Most common insurance problems in retail?

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shroomysoup

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For those who work in retail pharmacies, what are the most common insurance problems you encounter and how do you fix it? This will help me in the future. Thanks for answering!
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The one of the biggest problems in retail pharmacy is ******* patients. Patients who think their insurance is the pharmacies responsibility and not theirs.
 
MountainPharmD said:
The one of the biggest problems in retail pharmacy is ******* patients. Patients who think their insurance is the pharmacies responsibility and not theirs.
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The retail companies like CVS, Walgreens have made it worse by telling customers that we (pharmacists, techs, interns) will call the insurance companies for the customer to get issues resolved. Absolute bull****. If there is a rejection, you tell the customer there is a rejection, and the customer should call the insurance company to get it resolved.
 
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Sparda29 said:
The retail companies like CVS, Walgreens have made it worse by telling customers that we (pharmacists, techs, interns) will call the insurance companies for the customer to get issues resolved. Absolute bull****. If there is a rejection, you tell the customer there is a rejection, and the customer should call the insurance company to get it resolved.
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Exactly, when I intern at walgreen, I simply refused to call insurance. It's a pain the ass, and are on hold for 45 minutes... Screw that, I already work my ass off, can't even get a lunch or take a piss. Sorry, I'm not going through 4 years of pharmacy school to make calls for stupid patients who can't get keep their insurance straight. :smuggrin:
 
I will call from time to time, but make sure the patient knows that this is not my priority and it may take some time.

The absolute worst are customers who come through the drive through without their insurance card and expect you to call to get their ID number while they wait.

Most of the insurance problems are easy to fix and pop up over and over.
 
xiphoid2010 said:
Exactly, when I intern at walgreen, I simply refused to call insurance. It's a pain the ass, and are on hold for 45 minutes... Screw that, I already work my ass off, can't even get a lunch or take a piss. Sorry, I'm not going through 4 years of pharmacy school to make calls for stupid patients who can't get keep their insurance straight. :smuggrin:
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Half the time I make calls, the insurance agent asks me if the patient is there and ask to speak to the patient.
 
Sparda29 said:
The retail companies like CVS, Walgreens have made it worse by telling customers that we (pharmacists, techs, interns) will call the insurance companies for the customer to get issues resolved. Absolute bull****. If there is a rejection, you tell the customer there is a rejection, and the customer should call the insurance company to get it resolved.
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That is what we do at my Pharmacy. Have a question on your co-pay, deductible, prior auth, why this and why that? Call the 1-800 number on the back of your card and they will be happy to explain it, have a nice day! I do not play around with apathetic lazy customers anymore.
 
I guess I'm just different than everyone else or was trained differently...I do not disagree with any of you in that calling ins companies is a pain in the ass and time consuming...however, even when I worked at CVS, doing 2700-3000 rx's weekly, i always offered to make a call to the ins comp if a problem popped up...I believe it to be good customer service...Now, I always asked a tech to do it and if they were busy, i would find a tech (whom i knew was competent) to make the call...I would call as a last resort...I built a long lasting relationship with these people in servicing them any way I could.

This is why I did what I did with our new store...I no longer had drive thru issues, long lines, and angry customers...I am in a state of euphoria everyday i am at work (drug-free) with my Mozart Eine Kline Natchmusik playing from our Mp3 player...We are all relaxed...:)
 
Sparda29 said:
The retail companies like CVS, Walgreens have made it worse by telling customers that we (pharmacists, techs, interns) will call the insurance companies for the customer to get issues resolved. Absolute bull****. If there is a rejection, you tell the customer there is a rejection, and the customer should call the insurance company to get it resolved.
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Prior authorizations? Have the patient call? DUR rejection? Have the patient call? Drug not covered, have the patient call? To me, a quick fax to the MD will resolve these issues...Ambien CR not covered, fax over generic ambien...Lipitor not covered, as the patient what they have tried and fax over the alternatives...As pharmacists, we should not put blame on the patient...Believe me, I know how it feels when a patient is being an ass but in my experience, something triggered them being an ass...did they have a bad experience in the past or with another pharmacy or pharmacist? Did they just get diagnosed with a really really bad illness? Did they just lose a loved one...I always bit my tongue and let them vent to me...I never let them abuse us, but i would let them vent...while they vented, the call was being made to the ins comp to get them out...

I believe that if you wanna have a successful career as a pharmacist and a peaceful career, always look at your patient in the eye, be honest with them, greet them, smile, and most importantly, listen to what they have to say...
 
I just try to take care of the problem. I don't lecture them on how they're being a PITA by having me call for them or anything like that. It's not worth the headache. I don't even care to explain the situation to them if I straighten it out myself. Do they really care if the name on their card is wrong or if they have to present their new Medco card instead of that old Coventry card? No.
I'd rather talk to people about their medications, how frustrating the healthcare system is, or what they had for lunch... not insurance.
 
