Initiating RX claims to find out prices, without having the hard copy

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GreyFox2002

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Typical scenario: Patient calls pharmacy, says Dr. wrote for "over priced acne medication." Wants to know price. You tell them their Benzoyl Peroxide 3.746 % costs $150 for a tube, and they freak out and tell you they have Blue Cross and want to know their copay over the phone.

What exactly is the rule? Can you file a claim with a test rx, or is this technically fraudulent?
 
As an intern with a major chain for more than a year and a half, take this with a grain of salt. The pharmacists I work with are ok with telling a customer the price w/o Insurance.

It's typically frowned upon to put an Rx in without the script in front of you but I've seen several lead techs put it in for some patients with the script in front of them. Never over the phone though.
 
I don't know if it's considered fraudulent or not, but I still wouldn't do it. Running fake scripts is a waste of our time, and if they really want to know the price before they come in they can typically call their insurance company to figure out their copay.
 
I wouldn't give them the price with insurance until the prescription was in front of me and it was complete.
 
Our system has a function called formulary check that allows for the drug, qty, and day supply to be entered and get a price from an ins, though I typically only allow this to be used for doctors on the phone because I can't rely on patients to convey rxs accurately and if you have the rx, no reason to not just fill it.
 
Seriously? In my 10 years of practicing, ive done this numerous times for patients. Ive never been in trouble with anyone. Now, if you're a busy store and dont want to deal with it fine, but if you have the time, why not do it? I just tell the patient that the price im giving them is based on the information they have given me. Patients usually appreciate it...I dont mind doing it.
 
Yeah, no harm as long as you reverse it once you're done. I agree with Doctor M that you need to protect yourself by telling the patient that the quote is based on the information that they provide. Better to provide them this information over the phone than to get the script, fill it, have them come in to pick it up only to tell you at the register that they don't want it and now you have to return it to stock wasting more of your time and their time. The formulary check is also an option, but isn't always accurate and provides less information as it will only say "rejected" and not provide any reason for the rejection.
 
Seems like too much of a hassle for me. Have them call their insurance and find out what their copay would be. This should be the routine instead of having us jump through hoops on the possibility that they may give us a script. I also have patients do the same for vacation overrides, if they know in advance that they will be leaving.
 
Doctor M said:
Seriously? In my 10 years of practicing, ive done this numerous times for patients. Ive never been in trouble with anyone. Now, if you're a busy store and dont want to deal with it fine, but if you have the time, why not do it? I just tell the patient that the price im giving them is based on the information they have given me. Patients usually appreciate it...I dont mind doing it.
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I agree. I do it too. Other people I work with always seem to give people a hard time about it, and then they end up arguing with them. It doesn't take long to do, why not just provide the customer service? I once heard that the corporations don't like to do it because each one costs a few pennies or something. I'm not sure if that is even true, and even if it is, I hardly think the number of times we do it would really break the bank.
 
It does cost money every time you submit a claim, but I'm not aware of the extent that non-productive submissions have overall.

I wish people would just visit their PBM website and see if they have a formulary checker, because many of them do. That way they can check their co-pay every time they get a new Rx.

CVS has a formulary checker, but we don't have one where I work. I just tell people the cash price and that it will probably be much cheaper with insurance (if it's something simple like a Z Pack or something). I will only check their co-pay if they give me the Rx like their going to fill it.
 
GreyFox2002 said:
Typical scenario: Patient calls pharmacy, says Dr. wrote for "over priced acne medication." Wants to know price. You tell them their Benzoyl Peroxide 3.746 % costs $150 for a tube, and they freak out and tell you they have Blue Cross and want to know their copay over the phone.

What exactly is the rule? Can you file a claim with a test rx, or is this technically fraudulent?
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There is nothing fradulent about it. However, think about what your doing. What the insurance company will charge the patient is between the patient and the insurance company. All we do at the pharmacy is bill the claim for them. We are not affiliated with the insurance company in anyway. If a customer wants to know what the insurance company will charge for thier medication I tell them to call the number on the back of the insurance card and ask them. Running a claim through without the prescription costs the pharmacy money in labor and for the transmission as well as creates holes in your prescription files.

