ISO Monsey pharmacy w/ no Medicaid co-pays

watergirl

Tue, Jul 09 2019, 1:35 pm

amother [ Green ] wrote:

Aren't copays determined by the insurance plan not the provider? It may not be legal for a provider to just say 'we don't charge the copay'

I’m googling this issue... I don't think its legal for a pharmacy to charge this $200/person fee to medicaid patients at all. There is no copay.

OP, your friend needs to go to a non-heimish pharmacy. Try Walgreens. They don't play these games.

amother

Tue, Jul 09 2019, 1:50 pm

It's legal. First time she was charged the co-pay. It's $200 per recipient per year. The pharmacy is looking for a giant chunk of money. This is a giant chunk of money she doesn't have. She needs a place that won't charge the co-pays

Walgreens has delivery fee.

amother

Tue, Jul 09 2019, 1:51 pm

ShishKabob wrote:

I'm living in Monsey for more than 3 decades. I never heard of such a thing.

Can you share your pharmacy please? I could PM you if you like.

amother

Lime

Tue, Jul 09 2019, 2:02 pm

Are you sure your friend has medicaid?
I live in Monsey and have used quite afew pharmacies and I've never heard of such a thing ever. The copay is per medication.

watergirl

Tue, Jul 09 2019, 2:03 pm

amother [ OP ] wrote:

It is NOT legal to charge a fee to medicaid patients. This is not a co-pay. This is a made up fee that they are charging. Sure, they can charge a fee, but please dont call this a co-pay, which indicates that its part of the medicaid. It is not. You are not allowed to charge a fee for meds. Fee for delivery service, sure. Learn your rights. She needs to call her case manager and ask and she will be told that no, this fee is not in any way connected to medicaid.

You did not mention in your OP that your friend needs delivery. If thats required, thats a different story. The fee that she will be paying for them to deliver, or even to take an Uber to pick up her meds, is STILL cheaper than this crazy extortion that they are charging her.

amother

Tangerine

Tue, Jul 09 2019, 2:10 pm

watergirl wrote:

There is a $1 prescription copay for generic drugs. I just googled it

watergirl

Tue, Jul 09 2019, 2:12 pm

amother [ Tangerine ] wrote:

There is a $1 prescription copay for generic drugs. I just googled it

Ok fine. A dollar. Not in my state but ok. Thats not $200/person/year.

amother

Tue, Jul 09 2019, 2:13 pm

amother [ Lime ] wrote:

Are you sure your friend has medicaid?
I live in Monsey and have used quite afew pharmacies and I've never heard of such a thing ever. The copay is per medication.

It is per medication. The pharmacy let it add up. Some meds were $.50. Some were $1. I told her to get a printout.

Meanwhile, the pharmacy must give her the medications, but the co-pay gets added to the total.

amother

Tue, Jul 09 2019, 2:15 pm

watergirl wrote:

Ok fine. A dollar. Not in my state but ok. Thats not $200/person/year.

It's capped at $200 per recipient per year. She has a lot of kids, so it adds up.

Delivery is free. The dollar or fifty cent co-pay was waived up until a few weeks ago.

amother

Green

Tue, Jul 09 2019, 2:21 pm

If she has a copay per medication and that has added to a total of $200 there is nothing wrong with the pharmacy asking her to pay her outstanding balance. Yes, it is a large amount because it wasn't paid when the prescriptions were filled so it added up.
Are you expecting a pharmacy to just say we will waive whatever copay your plan requires you to pay? Whether legal or not, most providers can't run at that rate. I don't know any that work that way. It can get them in trouble with insurance companies. (In my experience and understanding)

watergirl

Tue, Jul 09 2019, 2:23 pm

amother [ OP ] wrote:

It's capped at $200 per recipient per year. She has a lot of kids, so it adds up.

Delivery is free. The dollar or fifty cent co-pay was waived up until a few weeks ago.

So you are saying that over many years, she was filling prescriptions for her large family, and the pharmacy has always waived the fees. Now, they decided to un-waive the .50-$1.00 co-pay and consider it arrears, and expect her to pay what they had until now waived?

Whatever the case, this is something for her case manager to help her with. There may be ways to have the fee waived from their end.

thunderstorm

Tue, Jul 09 2019, 2:24 pm

I've lived in Monsey 19 years and never heard of paying $200 per person per family.
If the pharmacy didn't collect the copay each time they filled a prescription then they added it to a bill and they are sending the bill. I'm assuming this is an accumulation of more than one year. Unless every family member has had about 15 prescriptions filled per month.
If she wants to avoid a large bill in the future, the frum owned pharmacies can have a credit card on file and they charge the card the $1.00 copay when they fill it.

Amarante

Tue, Jul 09 2019, 2:36 pm

I don't think there is enough information for anyone to help.

The numbers don't add up and there seems to be confusion regarding whether there are even co-pays.

In any event, I can't imagine how each child in a family manages to need between 200 and 300 prescriptions per year - I am basing that on people writing that there is a $1 or 50 cent co-pay per prescription and a $200 annual cap per year. If a child has a terrible chronic illness, then there might be many prescriptions but most children do not have 200 to 300 prescriptions filled every year.

However, per MommyM the copays aren't even charged for children's prescriptions.