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"That's because the information on this card is outdated.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. 

Monday, December 30, 2013

Ignoring the Real Culprit

Guy. Beard. Tattoos. Weird tattoos. Age 35. Long hair. Looks like Jesus with tattoos. Lives at home with mom and dad. On Medicaid. Gets Oxycontin and Oxycodone every month at taxpayer expense.

Usually this guy's mommy comes to the pharmacy to bring in his new prescriptions. For some reason THIS month he's here with his prescriptions. I see his mother over on aisle five looking at the eggs. Why people spend so much time looking at eggs is yet another mystery for another day. 

Anyway, I tell him we'll get his prescriptions ready. He wanders off. Maybe he can go over to the magazine rack and check out Tattoo magazine. I go to work on his prescriptions while my pharmacy partner Mickey shows up. He's at the computer next to me while I double count the prescriptions.

I see the guy's mommy walk down the aisle toward us, make eye contact, then walk off in the other direction. Weird tattoo guy comes up to the counter. I have him sign out his prescriptions (he's a WePay) and he takes off, rather hurriedly, in the other direction from where mommy went. At the time I'm thinking he's thinking his mom must be in that direction and that they need to leave. She's always been in a hurry before when bringing in his prescriptions anyway.

Twenty minutes later Mickey and I are still in our overlap discussing the day's issues when the phone rings. The tech answers and after listening to the caller for a minute announces to Mickey and me, "This lady says her son was shorted on his Oxycontin and Oxycodone."

I'm human. I've made counting mistakes before and I'm smart enough now to accept that and check the count before responding to these claims. I tell her to put the caller on hold while we check the count. I pull out the log book, look up the meds on the computer, pull out the medications, and count. EVERYTHING checks out. Add to that the fact that I double-counted them and Mickey was right there next to me the whole time. I didn't make a mistake.

I pick up the phone and explain what I've done to check out the situation. Mommy tells me she is loading her son's med box and that the Oxycontin is short four tablets and the Oxycodone is short six tablets. "No, wait," she says, "That one is short seven tablets."

I tell her that it isn't possible for all the reasons it isn't possible. I tell her we count by fives and if it was short by five tablets that might be the issue. I tell her that we double count. I tell her about the extra paper work and DEA tracking. I tell her that the manager was standing right next to me. At no point do I suggest that her narc-addicted, tattooed son on Medicaid might have something to do with it. 

She belts out to me, "Should I call the police and tell them what's happened?"

I think she thinks that will persuade me somehow.

"If you'd like," I tell her, "but you understand I didn't make an error. The count was correct when the bottles left the pharmacy."

"Well my son gave the medicine right to me!" she says, agitated.

"No. I saw him walk off in a different direction than you did. I don't know what happened to the medicine from the time he left the pharmacy until he met up with you and handed you the bottles, but..."

She cuts me off, "We've been shopping at Goofmart for years! This is so sad. I just don't know what we're going to do..."

Then I hear her husband in the background, "Well you're going to have to count the medicine BEFORE you leave the pharmacy next time!"

"This is very upsetting! We're good customers there!"


Talk about denial.

Friday, December 27, 2013

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Tuesday, December 24, 2013

In the Spirit of Christmas...

Levaquin Lady returned to the pharmacy today and once again showed me that the Spirit of Giving is never lost this time of year. 

She rolled up on our ride-on store grocery cart thing on a busy morning with more Levaquin scripts for her and her son. The "please give us twenty minutes" said by the technician was met with the usual blank face and a sudden inability to move the ride-on cart. Levaquin Lady was going to sit there and block traffic for the next twenty minutes (if she had to) to pressure us into moving faster.

We couldn't be mad, mind you, because as I said, she was showing us what the true Spirit of Giving means. But I'm getting ahead of myself...

A few days ago the Mighty Levaquin Boy was at the pharmacy late in the evening. He's here with a prescription for methylprednisolone 8mg (which for some reason is expensive at our pharmacy). He HAS to have it because he's allergic to prednisone (ba-dum-tiss). Trying to reason with Levaquin Lady or the Mighty Levaquin Boy on their medications has never worked in the past, so how is it going to work now? But he also has a script for Fluconazole. I try to tell him about Torsades and the possible interaction between Fluconazole and Levaquin, but he doesn't want to hear it. He just wants to know how much it is all going to cost.

As I said, methylprednisolone 8mg is not on our company's preferred list of medications so it is expensive. I tell him the price and I get the double take. I get a triple take. The Mighty Levaquin Boy then tells me about how he and his mom are destitute, poor beyond belief, begging in the streets, "gotta eat to live, gotta steal to eat," dirt dog poor. Oh please mister pharmacist, could you please, oh please do something?

We've been dispensing Levaquin to these people for three years now and I'm in the holiday spirit, so I tell him I'll sell him the meds at OUR cost. We're not losing any money (much, anyway) and he's getting the deal of the century. Levaquin Boy counters with, "Will it be less if I only get half the steroid?" I do some more computing and I get him an amount he can live with. I fill it, hand him info I printed on the interaction between Fluconazole and Levaquin, and send him on his merry way.

I'm proud of myself. I've helped someone who genuinely needed help. Poor 27 year old kid, living with his mom and can't find a decent place to live anywhere because everywhere they've been is infested with mold. How odd that I have multiple patients who live in the same apartment complexes that the Levaquin Lady has lived in but they've never had any problems. Despite all that, it seemed that Levaquin boy was genuinely in need of assistance. I did my good deed and Goofmart Pharmacy looks great in their eyes...

But back to today... as I'm filling the latest round of Levaquin for the Levaquin Gang, I notice something different about Levaquin Lady. The tech takes the meds to check her out (Nine minutes have passed during my flashback and she hasn't moved). 

"Mrs. Levaquin, your hair looks different," I say. It does look different. She's gone from being a blonde to a redhead and has a new hair style.

"Oh, yes, do you like it?" she asks? "I just had it done at [name of expensive hair salon] yesterday."

"It looks nice," I said, then added, "That was a really nice gift someone purchased for you." I admit, it was a loaded question.

Levaquin Lady responds, "Oh, no! I paid for it!" as she rolls away.

I'm in shock. Days ago I'm told that her and her son are completely destitute and here she is with a fancy new hair color and style.

Draw your own conclusions. As for me, I'm just the Crazy RxMan, falling for every whim of stupidity known to man.