Thursday, October 27, 2016

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.


Anonymous said...

I didn't blame the pharmacy but unfortunately, no one at my insurance company could tell me either.
30 minutes on the phone with my insurance company and all they could tell me was that my policy was unchanged from last year. Not one word changed. But they contracted with a PBM(I didn't, they did) so they forwarded me to them.
Another 30 minutes and they couldn't tell me why my cost went up(I have a high deductible. Once that is meet my cost is $0. There is no co-pay, no co-insurance, nada once the deductible is met. Had the same insurance with the same company paid for by the same employer (which happens to be me)).
After over an hour on the phone with both companies they couldn't tell and promised they would call me back the next day. A week later I had heard nothing and had received no mail. Called them back. Around the merry go round again with no info.
Eventually decided $13/month wasn't worth over 2 hours of my time and gave up. The next year, when insurance renewals were due, I asked the insurance rep about it. Got an answer. It made sense but at the same time, I never received a letter explaining the change before or after. The face sheet explaining benefits without all the 30 pages of legalese didn't mention it, and the representatives of the company itself didn't know it even when given 2 hours(and a few weeks) to figure it out.

Unknown said...

I wouldn't believe Crazy either, especially when I see his Escalade parked in back every day. Damn lying, rich pharmacists.

Anonymous said...

My favorite is when they say that it costs more than last time and want to know why. You look up the record in the computer system to check if it was billed differently at all. And you report back to them: This is the same price you bought it for the last two times you've gotten it. And they say, "It is? Oh."

tbunni said...

We get the same thing with patient copays here at the doctor's office, too. Many times just after the new year, and guess what? yep - new policy, even though their insurance company, etc. stayed the same, the copay went up. And most ID cards don't state the copay because they change so often!

My favorite one was a feisty gentleman, not yet elderly, but practicing, I think, who informed me that I should absolutely know what his copay and deductible were, since I set them. I hated to let him know that I really didn't have that kind of power...sigh....