well, although something showed up in their system to give them this message.

 

[PikminOC]

So how much is overhead birchswing, malpractice etc? Please let me know how much you think overhead is, what percentage? And how much our med school loans are that we are paying off. And how many years we put into getting to being a psychiatrist? There is no part time job we able to hold while being in med school and residency. This isn't midlevel schooling. Please elucidate me on how much the take home is.

 

[PikminOC]

i am not sure if this differs by state but i have not signed up for either the medicaid or medicare thing despite being told my patients wouldn't continue getting prescriptions if i didn't and lo and behold they still seem to be able to manage to fill their prescriptions. presumably your psychiatry sees a lot of medicaid patients (or maybe even all medicaid as it would be unusual for psychiatrists with predominantly insured patients to take medicaid) so one would think this would be an issue for her other patients?

i am pretty sure it would be illegal for her to charge you to sign up to the portal. and i cant believe you're her only medicaid patient so either the pharmacist is making something out of nothing, or your psychiatrist will be having to sign up for this sooner rather than later in order for her patients to get their rxs filled.

In my state, the Medicaid patients cant get their meds filled if I prescribe it as I am opted out. They cant even pay cash for the meds as that goes against their Medicaid contract.

 

[PikminOC]

Your reimbursements are relatively low. The pay is still extremely high. But I'm not sure how we ended up talking about reimbursements, unless you're equating physician reimbursement with prescription benefits.

To be honest, your original reply to me in this thread did not indicate you understood my original post. I didn't want to point out that you have responses that are apropos of nothing.



You immediately assumed this had something to do with needing a prescription between appointments (you can re-read everything I've written and see that it doesn't). It has nothing to do with what she charges. I was merely suggesting as an aside that if I ever can get her to sign up for this, she will probably charge me to do something that is considered customary as that has been a pattern. But the crux of my post was a specific inquiry about this Medicaid portal enrollment, which for some reason affects my prescription coverage. My prescriptions from my cardiologist are going through fine, and he is also a Medicaid provider. The ones for her are not. According to the information I have, even though she is receiving reimbursements for our appointments from Medicaid, she is not complying with some rule that required her to sign up for a portal. Why that has anything to do with my prescriptions from her being covered, I don't know. But from what I've been told this is not a matter of psychiatric reimbursements being out of par with other reimbursements; from what I have been told, this is a case of not being able to get prescriptions benefits if your doctor isn't signed up for this portal. And my comment about the salaries of doctors is that it seems they are paid well enough to stay on top of signing up for things they are required to.

My complaints, when I've had them, are extremely specific. And yet you've painted me broadly as ungrateful and complaining.

It doesn't bother me that you hypothetically wouldn't accept me as a patient when you seem to have difficulty understanding situations described by others outside of the way you've experienced a completely different situation involving shared keywords that seem to light up your synapses and trigger reactive responses.

I am glad that you express your anger because I would never doubt there are stressful parts to your job that I don't know about or possibly couldn't understand. I also vent frustration. You might be surprised how copacetic I am in person. The things I complain about on the Internet are not things I complain about in real life. There are almost no psychiatrists taking new Medicaid patients (nor is my current psychiatrist taking additional Medicaid patients). I would be stupid to complain to my psychiatrist. I don't even complain when she takes social phone calls in the middle of appointments. The Internet is a release valve for a number of people.

Your reimbursements are relatively low. The pay is still extremely high. But I'm not sure how we ended up talking about reimbursements, unless you're equating physician reimbursement with prescription benefits.

To be honest, your original reply to me in this thread did not indicate you understood my original post. I didn't want to point out that you have responses that are apropos of nothing.



You immediately assumed this had something to do with needing a prescription between appointments (you can re-read everything I've written and see that it doesn't). It has nothing to do with what she charges. I was merely suggesting as an aside that if I ever can get her to sign up for this, she will probably charge me to do something that is considered customary as that has been a pattern. But the crux of my post was a specific inquiry about this Medicaid portal enrollment, which for some reason affects my prescription coverage. My prescriptions from my cardiologist are going through fine, and he is also a Medicaid provider. The ones for her are not. According to the information I have, even though she is receiving reimbursements for our appointments from Medicaid, she is not complying with some rule that required her to sign up for a portal. Why that has anything to do with my prescriptions from her being covered, I don't know. But from what I've been told this is not a matter of psychiatric reimbursements being out of par with other reimbursements; from what I have been told, this is a case of not being able to get prescriptions benefits if your doctor isn't signed up for this portal. And my comment about the salaries of doctors is that it seems they are paid well enough to stay on top of signing up for things they are required to.

