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"That's because the information on this card is outdated.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

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Anonymous said...

I no longer work in retail any more (Halleluja), but a little part of me still dies whenever I hear stories like this.

Anonymous said...

The competitor filled a C2 script and let the patient walk off with the original prescription?

Anonymous said...

I still can't wrap my head around the concept that people expect us to figure out their insurance coverage.

I feel like I always come back to this but do these idiots throw a fit at their local MegaMart when their credit cards don't work? Do they scream at the cashier saying they have to look up their information because their cards are 'current?' Of course not. They just cook up some other lame excuse to emotionally vent on some poor soul in retail just so they can get a gift card or whatever.

You know the movie 'The Purge?' We should have the non-fatal equivalent for retail. ALL retail. And the actual day is not released to the public. On said day, short of committing homicide, we retail folks can do anything and everything we want. Act like a spoiled 2 year old and treat my staff like crap? They get to line up and punch you in the face. No insurance? GTFO while I laugh like a hyena in your stupid face. Try to call corporate to complain? The call reroutes directly to me where I get to keep on laughing like a hyena while I kick your ass just for the hell of it. On welfare and somehow live a better lifestyle than me or my staff? We kidnap your parasitic ass and throw you into a room with other welfare parasites where you can Thunderdome it until only one person is left standing. The prize? I'll waive your copay.

Can you tell my staff and I have weird conversations?