Learning insurance

[icekitsune]

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During my rotation, my preceptors told me that I don't need to learn insurance and the problems because its different for every company. However, since i didn't work in retail, how do you learn it or you just get trained on the job as a pharmacist, out of curiousity? I have several friends who never worked and got hired but idk how they are doing in regards to insurance issues and the such.

 

[Travex]

Read the reject. If that fails make the tech/intern call the insurance company and work it out. Ta-da.

 

[TLAD123]

Read the reject. If that fails make the tech/intern call the insurance company and work it out. Ta-da.

Lol, nice.

You learn the process, not necessarily a set something.

Basic BIN, PCN, ID, group number gathering are easy - ask for the patient's card. If the patient doesn't have their card, that's not necessarily something that needs to be learned ... you need the card, or some piece of information that will lead to the info you need (another pharmacy's phone that has it on file, the help desk number at the insurance, etc.).

Calling an insurance company just takes a special kind of patience, one that many never master (how can you be patient with a mindless insurance help desk minion who reads a script?).

Each system is different (RiteAid's GenRx, NRx, whatever CVS/walgreens/kroger/giant eagle/target etc use) with how they handle the info. Somehow you link the insurance to the patient so when you run the Rx it is billed.

Rejects - just read the reject and it tells you what needs to be done. Prior auth - ask the pharmacy what their process is. Refill too soon - tell the patient it's till soon (it will tell you the date mostly), etc.

 

[jfm5958]

Lol, nice.

You learn the process, not necessarily a set something.

Basic BIN, PCN, ID, group number gathering are easy - ask for the patient's card. If the patient doesn't have their card, that's not necessarily something that needs to be learned ... you need the card, or some piece of information that will lead to the info you need (another pharmacy's phone that has it on file, the help desk number at the insurance, etc.).

Calling an insurance company just takes a special kind of patience, one that many never master (how can you be patient with a mindless insurance help desk minion who reads a script?).

Each system is different (RiteAid's GenRx, NRx, whatever CVS/walgreens/kroger/giant eagle/target etc use) with how they handle the info. Somehow you link the insurance to the patient so when you run the Rx it is billed.

Rejects - just read the reject and it tells you what needs to be done. Prior auth - ask the pharmacy what their process is. Refill too soon - tell the patient it's till soon (it will tell you the date mostly), etc.

This! Plus it will come with experience. We have an insurance company that says Prior Auth required plus some weird code/letters when really it's just a refill too soon. When in doubt just call or have the tech/intern call the insurance company to see what's going on. They are usually helpful if you can get a representative on the phone.

 

[TLAD123]

This! Plus it will come with experience. We have an insurance company that says Prior Auth required plus some weird code/letters when really it's just a refill too soon. When in doubt just call or have the tech/intern call the insurance company to see what's going on. They are usually helpful if you can get a representative on the phone.

Yeah, I've had this happen a few times too with the refill too soon in disguise. I would say if they allow you to, try calling the insurance yourself and see what it's like. It's really not that bad. With the voice prompts, I always say "representative" until I get someone on the phone, if the system recognizes that word... I hate messing with voice prompts. Once you call a few times, it's just another thing you do during your day and isn't hard... it just takes time.

 

[owlegrad]

Yeah, I've had this happen a few times too with the refill too soon in disguise. I would say if they allow you to, try calling the insurance yourself and see what it's like. It's really not that bad. With the voice prompts, I always say "representative" until I get someone on the phone, if the system recognizes that word... I hate messing with voice prompts. Once you call a few times, it's just another thing you do during your day and isn't hard... it just takes time.

True! Do not waste your time with the automated system. It will never, ever help you and as soon as you get a person they ask the same questions.

 

[TLAD123]

True! Do not waste your time with the automated system. It will never, ever help you and as soon as you get a person they ask the same questions.

Yeah... I find this one of the more annoying things. No matter how many pieces of information you enter into the automated system (NPI, Rx number, etc.), the individual you get connected to always asks the same questions... and then if they find out you called the wrong department, they transfer you (i.e. Medicaid/cal, medicare), and then you get asked the same questions as before, even if its the same company. That's where my patience was always tested.

Also don't be afraid to ask for a supervisor if you aren't getting a cohesive/sensical answer... the reps are usually reading whats on the screen and don't really know what's going on. Sometimes they do, but its hard to tell who does and who doesn't.

Tips: Memorize your pharmacy's NPI (you eventually will anyway, since you'll have to call insurances a lot), and know where your pharmacy's Tax ID, NABP, and DEA are.

 

[Ackj]

True! Do not waste your time with the automated system. It will never, ever help you and as soon as you get a person they ask the same questions.

Yeah, I find it so odd that they ask for your store's NPI, the RX number, fill date, and then the person picks up and asks you all that stuff all over again. What is the point of entering it?

Actually, there is one time that the automated system is helpful. When there is a major overhaul that all the BIN or PCN for a plan get changed, sometimes there's an automated message telling you what the new numbers are. You can just write it down, because probably 25% of your patients will need their info updated with that new BIN/PCN they'll give you. Unfortunately, that automated message will play for 2 months, far beyond its usefulness, and just make you wait an extra minute before finally getting to the person you're trying to talk to.

I would recommend putting all pertinent info right on your phone with a post-it or paper taped onto it. Just in case you need the NPI, NABP, DEA, phone, fax, address, zip code, etc and you can't think of it immediately. Sometimes I'll go blank, or think of the store where I had a rotation, or another store I interned at, and it takes me a few seconds to get it straightened out, so definitely just have it written on the phone.

 

[owlegrad]

I would recommend putting all pertinent info right on your phone with a post-it or paper taped onto it. Just in case you need the NPI, NABP, DEA, phone, fax, address, zip code, etc and you can't think of it immediately. Sometimes I'll go blank, or think of the store where I had a rotation, or another store I interned at, and it takes me a few seconds to get it straightened out, so definitely just have it written on the phone.

Yeah I agree with that. At CVS you can hit F11 I think to call up that store's info. Just hit print screen, cut the page down to the important info, and tape that right by the phone. If not CVS, same idea applies.

 

[joetrisman]

True! Do not waste your time with the automated system. It will never, ever help you and as soon as you get a person they ask the same questions.

Yes. I keep hitting 5s until it quits trying to figure out what Im doing and sends me to a rep

 

[owlegrad]

Yes. I keep hitting 5s until it quits trying to figure out what Im doing and sends me to a rep

Oh you are calling about a rejection? We have another dept for that.

 

[Rockinacoustic]

Yes. I keep hitting 5s until it quits trying to figure out what Im doing and sends me to a rep

"The rx number you entered was 5..5..5..5..5... is that correct?"