Monday, September 2, 2013

And how will you be paying for that?

CrazyRx Man recently posted "Why it takes TIME to get your Rx filled" and it was a great summary of all the potential obstacles, safety steps and other assorted procedures your pharmacist must perform before handing you those pills in a bottle.   It made me want to elaborate a little more on the step which involves submitting the claim electronically to your insurance, because people sometimes just don't get it that this is the PAYMENT step.  And just like any other retail transaction, we can't let you walk out with the goods until they are paid for.

Most people pay for stuff nowadays with a credit or debit card.  As long as you swipe your card and it is not 'declined' you are on your way.  Now imagine if there were conditions put on that card (like an insurance plan would do) which involved more than just having money on it.   To use my favorite analogy, let's say you are buying a new couch at a furniture store.  You swipe your card at the sales desk and any one of these messages pops up on the screen:

1. Too soon!  You bought another similar piece of furniture 3 months ago. There's no way that could be worn out yet.  You're gonna have to call us and explain yourself.

2. Prior authorization required!  That is a very expensive leather sofa.  We need to know why you can't get something cheaper.

3. Plan limitations exceeded! We'll only let you buy one with 2 cushions, not 3.

4.  Plan limitations exceeded! We prefer you to buy Sofa World brands, not Sofas 'R Us.

5.  Invalid days' supply!  You need to estimate how long this couch will last you.  We think it should be 12 years, not whatever you put in.

6.  Step therapy required! We need you to try a loveseat before you can move up to the full-fledged couch.

7.  (And if none of those get you...)  Card number not found! The number on your card is NOT the same number that we need to process this purchase.  You need some other numbers which we're not going to tell you until you have been on hold with us for at least 10 minutes.

No wonder I need some couch time when I get home from work.