I am so sick and tired of irresponsible people who think the pharmacy is responsible for thier insurance. I do not think it is good customer service to baby people on thier insurance. It is thier insurance and thier responsibility to know the details of thier plan. My responibility is to send the claim to them and collect the co-pay. If a customer wants to know why the co-pay is so high, why it is not covered or anything else I tell them to flip that card over, dial the number and ask them why.
 
pharaday said:
I agree. I do it too. Other people I work with always seem to give people a hard time about it, and then they end up arguing with them. It doesn't take long to do, why not just provide the customer service? .
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As I mentioned above I think you are doing the customer a disservice. People need to be responsible for themselves.

pharaday said:
I once heard that the corporations don't like to do it because each one costs a few pennies or something. I'm not sure if that is even true, and even if it is, I hardly think the number of times we do it would really break the bank.
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Take a company like CVS with over 6000 stores. If each store does several price check claims a day times 6000 plus stores it can add up.
 
R2pharmD2 said:
I don't know if it's considered fraudulent or not, but I still wouldn't do it. Running fake scripts is a waste of our time, and if they really want to know the price before they come in they can typically call their insurance company to figure out their copay.
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This is exactly what I tell them.
 
On many, many PBMs' websites, you can check the co-pay beforehand. People do not like doing a little bit of work. I do not know your insurance policy. That is your responsibility.
 
when i worked a 50 a day store, id do it

when i worked a 500 a day store, id tell them to call the # on the back of their card
 
I am surprised how many people will not do this. If you delete it out after typing it, I don't think you are charged for submitting it to begin with - I could be wrong, but I don't think they charge for a claim that is reversed.

Either way - if you won't, they will find a pharmacy that will. Why lose the business? Sometimes I will say, in the future you can also call the number on the back of your insurance card. Most of the time I just run a formulary check, I wasn't aware that not all pharmacies have this?
 
MountainPharmD said:
There is nothing fradulent about it. However, think about what your doing. What the insurance company will charge the patient is between the patient and the insurance company. All we do at the pharmacy is bill the claim for them. We are not affiliated with the insurance company in anyway. If a customer wants to know what the insurance company will charge for thier medication I tell them to call the number on the back of the insurance card and ask them. Running a claim through without the prescription costs the pharmacy money in labor and for the transmission as well as creates holes in your prescription files.

I am so sick and tired of irresponsible people who think the pharmacy is responsible for thier insurance. I do not think it is good customer service to baby people on thier insurance. It is thier insurance and thier responsibility to know the details of thier plan. My responibility is to send the claim to them and collect the co-pay. If a customer wants to know why the co-pay is so high, why it is not covered or anything else I tell them to flip that card over, dial the number and ask them why.
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I agree with you Mountain- I get this question asked often and I refuse to do it- no because I am lazy or selfish but because of the reasons cited above. I think some people really have to take responsibility on their own.
The only time I will doing something close to this is if I get a prior authorization let's say the insurance company doesn't cover Nexium- I may change the drug to Protonix, Aciphex, or Omeprazole just to see which one it will cover and then inform the customer and/or MD's office and I only do that if I am working on that problem as it arises but generally I do not type in a script if it's in front of me.
I have a Flexible spending account- what if I contacted my Dentist office and said run a claim though for veneers I want to see if my FSA or my Dental insurance will cover it- Do you think the Dentist office is really going to do that for me? Whoever said it was good service imagine if you had tons of these request coming through daily or if you think it's a good idea post a sign outside your Pharmacy that reads:"calls us before you bring in you prescriptions and we will tell you exactly what each medication cost- imagine the extra labor, time wasted, revenue wasted(albiet small it's still money) paper wasted, etc.
 
We live and practice in the USA, ground zero of narcissist central. So you guys are going to take a stand because people should take care of themselves? You must smoke some funny cigarettes. You are not going to change anybody. It takes the exact same time to do it as it does to tell them no. The test claim is built into the CVS computer as a Formulary check since it is now recognized by the NCPDP as a vailid submission.
 
I'd do this for the most part and it's amusing to me that so many people refuse to do it. It's like people get off on refusing to help.
 
As someone who has worked for a place that was audited more times I can count, I can tell you that it is legally considered fraud to bill for a prescription which you do not legally possess. In some states, you can have your license revoked just for that.

And depending on how your contract is setup, the majority of the time you are billed for that submission and a reversal will not get rid of that charge. If, for whatever reason, you are audited by the PBM or a state/federal agency and they happen to audit that particular transaction... well you're screwed.

