Tuesday, November 2, 2010

Theater of the Absurd

Prescription medication for customer is being increased from 40mg per day to 60mg per day. Thus, the prescription is written as 40mg tabs, take 1 and 1/2 daily, because there is no 60 mg tablet. Easy -- peezy !!!

Insurance company says no, we will only pay for one 40mg tablet daily. We advise the customer that this medication is inexpensive, and he can buy a month's supply for cash at under $14.00.

Customer says NO WAY and wants it covered under his insurance. Since we're all about the customer service, we send it off to the doctor's office for a Prior Authorization.

A few days pass. A nurse actually calls (!) and says the prior auth is approved. I run the prescription again -- it rejects. I call the insurance company and sit on hold for about 10 minutes. Finally the person on the other end tells me it is approved, but the customer must take three 20mg tablets instead of 1 and 1/2 of the 40mg strength.

OK. I run that through, and the copay is MORE than if the customer had just paid cash for the month's supply of the DAMN 40mg.

Customer comes in later, and when given the two options elects to pay cash price for the 40mg. Customer also is pissy and registers his unhappiness that the insurance company is telling him 'what to do.'

I wish I could total up the salaried time that everyone involved spent on this. Sometimes you just have to laugh in this job. And again, I am reminded of (a) why healthcare is so expensive in this country, and (b) why your prescriptions take so long to fill.

On another note........ we all hate it when management dictates we have to give a spiel to the customer at checkout, whether it be upselling or telling them about a special or asking for a donation to something. I was reminded how much I hate this myself when I attempted to buy a cheap paperback book the other day at Barnes and Noble.

Check out lady: Are you a member with us?
Me: No.
C-O-L: Do you know about the program?
Me: Yes, and no thanks.
C-O-L: Would you like to donate a book to our book drive?
Me: Not at this time, thanks.
C-O-L (now typing into the computer): What is your e-mail address?
Me (out loud): I don't use e-mail.

By the way, I TOTALLY lied cause I do use e-mail!!

Can't wait for the Christmas shopping season.


Anonymous said...

Lol! Speaking as a former Barnes and Noble employee, we hate all those damn questions as much as, if not more than the customers. Different retail, different schpiel...

Grumpy, M.D. said...

Recently I tell all my patients on generics to ask what the cash price is. Even for my own cholesterol junk it's cheaper than my co-pay.

lovinmyjob said...

I actually remember back in the day when there was no such thing as rx insurance. The only thing we had to deal with was state Medicaid. Once insurance started becoming more "popular" and everyone started having it, that's when I started to see prices climb. Then direct to consumer adds started popping up and again prices started to climb. Next came PBMs and once again prices climbed. My "theory" is that all of this crap has cause A) the customer to have not freaking clue how much their meds really cost B) why it takes so long to fill an rx and C) it allows drug companies to charge whatever they want because "the insurance will cover it". Once again, I say we don't need healthCARE reform we need health INSURANCE reform. I am insulted by the term "healthcare reform" because it suggests that those of us providing the CARE are not doing our jobs thus Uncle Sam has to step in and tell us how to do it. When, in fact, its the insurance industry that needs to be told "hands off" and let us do our jobs!!!

The Redheaded Pharmacist said...

And people wonder why healthcare costs so much. All this wasted time and manpower dedicated to jumping through the inevitable 15 hoops it now requires for an insurance company to pay for one generic medication. This is why I have concerns about healthcare reform: does it really address any of these critical issues that actually impacts quality and price of care?

Unchained Pharmacist said...

A lot of the delay and stupid things are because the 1-800-overseas people are NOT allowed to make any decisions. Come to think of it, they are like the pharmacy tech in California. Our laws here prohibit techs from making any decision that requires exercising judgement. But I digress.

Insurance companies need to either give their customer service people the ability to make these calls or replace them with people who can.

I am sure we would rather hold 10 minutes to talk to someone who can resolve the matter in 5 minutes than hold for 5 minutes and spent 20 minutes being bounced from person to person and having to explain the situation over and over again (I thought warm transfer was the standard in customer service).

Sarah G said...

Where did you find a CHEAP paperback at B and N?