Tuesday, December 31, 2013

Let's Waste the Pharmacist's Time!

Dick Heis comes to the pharmacy with a prescription for Adderall. He's not a new patient but the last time we filled for him was six months ago. I type it all in and attempt to adjudicate.

Coverage Terminated in May, 2013

I tell Dick about the result and ask him if he has his new card. He hands me a Blue Cross Blue Shield of Somewhere card and I check on the computer. It's the same information I have on file. I tell the patient his card is expired.

"No, it is NOT!" he responds, angrily. Somehow, anger seems to be the usual response in this scenario.

I turn the monitor around and show him the reject on the computer screen.

"I have active coverage," he says.

"I believe you," I respond, "but this isn't your active coverage information."

"I just came from <competitor across the street>. They told me the same thing!"

"That's because the information on this card is outdated. Perhaps you have a new card at home?"

"This IS the CURRENT information!" he says in anger again. "Why don't YOU call the insurance and verify that?"

If I had any waiters or anything pending I would have said no, but it's been quiet and I decide what the heck, I'll give it a whirl.

After playing the little game with insurance for 3-4 minutes (I love answering "Yes or No" when the system asks me to answer "Please say Yes or No") I finally get to a representative and explain the situation. She gets the information needed and tells me that the patient has no active coverage.

I tell this to the patient.

He's really angry now and proceeds to get on his cell phone immediately.

Thirty minutes later he comes back with a NEW ID number and group number for the same BCBS. 

"For some reason I have a new ID number," he says sheepishly but without any apology.

I put in the information. This time it comes back with a reject:

May fill on <future date of 28 days>

"What does that mean?" he asks.

I tell him that it must have been filled somewhere else recently.

"I did NOT fill it somewhere else!"

Here we go again. "You said you were at my competitor. Did you get it filled there?"

"They were having the same problem you had, so I brought it here."

Essentially, what Dick Heis is telling me that he went to my competitor and when they told him his insurance wasn't active, he argued with them, probably asked them to call his insurance (which gave him the new card info), and for whatever reason he ended up at my pharmacy thinking somehow the same issue wouldn't come up again. Instead, however, he has wasted the time of two pharmacies and two pharmacists because of his belligerent inability to accept reality. 

A quick call to the competitor, a reversal, and then a filled Rx at my pharmacy... and Dick Heis is finally happy, but never once apologized for running us all around like Chef Ramsay's cooks for no reason at all.

PEOPLE: We're NOT lying when we tell you that your insurance information isn't correct. We MAKE MONEY by filling prescriptions. I PROMISE YOU that we're not going to lie to you about this. 


Anonymous said...

Just wait until tomorrow. "Oh no, my insurance didn't change in 2014."

pharmaciststeve said...

Just wait until Jan 1, 2014 when they expect to get their "obama drugs".. at no charge of course.. remember Jan 1, 2006 with the Medicare part D transition ?