The Disconnect Between the Customer Service Line and the Pharmacy Help Desk

Every pharmacy employee has been through this situation, and we all know how much it sucks....

A customer comes to the pharmacy with a nice upper respiratory tract infection for which her doctor (most likely inappropriately) prescribed some expensive antibiotic (we'll say Levaquin for this example). You got to fill the prescription for her, and you get the message "Covered Terminated." That beautifully simplistic message is usually the beginning of a stressful and frustrating customer encounter.

You get the attention of the waiting customer to tell ask her if she has a new insurance card. Of course, she does not. You then ask if anything has changed in her job since the time she last filled a prescription. From here, the story can vary a little bit. Sometimes she'll say "no, everything is the same." Other times, she'll all of a sudden remember that she just changed jobs a month ago. In this example, the customer changed jobs, but never received an insurance card.

From here, the standard advice is to tell her to contact her human resources department; They can give her the number of her PBM, and she can call to find her coverage information. She complains a bit, but after you assert that there's nothing you can do, she leaves to make a few phone calls. Before leaving, you tell her to make sure she gets the correct BIN, PCN, ID#, and RX Group, which will ensure you'll have all the information necessary to bill her PBM.

An hour or two later, she calls the pharmacy saying she has all the information. However, the only information she has is that her insurance is through (insert big name PBM here because apparently I can get in trouble over using an actual insurance company name in a fictitious example). She called them, but they wouldn't give her ID#, and instead, told her told her that the pharmacy can call this 1-800 number, and he'll be able to get all the information.

Of course, this makes you flipping mad because there's no good reason why her insurance company would deny telling a customer her own ID#. Now, because the PBM is so fucking stupid, you have to waste 10 minutes of your valuable time calling to get the processing information that A) they should have sent to the customer in the form of an insurance card already, and B) they could have just told her over the phone.

Then there's the other variation to this story that maybe even more infuriating. The customer calls the customer service line to get the information only to talk to someone who has no fucking clue about how a pharmacy claim needs to be billed. Therefore, the dumbfuck will give the customer the completely wrong ID# (I honestly have no idea where this ID# ends up coming from), and you'll waste even more time trying to bill the claim with the wrong ID#. Eventually, in the name of good customer service, you'll have to call the PBM help desk and ascertain the correct number. Another waste of time.

When this happens, I always make it a point to tell the customer that for whatever reason, the people you talk to when you call the customer service line have no idea what they're doing, and the information they give is almost always the wrong information. It really is a small miracle when customers actually are able to get all the necessary infomation on their own without an insurance card. You'd think it would be easy. You'd think that if a customer call the customer service line and asks for their pharmacy insurance information, all the person would have to do is transfer the customer to the pharmacy department. I guess this requires an advanced degree to figure out though.

One of our clerks (a particularly grumpy old fellow) made a great suggestion. He said that there should be a phone right outside of the pharmacy that has the 1-800 numbers of all the major PBMs programmed into it. If any customer has a problem, we just point them to the phone and tell them to call. I loved this idea, but my only concern would be that there would end up being a line that wraps around the pharmacy 3 times with all the insurance problems that pop up during the day. We'd be better served to have a freaking call center attached to the pharmacy.

Hey... maybe that's the future of pharmacy. You have a a prescription department and right next door, you have a call center with about 10 telephones for people to call their insurance companies.