The odds that they will leave for another pharmacy because you won't check a copay price is a bit ridiculous. If they're going to leave for that reason, they wouldn't be worth having as a patient anyways because they'll find some other minute reason to bolt.

Remember, just because they want to give your pharmacy business, does not always mean that it is good business.
 
phathead said:
As someone who has worked for a place that was audited more times I can count, I can tell you that it is legally considered fraud to bill for a prescription which you do not legally possess. In some states, you can have your license revoked just for that.

And depending on how your contract is setup, the majority of the time you are billed for that submission and a reversal will not get rid of that charge. If, for whatever reason, you are audited by the PBM or a state/federal agency and they happen to audit that particular transaction... well you're screwed.

The odds that they will leave for another pharmacy because you won't check a copay price is a bit ridiculous. If they're going to leave for that reason, they wouldn't be worth having as a patient anyways because they'll find some other minute reason to bolt.

Remember, just because they want to give your pharmacy business, does not always mean that it is good business.
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You are woefully out of date. do you know what NCPDP is? They have the formulary check or test claim or built in to their lastest standards which all PBMS recognize. SO no fraud is involved. You need to keep up with what goes on in your industry.
 
Old Timer said:
You are woefully out of date. do you know what NCPDP is? They have the formulary check or test claim or built in to their lastest standards which all PBMS recognize. SO no fraud is involved. You need to keep up with what goes on in your industry.
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Hmmm so what you're saying is that what three PBMs have told me in the last year and a half is wrong? Best make sure you let them know that.
 
owlegrad said:
I am surprised how many people will not do this. If you delete it out after typing it, I don't think you are charged for submitting it to begin with - I could be wrong, but I don't think they charge for a claim that is reversed.

Either way - if you won't, they will find a pharmacy that will. Why lose the business? Sometimes I will say, in the future you can also call the number on the back of your insurance card. Most of the time I just run a formulary check, I wasn't aware that not all pharmacies have this?
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You are charged by the processor. They charge you for the claim and then the reversal. Also, you spend your time, which costs your company money.

I don't like running rxs without the hard copy for 3 reasons. First, I don't trust the patient to read it right. Second, the more you process, the more likely you are to hit an audit trigger. Third, I have a better chance of the patient filling it with me if they hand over the RX.
 
Old Timer said:
We live and practice in the USA, ground zero of narcissist central. So you guys are going to take a stand because people should take care of themselves? You must smoke some funny cigarettes. You are not going to change anybody. It takes the exact same time to do it as it does to tell them no. The test claim is built into the CVS computer as a Formulary check since it is now recognized by the NCPDP as a vailid submission.
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Ya gotta take a stand somewhere. Every little thing we let go by is one more small piece of the profession destroyed.
 
MountainPharmD said:
Ya gotta take a stand somewhere. Every little thing we let go by is one more small piece of the profession destroyed.
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Do what you have to do. It's so much larger than pharmacy. It's the whole society. You can't change it and it's not worth the hassle to try.
 
bananaface said:
You are charged by the processor. They charge you for the claim and then the reversal. Also, you spend your time, which costs your company money.

I don't like running rxs without the hard copy for 3 reasons. First, I don't trust the patient to read it right. Second, the more you process, the more likely you are to hit an audit trigger. Third, I have a better chance of the patient filling it with me if they hand over the RX.
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1) It's pennies and it's called customer service.
2) There is no correlation between reversed claims and audits.
3) You only have the chance of pissing someone off and losing a customer. No upside for refusing.
 
If you don't work at CVS and you don't have the "formulary checker" you are still charged per submission, and I'm pretty sure it's still not something you are supposed to do unless you physically have the Rx. There is a difference between using a formulary checker and making up a "fake" Rx (even if you intend to cancel it) just because a patient claims they have the hard copy at home.

bananaface said:
You are charged by the processor. They charge you for the claim and then the reversal. Also, you spend your time, which costs your company money.

I don't like running rxs without the hard copy for 3 reasons. First, I don't trust the patient to read it right. Second, the more you process, the more likely you are to hit an audit trigger. Third, I have a better chance of the patient filling it with me if they hand over the RX.
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THIS.
 
phathead said:
As someone who has worked for a place that was audited more times I can count, I can tell you that it is legally considered fraud to bill for a prescription which you do not legally possess. In some states, you can have your license revoked just for that.

