Is this really a thing?

[Charcoales]

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If they have Medicaid (wisconsin at least?) can they pay cash if there is one of these rejections:

1. prescriber not covered

2. commercial health ins must be billed first, but they state they do not have commercial ins

3. refill too soon: mainly for a vacation supply and they don't want to wait for us to call the insurance since it is Friday night and ins isn't open until Mon am?

If we can't bill cash, where is proof I can hand to them so they'll believe me? Someone asked for proof I said it was what my manager told me since I wasn't actually sure where documented proof of this was...

 

[mydogatemysuboxone27]

If they have Medicaid (wisconsin at least?) can they pay cash if there is one of these rejections:

1. prescriber not covered

2. commercial health ins must be billed first, but they state they do not have commercial ins

3. refill too soon: mainly for a vacation supply and they don't want to wait for us to call the insurance since it is Friday night and ins isn't open until Mon am?

If we can't bill cash, where is proof I can hand to them so they'll believe me? Someone asked for proof I said it was what my manager told me since I wasn't actually sure where documented proof of this was...

I'm not really sure I understand the question. You're asking if you get any of those rejections is it okay to charge them cash for it if they would like to pay for it? If that's the question then yes, I don't see any reason why you can't charge them cash. It's really their decision I would think.

 

[Charcoales]

Yeah

I'm not really sure I understand the question. You're asking if you get any of those rejections is it okay to charge them cash for it if they would like to pay for it? If that's the question then yes, I don't see any reason why you can't charge them cash. It's really their decision I would think.

Yeah my q is if u can run it for cash, I've heard conflicting things like if they have Medicaid they're not allowed to pay cash but can t find a source for it

 

[Rouelle]

I can’t imagine a scenario in which a patient is forbidden from paying cash for a valid script. (Although I’m not in your state)

Unless perhaps it is your policy to only bill narcs to insurance...

 

[Corpseman]

I believe there is at least one state (Maryland or Massachusetts) that will not allow this.

 

[BidingMyTime]

I've heard there are states that forbid this, but have no experience with this. In IL, cash is king, there is no reason not to sell an RX to someone, just because Medicaid won't pay for it (assuming it's not an early narc....or maybe Clomid.)

 

[Apotheker2015]

If they have Medicaid (wisconsin at least?) can they pay cash if there is one of these rejections:

1. prescriber not covered

2. commercial health ins must be billed first, but they state they do not have commercial ins

3. refill too soon: mainly for a vacation supply and they don't want to wait for us to call the insurance since it is Friday night and ins isn't open until Mon am?

If we can't bill cash, where is proof I can hand to them so they'll believe me? Someone asked for proof I said it was what my manager told me since I wasn't actually sure where documented proof of this was...

Ok, I think I may have understood your question here.

1. Prescriber not covered: this is telling you just that. You have to fax or call the office and tell them that prescriber is not registered with Medicaid. Because it’s medicaid you’ll need a new script from a prescriber that is enrolled.

2. Commercial health insurance must be billed first: Check out their third party profile and make sure that you don’t have any plans on there that are no longer active. A GoodRx coupon will trigger that rejection (I think). So you have to deactivate that.

At Walmart the patient has to sign a form acknowledging they just told you they do not have commercial insurance and that they are fully responsible for the cost, if Medicaid ends up rejecting it. You end up bypassing it. I rarely deal with this.

3. Refill too soon: E.g., vacation override: well, the reasoning behind it, the way I understand it is that if they’re on Medicaid, how is it they’re going on vacation?

Of course, these issues arise on fridays right before closing. If they do not want to wait, they are welcome to take the prescription elsewhere. Follow your company policy. Walmart has it on the wire.

If something is not covered, they can’t just pay cash. They’re supposed to go through the PA/coverage exception process unless it’s an emergency (but it never is. It’s always saxenda, qsymia, brand name Ambien - something unnecessary). There’s a flow chart of the process.

There should be an after hours number, by the way. You should consult the Wisconsin Medicaid website.