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.