And depending on how your contract is setup, the majority of the time you are billed for that submission and a reversal will not get rid of that charge. If, for whatever reason, you are audited by the PBM or a state/federal agency and they happen to audit that particular transaction... well you're screwed.

The odds that they will leave for another pharmacy because you won't check a copay price is a bit ridiculous. If they're going to leave for that reason, they wouldn't be worth having as a patient anyways because they'll find some other minute reason to bolt.

Remember, just because they want to give your pharmacy business, does not always mean that it is good business.
Click to expand...

The larger point is, if you don't take care of your customers they will leave. This is just one small example of a small thing you can do - check the price when asked. Formulary check is quite easy, at least at CVS. I am sure Walgreens has the equivalent. I am surprised that all pharmacies don't.


bananaface said:
You are charged by the processor. They charge you for the claim and then the reversal. Also, you spend your time, which costs your company money.

I don't like running rxs without the hard copy for 3 reasons. First, I don't trust the patient to read it right. Second, the more you process, the more likely you are to hit an audit trigger. Third, I have a better chance of the patient filling it with me if they hand over the RX.
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I am mildly surprised that claims are charged for being submitted and reversed. Claims are reversed all the time for multiple reasons. I wasn't aware that we pay for both. I say mildly because when it comes to ins, little suprises me anymore.
 
meister said:
I'd do this for the most part and it's amusing to me that so many people refuse to do it. It's like people get off on refusing to help.
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Some people look for anything they can to not help people. No one here of course, but in general.

One of my pharmacists told me that one thing you have to remember about most people who work in a pharmacy is, they don't want to fill prescriptions. I find that to be more and more true the more experience I get.
 
owlegrad said:
Some people look for anything they can to not help people. No one here of course, but in general.

One of my pharmacists told me that one thing you have to remember about most people who work in a pharmacy is, they don't want to fill prescriptions. I find that to be more and more true the more experience I get.
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Good point. I get paid the same weather I do 50 a day or 500 a day. I am only human. I'd just as soon do 50 a day.
 
owlegrad said:
The larger point is, if you don't take care of your customers they will leave. This is just one small example of a small thing you can do - check the price when asked. Formulary check is quite easy, at least at CVS. I am sure Walgreens has the equivalent. I am surprised that all pharmacies don't.
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When they coming in asking how much Singulair is, we can tell them off the formulary sheet.

When they have some whack insurance that we hardly use with an even more off-beat drug request, we don't know. Not even WAGs has all of that info handy, at least from what I've seen.

This is especially true for people who have deductibles and/or co-insurance for certain meds. You cannot account for those, no matter what 'formulary sheet' you have.
 
Is CVS the only company that can run a formulary check on the computer system? I would be suprised if that was the case - I didn't think any one retail pharmacy had a capability that any of the others did not.


Completely unrelated, how could anyone possibly prove that you typed in a script without having it? If you immediately delete it afterward (not just put it on hold, but completely delete it), how can anyone prove if you had it or not?
 
owlegrad said:
Is CVS the only company that can run a formulary check on the computer system? I would be suprised if that was the case - I didn't think any one retail pharmacy had a capability that any of the others did not.


Completely unrelated, how could anyone possibly prove that you typed in a script without having it? If you immediately delete it afterward (not just put it on hold, but completely delete it), how can anyone prove if you had it or not?
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Better question is do you want to play Russian Roulette with a state/federal agency and bank on the fact they won't pursue it? I have seen some anal, anal inspectors over the years who just look for a reason to bend you over backwards.
 
One time at CVS, i had a patient ask me how much celebrex would be and i explained to him that i needed the rx. I spent like 7-10 minutes explaining why i could not do it. i finally ran the claim and i was off the phone in seconds. From that point on, i just run the claim and reverse it. Patients appreciate it. Even filling 600-700 daily, i found the time to just do it. Patients like being spoiled. The above comments as to why you wont do it are foreign to me. As for losing a license or losing contracts, give me a break. Insurance companies are NOT going to audit you for running a claim to check a price. How the hell are they gonna know? I say just take care of the customer. And i can tell you, you do get charged for submission, but its customer service. Companies give away more in gift cards than a damn $0.02 cent fee.

