Wednesday, January 20, 2010

The January Experience

Every retail pharmacist has a wonderful little anecdote about the craziness of working in a retail pharmacy in January. I figured I'd share a story that I feel epitomizes the entire January experience.

A customer comes to pick up some prescriptions. They were filled, but billed for cash because we needed her new insurance information.

"But I have the same insurance as before!!" she exclaimed.

"No, I'm sorry, but something must have changed because when we billed it, it came back 'filled after coverage terminated,'" I replied.

She continued to insist that nothing changed and then busted out her insurance card as proof. It was a Cigna card, and of course, it wasn't a pharmacy card as it didn't mention RX anywhere on the card. I explained to her that it was only her medical card, and she must have a separate pharmacy card.

"This is the only card I got!!!" she asserted.

"Fine... I will call the insurance company, but I guarantee they're going to tell me exactly what I told you," I said to her. Then I proceeded to call them. After 5 minutes on hold, I got to speak to a representative. This representative, as predicted, told me she no longer had prescription coverage with Cigna. However, amazingly, he was able to tell me that her new coverage was through Express Scripts.

I thanked the representative, hung up the phone, and then proceeded to call Express Scripts. After another 5 minutes on hold, I was able to speak to a representative who gave me all the information I needed to bill the claim.

Great! It only took 20 minutes of my time, but I was able to bill her prescriptions to the correct insurance. I told her that she was all set, and she responded, "Did they just change the ID number or something?"

"No... Your insurance is through an entirely different processor now. Your pharmacy claims are now being handled by Express Scripts," I informed her.

"Express Scripts? OHHHHHHHH!!!! So that's what must be in that letter from Express Scripts that's sitting unopened on my kitchen counter!!!" she said.

(FUUUUUUUUUUUUCK YOOOOUUUUUUU!!!!!) I didn't yell out loud but really really wanted to.

Every part of that story is true, and I think it perfectly sums up the entire month of January in the retail pharmacy world. We waste so much freaking time trying to bill and rebill insurances because customers are too fucking stupid to bring the new insurance card to the pharmacy.

Furthermore, how can you not know what benefits you have? I don't know how other places work, but I know that every year, I'm responsible for choosing my benefit options. I must enroll in medical, pharmacy, and dental plans. I get a big information packet that fully explains all my options. Is this unique to my employer? Is it really a big mystery to some people?

And while I'm ranting, why the hell do people save old insurance cards? I get so annoyed every time I ask someone for a new insurance card, and they pull out a wallet containing every insurance card they've ever been issued for the last 15 years. Get rid of the old cards! You don't need them anymore. Even if by some incredibly small chance you do need one of them some day, just keep them at home. Why do they all have to be in your wallet?

I had another conversation with a different customer about why her copay suddenly jumped from $10 to $40.

"Why is it so much now? It's always been $10!" she said.

"Ma'am, it was $10 on your old insurance. You have new insurance now, and they're charging a $40 copay," I tried to explain.

"But, why would it suddenly go up when it was always $10," she once again stated.

"That... was... your... old... insurance. This is a different insurance plan," I tried to spell out as clearly as possible to her.

"Whatever... I don't get it. I'm going to call them to complain," she said becoming irritated.

"Good... You do that," I replied.

I hate to side with insurance companies on anything because they make our jobs about 100 times harder than they have to be. However, often times, the customer's stupidity is just as much to blame for these situations. Whether it's not bringing in their new insurance cards, not knowing that they have new insurance, or not understanding that different insurances have different formularies and copay structures, customer stupidity is just as hard to deal with as insurance company stupidity.

I can't wait until this month's over. Who am I kidding though? February is only marginally better.


Anonymous said...

"We can hold your medication while you get the copay situation settled with your insurance or you can pay the copay."
If you do not train your patients to take some responsibility, you are making more work for yourself now and in the long run. My pharmacy manager has most of the regulars pretty well trained that insurance is their responsibility.
That does not mean we will not help patients who are truly confused or getting the shaft/lost in the mix of their insurance company, because we will help when the situation calls for it.
January is the pits though when it comes to insurance complaints!

Frantic Pharmacist said...

And after going through all that for a customer, my greatest wish is to say, "Just so you know, I was under NO OBLIGATION WHATSOEVER to make those calls for you. So just remember that the next time you want to transfer all your prescriptions out of here for some stupid gift card...."

Anonymous said...

Print out the insurance rejection, staple it to her bag and if she gets her panties in a bunch, have an extra phone w/a super-long cord at the ready. Let her deal with the ins/PBM...give her the distinct pleasure of seeing her ins premiums at work. I didn't go to p-school to be someone's secretary. Medical or safety issue and I will twist myself in a knot for you to get it sorted out. HOWEVER, if you can't spend at least as much time to get to know your insurance as you do to research that 50inch flat screen you have hooked up in your double wide, that's not my problem. You can't go to the mall or out for dinner and have the cashier or waiter call Mastercard when the card's refused.

Jaded Pharmacist said...

Of course you can't forget the other player in the January Experience. How about them deductibles, huh?

