Monday, May 30, 2016

Stopping the Nazis

A tall, muscular dude with tattoos steps up to the drop off window. He has a script for Oxycodone 30mg.

"Your store down at Bedlam and Fastway sent me over. They said you have Mallinckrodt brand."

Oddly, that store had called about 15 minutes previously and asked if I had Oxy 30. I had told them no.

"We're out. We've had trouble with the paperwork with our supplier lately. We're waiting for an order to come in tomorrow," Flynn tells them.

Meanwhile, I'm starting to get angry. I'm wondering why the tech or pharmacist (that called about our Oxycodone supply) still sent the guy to see me. 

"It's those damn Jews on Wall Street," the guy spits out, like he has some inside knowledge as to our supply issue. He reaches up to scratch his head and I can see a swastika tattoo on his arm. He's a Nazi thug.

NOW it dawns on me... the ladies at the Bedlam and Fastway Goofmart sent the thug over so I can deal with him. 

Thanks, ladies.

<cue Indiana Jones Music>

Now at this point I'd like to say that a scuffle occurred and there were many bruises and bloody lips. 

I'd like to tell you that I beat that Nazi thug but good while the crowd that formed at Goofmart cheered me on. Most of all, I'd like to tell you that Karen Allen was there to make out with me after the fight.

But instead I can only tell you that the guy just walked away.

<Indiana Jones music ends, abruptly>

Saturday, May 28, 2016

It Starts with an "M"

"Where's your mouthwash?" she asked.

"It's on aisle eight," I reply, "On the left."

"I was just there. I didn't see my mouthwash. I can't think of the name of it. It starts with an 'M'."

"I'm sorry, I don't know mouthwashes, and I'm not good at Scattergories."

<blank stare>

I step to the computer and type in "Mouthwashes that begin with M" into a Google search. I find a website that lists about 20 different brands. I start asking her, going down the list. And none of them start with 'M'.

<blank stare>

"I'm sorry, maybe someone from the front of the store can..."

Lady walks away. Not a word, not an insult, nothing. She just walks away from me before I can finish my sentence.

I feel inadequate now. Someone please hold me.

Thursday, May 26, 2016

Throwback Thursday: Expired Insurance Breeds ANGER

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 Expired

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, not looking me in the eye... 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. The anger is back.

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. 

Original Link

Monday, May 23, 2016

Medicaid Mary and a $4 Prescription

How did things get so bad so quickly in our nation? How?

A patient of our Goofmart Pharmacy presents a prescription for Xanax on a busy Friday afternoon. We get a lot of people preparing for their weekend by dropping off narcs and sedative type prescriptions on Friday (despite the fact we're clearly open Saturday and Sunday).

This patient is Medicaid Mary. You might have read about her before here. Her script is for a small quantity of Xanax. The floater tech processes the prescription but it won't go through on the insurance. The rejection looks like she has to go to a specific pharmacy so the tech runs it through on a discount card we use. The cash price is $4.45. That's certainly cheap enough for most everyone.

Among the chaos of phones ringing, people picking up and dropping off, and filling prescriptions Mary's prescription makes it way to the window where another tech tells her that the insurance isn't working but that it is only $4.45. Mary opts to pick up the medication. All is good with the world, right?


An hour later Medicaid Mary's insurance calls. The lady demands to speak to the pharmacist, so the tech hands her over to me. The lady is quite snotty and belligerent. She tells me that Medicaid Mary called and she's upset and that we didn't process the prescription correctly because it is covered in our pharmacy. I try it again. Same rejection, so I start getting belligerent back with the snot-nosed witch on the phone. I tell her that it isn't working and that when THEY fix it I'll try it again. I then tell her I'm busy helping OTHER patients and don't have time to fiddle with a freaking four dollar prescription. I tell her I'll put her on hold while I go be a pharmacist and help the patients with insurance that works.

By the time I get caught up ten minutes later she, of course, had hung up. You see, you wait for insurance on the phone -- they don't wait for you. So you'd think this is over, right?


Ten minutes later one of the sub commanders from the front of the store appears at the pharmacy. He's holding a piece of paper and says that a "customer" is on the phone demanding that he get the following information (BIN, PCN, Group, ID... all the pharmacy goodies that make a prescription process) for Medicaid Mary. After a couple of questions I determined that it is NOT Mary on the phone. Rather it is snot-nosed witch that called the front of the store and demanded that the sub commander go get this information from me.

I don't know about you... but this is the FIRST time anything like this has ever happened to me. What kind of Medicaid insurer calls the grocery and demands information?

I tell the sub commander, all of about 17.5 years old, that he's not HIPAA certified and that I can not and will not release that information to be walked to the front of the store and disappear. I tell him that snot-nosed witch is NOT a customer and if she wants the information to call me. 

"But she said you were mean to her. She doesn't want to talk to you."

I laugh inside. Mean? This is a good day. You should see me when I'm really in a bad mood.

"She needs to talk TO the pharmacy. If she wants the information, she needs to talk to me," I reply. Sub commander walks away. His brainwashing isn't complete yet so I still have some power over him.

Snot-nosed witch finally calls again. I verify the information with her. She fixes something on their end and the prescription processes. Co-pay for the patient? 45¢ Yep. We charged her $4.45 and now owe her a whole whopping $4. I call Mary and tell her we owe her $4. You'd think she'd come back in a few days to get her refund, right?


Within thirty minutes here is Medicaid Mary to collect her $4 refund. Oh, I imagine she probably spent $1 in gas driving to the pharmacy and back based on her address, but that's irrelevant. $4 is $4, and we're certainly not going to let the pharmacy have that $4 overnight.

So... five or six phone calls, multiple people involved, time wasted by me, snot-nosed witch, the sub commander, and my tech all over $4... a Medicaid prescription that taxpayers pay (a WEPAY). This is yet another example of government bureaucracy out of control that costs all of us multiple times over. And because it's not my money directly, you think I should be ok with all of this?