Many of you young kids, if you want to know how to win a customer, and many of you have asked me "how did you open a store blah blah blah", i can tell you, doing little things for the patient goes a LONG way. Something as simple as running a claim. Taking 2 mins of your time. I never understood why i ever argued with a patient. I learned the hard way. I guess what im saying is, if it wont get you in trouble and its not illegal, why not do it?
 
Doctor M said:
One time at CVS, i had a patient ask me how much celebrex would be and i explained to him that i needed the rx. I spent like 7-10 minutes explaining why i could not do it. i finally ran the claim and i was off the phone in seconds. From that point on, i just run the claim and reverse it. Patients appreciate it. Even filling 600-700 daily, i found the time to just do it. Patients like being spoiled. The above comments as to why you wont do it are foreign to me. As for losing a license or losing contracts, give me a break. Insurance companies are NOT going to audit you for running a claim to check a price. How the hell are they gonna know? I say just take care of the customer. And i can tell you, you do get charged for submission, but its customer service. Companies give away more in gift cards than a damn $0.02 cent fee.

Many of you young kids, if you want to know how to win a customer, and many of you have asked me "how did you open a store blah blah blah", i can tell you, doing little things for the patient goes a LONG way. Something as simple as running a claim. Taking 2 mins of your time. I never understood why i ever argued with a patient. I learned the hard way. I guess what im saying is, if it wont get you in trouble and its not illegal, why not do it?
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I agree to a certain extent. I am of the opinion that to run something like that then a senior tech or pharmacist should do it only (interns as well if they show their stuff.) My pharmacy manager had to make it a house rule not to do it because a bunch of techs did it for people but left the meds in the queue. They would leave them as waiters and then forget about them so now we have a med that is getting filled without an rx and oftentimes past the waiter time limit, dinging metrics. As a result of the absent-mindedness and *******ery of the techs it's no longer allowed. We even had some floater pharmacists who didn't check refills (WTF??) and let them go through only to get the rx later and either PUT IT ON HOLD (since we already have the "rx" anyway now) or they would have to go back through and re-scan it. It made quite a mess and some audits did prove issues since a patient filled the med somewhere else like a $4 generic or something and the rx was sitting in the bin.

Yes some of it can be fixed but it's easy to overlook until it's too late. So now if that happens I just let the lead tech or a tech proven to be on their **** do it or a pharmacist or intern.
 
phathead said:
As someone who has worked for a place that was audited more times I can count, I can tell you that it is legally considered fraud to bill for a prescription which you do not legally possess. In some states, you can have your license revoked just for that.

And depending on how your contract is setup, the majority of the time you are billed for that submission and a reversal will not get rid of that charge. If, for whatever reason, you are audited by the PBM or a state/federal agency and they happen to audit that particular transaction... well you're screwed.
Click to expand...
Unless the audit happens WHILE you are processing this, there is absolutely no way you can have a charge brought against you. Think about it: if you processed the claim, the patient said "nevermind, give me the rx back," and you reversed the claim, what would happen? The same end result: a reversed claim, and no hard copy rx to show for it. Any auditor would not be able to tell the difference between that common scenario, and one where you did a "fraudulent test" rx.

Would it be better for the patient to call ins themselves? Of course, but we can't expect that to happen. Usually we say "I can give you a cash price, but we need an rx to see what ins will charge." If they persist, we tell them to come in so we can see exactly what the rx says so we can understand what the doctor wrote. Then we'll process the claim, and tell the patient before it gets filled. If they object, at least we didn't waste the time filling and returning to stock.
 
Doctor M said:
One time at CVS, i had a patient ask me how much celebrex would be and i explained to him that i needed the rx. I spent like 7-10 minutes explaining why i could not do it. i finally ran the claim and i was off the phone in seconds. From that point on, i just run the claim and reverse it. Patients appreciate it. Even filling 600-700 daily, i found the time to just do it. Patients like being spoiled. The above comments as to why you wont do it are foreign to me. As for losing a license or losing contracts, give me a break. Insurance companies are NOT going to audit you for running a claim to check a price. How the hell are they gonna know? I say just take care of the customer. And i can tell you, you do get charged for submission, but its customer service. Companies give away more in gift cards than a damn $0.02 cent fee.