Many of my customers aren't intelligent enough to place a simple call to an insurance company. I find it's often less of a hassle to just handle it myself rather than have to listen to them call and complain all day.
 
January 1st sucks for this reason. Clueless people who don't want to do anything for themselves. This is before my time, but older pharmacists reminisce about the times when patients paid out of pocket and submitted their own claims and got reimbursed by their own insurances. I think the majority of people would be mentally incapable of doing that now. :laugh:
 
I'll call the insurance when I know it can be resolved, like a change in the group or override. But I will never call the insurance when the customers says "I am not supposed to pay that much call the insurance!". Because I have and the price has never changed. I mean you might find out that they have deductible or whatever but I just tell them that is what the insurance is charging you, if it's wrong then you have to call them and find out why. Guess what they call and then come back and pay it, I've never had anyone call and then tell me it was wrong and I need to Reprocess it.
 
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J DUB said:
I would work in other aspects first and retail last....

hospital, home infusion, long-term care...etc....

I rather make less money than suffer in retail hell.....:thumbup:
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I had the same thinking 1 year ago...I would rather walk on hot coal than work for CVS or Walgreens...But I was lucky and was able to open up a store of my own with a business partner...Our store is a retail store, but very clinical as well...If i didnt get the opportunity that arose, i would be walking on hot coal everyday...:)
 
Doctor M said:
I had the same thinking 1 year ago...I would rather walk on hot coal than work for CVS or Walgreens...But I was lucky and was able to open up a store of my own with a business partner...Our store is a retail store, but very clinical as well...If i didnt get the opportunity that arose, i would be walking on hot coal everyday...:)
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Is retail that bad to some people? :laugh:
 
crazybob said:
Is retail that bad to some people? :laugh:
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I remember doing Indian Runs in High school for Football practice...I would rather do those all day than work retail chain...It really depends on the store you get...I got a busy store with lots of problems...
 
crazybob said:
Is retail that bad to some people? :laugh:
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IMHO, YES! Forget lunch, forget breaks. It's a sweat shop operation in my store. Pharmacist cracking the whip, always short staffed, techs that turns over in less than a year, the customers bitching and moaning. Oh, and of course it's the ghetto, so everyone is on medicaid and on drugs. The store been robbed 3x including a guy who had a bomb (so he said). The drive thru window has been shot at, bashed with baseball bat, with a bullet stuck at the eye level, our car windows have been smashed in... And all the while, these free riders and drug addicts throw a fit because their vicodin or percocet isn't filled in 15 minutes or are refill too soon. YEP, the joy of retail pharmacy. :rolleyes:
 
Community/Retail pharmacy:
Both Technicians and Pharmacists spend an exorbitant time on 1800 calls on hold or waiting for reps who barely speak the English. (today's record: 20 minutes for an explanation on why opium tincture comes out to $390/bottle- retail is $790- but it says 'drug not covered'.)

- dumb patients. no RX card, no card for anything, Medicare, Medi-Cal, ANYTHING. And they expect me to be psychic and tell them their copay by looking at the prescription. Sometimes it's amazing they even know their own names.
- drug not covered. Not on formulary, MD writes for Lunesta (NOT covered without PA, heck.... why do you write for Lunesta when Ambien hasn't even been tried yet)....
- emergency drug not covered. Lovenox SQ bid, $1500 worth of injectable medications that need to be dispensed TODAY to prevent a clot and doc/NP/PA hasn't bothered to do the Prior Auth, of course.
- Donut hole of Medicare Part D. Try explaining that to a patient who doesn't understand terms like 'deductible' and 'coverage gap'. (hand over phone to patient while on line with insurance. They don't want to hear it from you, anyway.)
- Refill too early, patient going on vacation IN A FEW HOURS and I NEED MY VICODIN and OXYCODONE and BIRTH CONTROL NOW NOW NOW, darnit!
 
Oh, don't forget tech call ins with no replacement so you are running around like crazy. Customers yelling at you and calling corporate on you because of the wait time. No help from up front, no one typing or filling except for you. Phones are ringing like crazy. Oh and have you verified your quota for other stores yet?
 
Apteka said:
- Refill too early, patient going on vacation IN A FEW HOURS and I NEED MY VICODIN and OXYCODONE and BIRTH CONTROL NOW NOW NOW, darnit!
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I love these. I always tell them, "All of our computers are nationally connected, so whenever its time for your refill, one of our stores at your vacation spot would be happy to fill it for you". I've never had a rebuttal to that.

We do upwards of 800-1000 Rxs /day so I'm stoned cold about calling insurance companies as I could help at least 20+ other people in the time it would take you to make the phone call to your own insurance company. I make exceptions if we are slow, the patient getting the rx is a child (for antibiotics, asthma med, etc), or if it is obvious the patient has just came from the ER and is in pain. I tend to think that I would be a lot more sympathetic in a lower volume store though...
 
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