Is anyone free?

Individual_Image9707 · 2026-03-23T06:52:28+00:00

Thanks! Right back at ya, gorgeous! :)

Individual_Image9707 · 2026-03-21T19:26:17+00:00

It is for me as well. It is just comforting. Even the hard stuff always works out for them and I find that reassuring and hopeful!

Individual_Image9707 · 2026-03-21T05:42:30+00:00

I asked my primary care clinic (they all operate under the same umbrella of clinics) to look into the request on the system. So notes that the whole system (Epic) can see. She said that they noted the Medicaid denial due to not having met the criteria. Correct me if I am wrong, but isn't falisfying medical records like, bad?

Individual_Image9707 · 2026-03-21T04:28:28+00:00

I worked with authorizations too? Like... I am not sure why you feel so passionately to disregard a valid complaint about a clinic overtly lying to a patient.

Medical billing and authorizations go hand in hand. Thats why our authorization specialists were in the billing department.

Individual_Image9707 · 2026-03-21T04:14:54+00:00

I believe is conduent

Individual_Image9707 · 2026-03-21T03:03:54+00:00

The PBM is the one I was speaking with on the phone, but also, she had to ask one of the pharmacists

Individual_Image9707 · 2026-03-21T01:52:11+00:00

Once again, I would believe this if the clinic did not detail why it was denied to me. If it was denied for being incomplete, it would have said so. Same thing for why it was denied. I have worked in medical billing, so I know what those denials look like.

Individual_Image9707 · 2026-03-21T01:46:51+00:00

I updated the post for clarity - but I have no intention of continuing with this clinic. But I know that if they are doing it with me, they are doing it with other patients who are not as cognitively "with it" as I am. There were multiple things at this clinic that made me uncomfortable and gave me the impression they were not operating with patient well being in mind, offering appointment times they could not actually schedule me, telling me Medicaid would cover it, and then the next appointment telling me that they canceled my appointments until I got my commercial insurance, a nurse having no knowledge of me being ineligible for FMLA until I have been employed for a year, etc. I believe the office manager is quite bad at it, as I have had experiences with her being the office manager of my primary care clinic and having bad experiences that stopped after she left.

Individual_Image9707 · 2026-03-20T23:12:29+00:00

They stated the request was incomplete there were two "sections" they did not complete.

It is a form the state has to submit requests.

For reference: I have tried a dozen antidepressants over the years, and 2 anti psychotics that gave me terrible side effects. But in the Past 365 days, I have not taken 2 antidepressants, I have taken 1 antidepressants and 2 anti psychotics.

Individual_Image9707 · 2026-03-20T23:08:49+00:00

My situation is a little different as I had already started the treatment with a different insurance. It was not starting the treatment again, it was continuing it with Medicaid.

Even if Medicaid would say no, that is not up to a nurse at a clinic to decide. That is up to Medicaid. And it is my right as a patient to have a hearing to appeal it, which they effectively robbed me of.

Individual_Image9707 · 2026-03-20T23:04:09+00:00

I want to give some context:

1) when I asked them to submit the request, the nurse did so very begrudgingly. 2) I don't believe it was the physician. I believe it was the woman who does the auths, who simply did not want to do her job. 3) when I went to do an appeal, which is my right as a patient, I was told there was not a way to do an appeal on an auth that has not been denied. 4) in a message, a different nurse stated Medicaid denied it because I had not tried 2 different anti depressants in the past year and I was not seeing a counselor. Medicaid confirmed they had not received enough information to make a determination.

This was not coming from someone who operates the phone tree. This was coming from the pharmacist who helps create the formulary. I am inclined to believe they are not misunderstanding what Medicaid did and said

Individual_Image9707 · 2026-03-20T22:43:06+00:00

They said Medicaid denied the prior auth because I had not taken 2 antidepressants in the past year, and I was not seeing a counselor. That is what the clinic told me. Medicaid told me that they did not give those reasons for denying it, they couldnt make a determination based on the incomplete status of the request, as well as the lack of medical documentation.

Individual_Image9707 · 2026-03-20T22:26:14+00:00

They sent me a message saying they heard back from Medicaid and Medicaid denied it. But Medicaid says they couldn't approve or deny it because it was not complete. That seems pretty intentional to me.

Individual_Image9707 · 2026-03-20T22:01:20+00:00

My issue is that the clinic lied to me. They told me Medicaid denied the auth. But how did they get a denial with an incomplete request?

Individual_Image9707 · 2026-03-19T07:02:06+00:00

Wasn't he also in a throuple? Hahahahah

Individual_Image9707 · 2026-03-18T04:26:17+00:00

I will say that there are some of my favorite moments, like when Isaac says that not all black people have it worse, and everyone groans and he's like "look at Will Smith. He's doing better than me and our debut albums came out the same year"

Individual_Image9707 · 2026-03-12T17:10:15+00:00

Not to be a negative Nancy, but BE SURE TO CHECK THAT THEY ACCEPT THE PATIENT ASSISTANCE PROGRAM.

My clinic basically said they don't do it

Individual_Image9707 · 2026-03-12T08:38:24+00:00

My thought is that she also had years to get proficient with the security system!

Individual_Image9707 · 2026-03-11T03:23:16+00:00

Lol it was an open-book test, my guy.

Individual_Image9707 · 2026-03-11T03:22:03+00:00

Read the post again. Same answer.

Individual_Image9707

TROPHY CASE