Tuesday, August 6, 2013

Why did my co-pay go up?

It happens almost every day:

Crazy RxMan: "Your total is $20 today, Mrs. Amountwatcher."

Mrs. Amountwatcher: "What do YOU mean, $20? It's ALWAYS been $15. YOU made a mistake. Get on the computer RIGHT NOW and fix it."

Crazy RxMan: "We submitted the claim to your insurance, PAYNOW, just as always, and the claim came back this time for $20. Something might have changed with your insurance or formulary. Perhaps you received a letter in the mail about a co-pay increase for this medication. There's a lot of reasons why it might have gone up, but it's not because we made a mistake."

Mrs. Amountwatcher: "No, I did not get a letter. Nothing has changed. YOU made a mistake. I demand that you call them and find out what is going on."

Crazy RxMan: <sigh> 

Here we go again. If we are not currently busy, I will call the insurance for the patient and once they tell me the co-pay did indeed go up I will hand the phone to the patient so they can hear from the insurance that the co-pay has gone up. Other times I just tell the patient I will be happy to keep the medication in will-call until they "straighten it out" with their insurance. In that case they just come back a few days later and pay the new price.

This scenario has played out sooooo many times I can't keep track. For some reason people refuse to be the caretakers of their own insurance information. They refuse to open their mail or read the fine print on their insurance documents. They just assume we're trying to "get them" at the pharmacy, and once they find out that yes, indeed, their co-pay has gone up and it has nothing to do with the pharmacy, do you think we get an apology?

Co-pays change. Prices increase. Policies change. Insurance changes. The entire system is dynamic. What's true today isn't always true tomorrow. STOP blaming your poor pharmacist or pharmacy technician when you get bad news at the pharmacy. We're doing the best we can to deliver your medication to you. We don't need a beating at the register.


Emma said...

I hate people!

Anonymous said...

I hate when people refuse to admit the possibility that they made a mistake :C

If it were me, I'd blink in surprise, I'd ask if they were sure... then thank them, pay and go home and call the company to figure out what the story is.

Anonymous said...

I tried to call the insurance company.
I have a high deductible policy but once it is reached everything that is covered is covered 100%.
I had the same policy for 5 years.
In year 6 I had the same policy. I did not get a new card.
For years my 1 medication cost me $x the first 2-3 months with $x going up a little each year. Then, since my family has a couple of expensive medical conditions, we would reach our deductible by Spring and then my 1 medication would be 100% covered the rest of the year.
Then year 6 things changed. I paid my $x the first 2-3 months, then paid $0 for 2-3 months than all the sudden paid $13 one month.
I called my insurance company.They told me there was no change in my policy.
I called the agent at work who handles our insurance. Yep, same policy. Premium went up a little but otherwise no change. Call insurance again. Same policy, no changes occurred. But we don't handle your prescriptions. We farm that out to a PBM(that you had no knowledge of or access to the contract for). 45 minutes on the phone x 3(so over 3+ hours now all told) and no one knows anything except my policy is the same as every other year. Yet, another $13 is due the next month.
At some point my time is worth more than the $13 so I gave up and just paid it.
Next year at the annual business meeting our insurance agent states, oh yeah, there was a change. Some drugs that are not preferred have a small penalty if you won't change.
Was I told I was paying a penalty? No. Did the insurance company or the PBM even know that? Apparently no.