Many of you young kids, if you want to know how to win a customer, and many of you have asked me "how did you open a store blah blah blah", i can tell you, doing little things for the patient goes a LONG way. Something as simple as running a claim. Taking 2 mins of your time. I never understood why i ever argued with a patient. I learned the hard way. I guess what im saying is, if it wont get you in trouble and its not illegal, why not do it?
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👍
 
Doctor M said:
Many of you young kids, if you want to know how to win a customer, and many of you have asked me "how did you open a store blah blah blah", i can tell you, doing little things for the patient goes a LONG way. Something as simple as running a claim. Taking 2 mins of your time. I never understood why i ever argued with a patient. I learned the hard way. I guess what im saying is, if it wont get you in trouble and its not illegal, why not do it?
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This is my pet peeve with pharmacists. They don't give a **** about winning or keeping the customer. They don't understand the customer you chase away could cost the store $20,000.00 in sales. That's why you are where you are and most of these kids will never be able to get there....
 
Old Timer said:
This is my pet peeve with pharmacists. They don't give a **** about winning or keeping the customer. They don't understand the customer you chase away could cost the store $20,000.00 in sales.
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Why should we? The big corporate chains treat thier employees like crap. We are looked at as an expense on a P&L statement that needs to managed and reduced to as small as possible. We work under managers who are out of touch with reality. We are not valued by our employers. We are forced to work with dangerous levels of staffing with no control. We are not given the proper resources to do our job and have zero control over the operation of the Pharmacy. We are employees of big corp chains who could care less about the safe and good practice of Pharmacy. You tell me why I should care? Do not give me the line of they give you a pay check so you owe it to them. For a pay check all I own them is 40 hours of work and meeting the minimum standards while doing it. If they want me to go above and beyond then they need to go above and beyond in the way they treat me. Treat me like an indentured servant and that is exactly how I will act. Treat me like a valued, respected member of the team and that is how I will act.

The last two companies I have worked for treat thier employees like crap. Not just the Pharmacy but everyone in the store. The negativity flows from the top right down to the employees and right to the customer. You can feel and see it when you shop in the store. We are always having meetings on how to improve customer service. I sit there and shake my head and laugh to myself because it is so obvious whatthey are doing wrong. There is no secret in how to get your employees to provide better customer service. Treat your employees well and it will be reflected in the way they treat the customer. Likewise, treat your employees like **** and thats exactly what kind of customer service you get....****.
 
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Jabberwocky12 said:
I agree to a certain extent. I am of the opinion that to run something like that then a senior tech or pharmacist should do it only (interns as well if they show their stuff.) My pharmacy manager had to make it a house rule not to do it because a bunch of techs did it for people but left the meds in the queue. They would leave them as waiters and then forget about them so now we have a med that is getting filled without an rx and oftentimes past the waiter time limit, dinging metrics. As a result of the absent-mindedness and *******ery of the techs it's no longer allowed. We even had some floater pharmacists who didn't check refills (WTF??) and let them go through only to get the rx later and either PUT IT ON HOLD (since we already have the "rx" anyway now) or they would have to go back through and re-scan it. It made quite a mess and some audits did prove issues since a patient filled the med somewhere else like a $4 generic or something and the rx was sitting in the bin.

Yes some of it can be fixed but it's easy to overlook until it's too late. So now if that happens I just let the lead tech or a tech proven to be on their **** do it or a pharmacist or intern.
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If the above was truly happening, then you need a new staff. That is incompetent in my opinion. Gotta hit that reverse key...
 
MountainPharmD said:
Why should we? The big corporate chains treat thier employees like crap. We are looked at as an expense on a P&L statement that needs to managed and reduced to as small as possible. We work under managers who are out of touch with reality. We are not valued by our employers. We are forced to work with dangerous levels of staffing with no control. We are not given the proper resources to do our job and have zero control over the operation of the Pharmacy. We are employees of big corp chains who could care less about the safe and good practice of Pharmacy. You tell me why I should care? Do not give me the line of they give you a pay check so you owe it to them. For a pay check all I own them is 40 hours of work and meeting the minimum standards while doing it. If they want me to go above and beyond then they need to go above and beyond in the way they treat me. Treat me like an indentured servant and that is exactly how I will act. Treat me like a valued, respected member of the team and that is how I will act.