My complaints, when I've had them, are extremely specific. And yet you've painted me broadly as ungrateful and complaining.

It doesn't bother me that you hypothetically wouldn't accept me as a patient when you seem to have difficulty understanding situations described by others outside of the way you've experienced a completely different situation involving shared keywords that seem to light up your synapses and trigger reactive responses.

I am glad that you express your anger because I would never doubt there are stressful parts to your job that I don't know about or possibly couldn't understand. I also vent frustration. You might be surprised how copacetic I am in person. The things I complain about on the Internet are not things I complain about in real life. There are almost no psychiatrists taking new Medicaid patients (nor is my current psychiatrist taking additional Medicaid patients). I would be stupid to complain to my psychiatrist. I don't even complain when she takes social phone calls in the middle of appointments. The Internet is a release valve for a number of people.

I have read your other posts. You are angry at your psychiatrist and release your anger on sdn all the time. I have not said anything until now. It's a culmination of all of your complaints that I see on here on a regular basis. Only you are allowed to be angry?

You also cannot afford a doctor out of network as you could barely cover your med expenses. You think we charge $50 a visit?

We take alot of liability in our patient cases. You just talk about benzos all the time. Your doctor is right to meet with you between apointmts if you have questions. She needs your chart in front of her and to document the conversation. The documentation has to be spot on, especially for Medicaid/are.

 

[PikminOC]

Your reimbursements are relatively low. The pay is still extremely high.
==
Explain this in the context of private practice psychiatry.

 

[birchswing]

I looked around a bit more and found that this is in fact the message the pharmacy is supposed to get from the Medicaid system. It also applies to non-Medicaid providers who have patients who have Medicaid--meaning that if a patient pays out of pocket for medical service but is prescribed medication that medication won't be covered by Medicaid unless the out-of-pocket provider signs up for this portal. The document I found said that the doctor gets several warnings before the patient is denied prescription coverage, but it is an odd form of communication and a bit passive aggressive (in that I assume they believe patients will complain to their doctors), but it's injurious to patients.

 

[PikminOC]

I looked around a bit more and found that this is in fact the message the pharmacy is supposed to get from the Medicaid system. It also applies to non-Medicaid providers who have patients who have Medicaid--meaning that if a patient pays out of pocket for medical service but is prescribed medication that medication won't be covered by Medicaid unless the out-of-pocket provider signs up for this portal. The document I found said that the doctor gets several warnings before the patient is denied prescription coverage, but it is an odd form of communication and a bit passive aggressive (in that I assume they believe patients will complain to their doctors), but it's injurious to patients.

Take it up with the government state and federal. Medicare/Medicaid.
In my state within the past year, they made it fraudulent if a medicaid patient pays cash for medications. If the doctor has opted out of medicare/aid, their prescriptions will not be covered. The pharmacy and doctor can report the patient for fraud if they pay outside of the system. Once again, this is to try and force physicians to accept it in order to keep those patients. Every state may be different. If you are able to find the state rule about this in your state, please post it. Verbal means nothing.

In order to sign up for the portal, you have to be IN Medicaid. AFAIK from my state and as a physician.

 

[alina_s]

birchswing, you have no idea how complicated and time-consuming "just" signing up can be. 50 states=50 Medicaid systems=1000's of opportunities for rules and errors.

For reference, I started a job at a corporate owned clinic with an office manager and lots of other providers who have signed up before. It still took about 4 hours of my time plus who knows how much time from the office manager and 6 weeks to get me added as a provider through this "simple" and "convenient" portal. 4 hours is a lot of clinic time- many of us get that much per week for any note writing and care coordination. Among other things, I got to fill out the same application twice because it only accepted input on the latest version of Explorer but let me fill the whole thing out before notifying me. It wouldn't accept that I had two valid licenses at once. It never accepted the clinic address due to formatting rules, so who knows where mail might go. It required me to find out the birth city and state of the corporate owner, who is across the country and I've never met. It also required the date when he had purchased or opened the clinic. So no, it is never "just" signing up. And FYI, Xerox won contracts to develop and run billing systems for several states- they were the great minds behind that registration process- and they're being sued for how it's gone. Where I work, practices have gone bankrupt because they never got the Medicaid payments or got them months-years late.