How to tackle this situation (Walg)

[Charcoales]

Its 8pm. Pt's State Ins only covers 30 day supply of expensive antiseizure medicine, and the ins office is closed. Pt says they are going out of the country for 3 months tomorrow at 7 am.

I should just tell them to pray we can mail it to them before their 30 day Rx is up or to postpone their trip till we can talk to their ins right?

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[CetiAlphaFive]

Its 8pm. Pt's State Ins only covers 30 day supply of expensive antiseizure medicine, and the ins office is closed. Pt says they are going out of the country for 3 months tomorrow at 7 am.

I should just tell them to pray we can mail it to them before their 30 day Rx is up or to postpone their trip till we can talk to their ins right?

Ok, I'm gonna make an assumption:
There are really only two options here if you're operating under the assumption that this guy is going to drive home, immediately have a grand mal and die, with the family suing you for millions.

You either give them an emergency 3 day supply, or you lie by saying you have 0 in stock.
The key here is that the only choice you cannot make is to simply refuse to fill a prescription.

What a patient does or doesn't do regarding a vacation is of no concern to you.

Just document everything in their profile.

 

[Sine Cura]

This happens once in a while where I work. They can get 30 days and suck it otherwise or pay cash for the rest. Do not bill every month to cover 3 months, do not call for overrides. If the patient wants an override, THEY can call first. BTW, all prescriptions can be filled without "insurance" subsidy! You are not really refusing to fill a prescription ever except for reasons of abuse/diversion.

Typically most people who do this are people you don't want at your pharmacy where they want **** at the last minute without working ahead of time. If you give a pharmacy time, ok. If you don't, go fly a kite.

The best part is when they are on Medicaid yet they can travel out of the country for months?

 

[owlegrad]

What's the problem? They can pay cash or hope they can get it in the other country. If they wanted the insurance to pay for it they needed to do it enough in advance to get it approved.

I am not unsympathetic though I was surprised how often this came up when I worked retail. Still there's nothing you can do. I'm surprised you would even be willing to mail it to them.

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[M0df]

It is really not your problem, especially at Walgreens where your hands might be tied on doing certain things. Of course you can go above and beyond reasonable service and give yourself a headache for months to come. I would just tell their relative/friend to mail it for them. I would not take on liability of mailing something out of the country and take a chance on it getting lost.

 

[ChalupaBatman86]

Its 8pm. Pt's State Ins only covers 30 day supply of expensive antiseizure medicine, and the ins office is closed. Pt says they are going out of the country for 3 months tomorrow at 7 am.

I should just tell them to pray we can mail it to them before their 30 day Rx is up or to postpone their trip till we can talk to their ins right?

It is illegal to mail medication outside the country unless you are licensed as an exporter. They can probably buy it OTC there.


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[txpharmguy]

They shouldn't have waited. Not your problem. Sell 30 days on insurance. Offer to sell other 60 days cash. If they're can't afford that, that's unfortunate, but not your problem.

 

[Sparda29]

Give them the 90 day supply, and bill 2 refills when the time comes.

 

[trailerpark]

Poor planning on your part does not constitute an emergency on my part.


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[farmadiazepine]

The same medication will be in another state if traveling within the US or in another country if traveling internationally. Patient can pay cash for the other 60 days of medications. If they can afford a 3 month vacation, they can afford their medication.

I have been making over 200k a year since I became a pharmacist about 6 years ago. I can't afford a 3 month vacation.

 

[Charcoales]

Great replies. We just gave them the 30 day supply and told them they would need to find a way to get the rest; maybe family mailing to them or getting the med there in the place they are going otherwise not much we could do.

 

[BidingMyTime]

Give them the 90 day supply, and bill 2 refills when the time comes.

Oh Sparda. You bring spirit to this board, I will be saddened the day I learn you are in federal prison for insurance fraud.


To the OP, from what I've learned, most state insurances don't do vacation overrides (I suppose they reason, if the person can afford a vacation, why are they on state insurance?) Granted there are hardship cases, maybe they had a family member die overseas and are rushing out of the country....but ultimately, the bottom line is, unless you are running a charity, they pay cash or *they* figure something else out (ie like have a friend pick up the prescription for them next month and mail it to them.) You didn't make their insurance rules, so it's not your fault if they can't have 3 months of their medication.

 

[Digsbe]

Cash it out if insurance won't cover it and you can't call them. There is literally nothing you can do and it's not within your power to work an insurance miracle. FYI, most countries likely won't let them import more than a month's worth of medicine and they'll need to arrange for care in the country they are visiting. Many Asian countries completely ban amphetamines and each country has their laws on importing prescription meds for personal use and nearly most have a quantity limit. I also wouldn't try internationally mailing a prescription medication to another country... Pharmacists need to stop trying to do things outside of our power, patients really need to own these healthcare issues as we are not the insurance company or prescriber.

When patients come up saying they lost/had their meds stolen and their insurance is kicking it back due to it being too soon I always tell them to call their insurance and explain the situation because 9 out of 10 times if I call they'll want to hear that info from the patient and not from me. I also don't have 20 minutes to spend on the phone for a fruitless conversation that is also out of my hands only to tell the patient that they need to call because they want to hear that from them, the policyholder asking their policy for an override. Some get angry, but I do explain how "well, if you lost it they'll want to hear that from you, and if it got stolen they may ask you about police report details that I obviously do not have."

 

[Sparda29]

Oh Sparda. You bring spirit to this board, I will be saddened the day I learn you are in federal prison for insurance fraud.


To the OP, from what I've learned, most state insurances don't do vacation overrides (I suppose they reason, if the person can afford a vacation, why are they on state insurance?) Granted there are hardship cases, maybe they had a family member die overseas and are rushing out of the country....but ultimately, the bottom line is, unless you are running a charity, they pay cash or *they* figure something else out (ie like have a friend pick up the prescription for them next month and mail it to them.) You didn't make their insurance rules, so it's not your fault if they can't have 3 months of their medication.

How is that fraud? The patient is getting everything the insurance paid for. There is no malicious intent.

 

[ldiot]

Either sell them the 30 plus the other 60 for cash or see if there is a vacation override/clarification code you can submit with the claim without needing to call the insurance to get it covered. If they refuse to pay cash then at least make sure they leave with the 30 tablets so you aren't putting them in any danger. You might even be able to sell them for cash and then refund them later if the vacation override goes through.

 

[M0df]

How is that fraud? The patient is getting everything the insurance paid for. There is no malicious intent.

Well you are billing for a service on a particular day that you did not provide on that date. In addition, you are taking a risk from purely business position that your patient will still have insurance and that drug will be covered in 30 days and in 60 days.