Whether a patient forgets they have a deductible or adamant they don't, it's annoying when it happens. Luckily I'm able to explain it to most people but those that just get pissed because "we're overcharging us and it's total BS" are the ones I want the throw out the door...

Anonymous said...

I think you should get this post published in some major newspaper. :)

Anonymous said...

My pharmacy fills 600+ per day. For the first few weeks, everyone was rejecting. Unless they were physically in the store, we didn't even bother calling them because we don't have the staff to make 600 phone calls a day. We just let people show up, and if they started to yell, we'd tell them to take it up with their insurance company. I keep hoping for the day I go in and don't get yelled at by the person who wasn't smart enough to remember to enroll in Medicare D for the new year.

I can't believe you actually made the effort to find this woman's information. I would have told her to call her company's benefits office.

Anonymous said...

I'm inclined to believe it's the classic 'head in the sand' idea.

For a long time, I really had no clue about health insurance. It was just something I signed up for at work that kicked in if spouse or kids had a health matter that required use of secondary or tertiary healthcare providers. Since we were terrifically
'healthy', didn't go for yearly physicals, rarely saw a doc, arranged kids' sports physicals at school, picked up scripts at just over cost from hospital pharmacy where I worked, brushed and flossed religiously, (eye exams weren't covered anyway), we didn't use health insurance 'benefits'.

For a long time, insurance wasn't offered in the part-time jobs we took as undergrads, and we couldn't get it anyway because of pre-existing conditions (long time resolved, yet still 'pre-existing' which made us ineligible). For many years we didn't use insurance.

It's only been recently with a major illness, that we used health insurance, and finally had access to prescription drug 'benefits'. Since it had a high deductible, we always paid cash, anyway.

So, my idea of health insurance, prescription drgu benefits, etc. has always been jaded. It seems all a big bloated set-up with Medicaid backdoor pricing agreements with manufacturers, Medicare and AARP reimbursement agreements. When was the last time someone used the Red Book to set a prescription price? I know about drug costs and AWP from before every business was involved in contractual insurance agreements and pricing, monopolies, the deep
discounter, marketing costs, how drug companies make arrangements with the FDA for indications that drug insurance companies will reimburse pharmacies, and competitive pricing in a town, etc. And, so, when I receive my own insurance card in the mail, I look at it with the jaundiced eye of an educated consumer, and tell myself, 'so this is the starting point' of what my maintenance med script might cost' if I get it filled here or there or somewhere else. I wonder at the reality of what my prescription costs me, and how much I pay for it. Like, what would I pay if I filled my own script online from someone in Bolivia, ordered it and dispensed it from my hospital pharmacy, had it filled through the mailout service, filled it at retail or independent, bought it brand name at a specialty clinic, or picked up cash at Wal-mart for $4? All these options have made the idea of simply using my own little insurance card at the 24-7 chain half a mile away seem surreal, and the matter of changing co-pays, or a new card in the new year, or other issues, seem irrelevant (head in sand), when there's only one script for thyroid hormone replacement pills.

My spouse still refuses to use any medication. When he broke his thumb which required surgical repair, the physical therapist insisted that he take something the first week before his therapy session so that he could get a good workout, but he flushed the Lortab after that, and managed to regain complete mobility without use of pain-killers.

Based on my experience as a hospital pharmacist, in the last 50-60 years using prescription drug benefits is relatively new to people that had always been healthy, and had no need to acquire prescriptions from regular retail pharmacies.

Whereas, some people have been
'born' into the luxury of using prescription drug benefits from a regular job and know the ins and outs, and think it's more than just some fragile artificiality set up for taking care of costs of drugs for some working people.

Ashley said...

I hate when its the same insurance...but suddenly the price goes up.

"why is it $40, when its always been $10?"

me-"idk...your insurance may have changed some of your plan."

"no-its the same. why are YOU charging me more?"

Same spiel over and over again!

Anonymous said...

Don't stop posting such articles. I love to read stories like that. BTW add some pics :)

pharmacy chick said...

Lets not forget "formulary change" mike. OMG. we have one HMO who I think trashed their entire formulary and made a new one, making sure that nothing that was covered LAST year was covered THIS year. I have a box full of PA requests for drugs that were covered last year but not this year. And yo know what? I just dont care anymore. I send them off and if they dont adjudicate, I tell the patient to call their dr or insurance. I don't have time for this crap anymore.

Anonymous said...

OMG! I totally agree with you.
Hate those insurance and deductibles! People just don't get it. And why do I have to spend 20-30 minutes to deal with your stupid insurance coverage? There are other customers waiting to be served, too. They just keep complaining and complaining. Geez

Meghan said...

Perhaps signs in every pharmacy would be appropriate. "It's the new year pharmacy patients. This means we need your NEW prescription insurance card. We are unable to look up everyone's information. If you don't have it expect to pay the full cash price. Thank you, pharmacy staff."

Anonymous said...

In a dream pharmacy we would have phones with a direct link to all of the insurance companies and just point them out to the patient. We often answer the questions about insurance with this line " I'm sorry, it's YOUR insurance and privacy issues prevent us from getting that information." Puts it back in their hands.