As I have mentioned before, Elli is interested in potty-training, and is doing moderately well at it. So she really needs two different "diapers" for her -- Pull-ups for daytime so we can more easily get her on and off the toilet, and large very absorbant ones for nighttime. We have to give her a large amount of formula shortly before bedtime, so for now, staying dry all night will be a physical impossibility.Because Elli has a Medicaid card, is over age 4, and has not so far been able to get out of diapers, we are able to get them paid for by Medicaid. This is a huge financial help, because the larger the child, the pricier the diaper because you get fewer in the package. Also, most people don't plan on paying for diapers after their children are 4 years old!
I called our local pharmacy yesterday to see if there was any way I could get her both types of diapers. The owner, Jane, got on the phone with me. She is a very nice lady who has worked with me to get Elli meds and supplies since Elli was born. She explained that, in theory, the answer is yes. I'm allowed to get 300 per month, and I usually use half that.
In practice, however, the answer is no. Medicaid only pays providers like her $0.46 per diaper. The problem is that prices have gone up, and she cannot buy them for less than $0.54 per diaper. So if she were to supply me with a case of pullups, she will actually lose about $10 per case.
As she put it, "I'll supply them at cost -- I'm a good sport. But I can't afford to lose $10 on each case."
I asked her if there was any way that she could legally bill Medicaid for what they will pay, then bill me for the difference. She said they had a rule against that at one time, but she would call and see if they have changed it. We both know it will take forever for them to adjust their reimbursement rate to reflect the price increases.
She talked to someone in our state capitol this morning, who asserted that no, Medicaid still would not allow you to bill a family for the difference in cost vs. reimbursement rate (which doctor's offices do all the time).
Not only that, but she told me that if I decide to buy pull-ups at her pharmacy myself, they actually will require me to sign a waiver stating that I am waiving my right to that benefit!
So they won't reimburse at a rate that anyone can supply the service at, nor will they allow someone to make up the difference by billing me, but they will make me waive my right to this benefit when I purchase the supplies myself.
You just can't make this stuff up!