The last two companies I have worked for treat thier employees like crap. Not just the Pharmacy but everyone in the store. The negativity flows from the top right down to the employees and right to the customer. You can feel and see it when you shop in the store. We are always having meetings on how to improve customer service. I sit there and shake my head and laugh to myself because it is so obvious whatthey are doing wrong. There is no secret in how to get your employees to provide better customer service. Treat your employees well and it will be reflected in the way they treat the customer. Likewise, treat your employees like **** and thats exactly what kind of customer service you get....****.
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Your motive for performing such a service doesn't necessarily need to be driving more business to the company. I would do this for a patient no matter how @#$%^ I was treated in my job. This is because I care about people and helping them out. I agree with you that we need to empower people to do things on their own, but some people are not capable of this for whatever reason. Should they be pushed to the side for this? I don't personally think so, especially if they are appreciative of you helping them out. Sure, you're going to encounter the person that feels that they are entitled to this kind of service and will not show any kind of appreciation, and if you can sniff that person out, I say feel free to deny them the service.

I understand that not everyone is going to feel this way. Some people go into pharmacy for whatever reason with no desire to serve the general population. You're right, though, I'm not going to go out of my way to perform for an employer that could give two @#$% about me. But what it comes down to is what your belief structure is. I know that we all have to do the stuff to keep "the man" happy in order to keep our jobs, but you can balance that with serving others if that is something that you value.
 
CUpharmD2013 said:
Your motive for performing such a service doesn't necessarily need to be driving more business to the company. I would do this for a patient no matter how @#$%^ I was treated in my job. This is because I care about people and helping them out. I agree with you that we need to empower people to do things on their own, but some people are not capable of this for whatever reason. Should they be pushed to the side for this? I don't personally think so, especially if they are appreciative of you helping them out. Sure, you're going to encounter the person that feels that they are entitled to this kind of service and will not show any kind of appreciation, and if you can sniff that person out, I say feel free to deny them the service.

I understand that not everyone is going to feel this way. Some people go into pharmacy for whatever reason with no desire to serve the general population. You're right, though, I'm not going to go out of my way to perform for an employer that could give two @#$% about me. But what it comes down to is what your belief structure is. I know that we all have to do the stuff to keep "the man" happy in order to keep our jobs, but you can balance that with serving others if that is something that you value.
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You are right. Thats what keeps most pharmcies going. The desire and will of each individual pharmacist to do what is right regardless of the impossible circumstances your employer places you in. That is also why nothing will ever change and why we will continue to be treated like indentured servents.

As I have stated before there are exceptions to every rule. As a general rule at my pharmacy we do not run a fake prescription through the system in order to get a price. It takes up alot of time and in the end it is the patients responsibility.

I am sick to death of rude and inconsiderate people. People expect the world and then want to pay pennies for it. I know it will never change and probably will just get worse. I am pretty hard headed and this is one of thoses times when rude demading incosiderate people really piss me off.
 
owlegrad said:
I am surprised how many people will not do this. If you delete it out after typing it, I don't think you are charged for submitting it to begin with - I could be wrong, but I don't think they charge for a claim that is reversed.

Either way - if you won't, they will find a pharmacy that will. Why lose the business? Sometimes I will say, in the future you can also call the number on the back of your insurance card. Most of the time I just run a formulary check, I wasn't aware that not all pharmacies have this?
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Walmart's system won't let you submit a claim without having first scanned in a prescription, and other systems might be similar.

I can only imagine the nightmare that could erupt if a "dummy" prescription somehow made its way through.

If the patient was there in person with the prescription, I would submit it but put a note in our system that says "do not fill until price discussed with patient."
 
owlegrad said:
I am surprised how many people will not do this. If you delete it out after typing it, I don't think you are charged for submitting it to begin with - I could be wrong, but I don't think they charge for a claim that is reversed.

Either way - if you won't, they will find a pharmacy that will. Why lose the business? Sometimes I will say, in the future you can also call the number on the back of your insurance card. Most of the time I just run a formulary check, I wasn't aware that not all pharmacies have this?
Click to expand...

We are charged a transmission fee on electronic claims, when we initially bill the claim and when we reverse the claim.

We don't do it for just anyone, but for our regular customers, why not. There is nothing fraudulent about it. It does suck to have a bunch of gaps in your prescription file, but it is nice to offer this level of service to our customers.
 
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