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Question to Retail Pharmacist

Discussion in 'Pre-Pharmacy' started by pharmacazoid, Aug 1, 2006.

  1. pharmacazoid

    pharmacazoid Member
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    Greetings all. In reading these threads and various blogs I've noticed that one of the chief complaints and the brunt of many jokes are patients problems with insurance/ co-pay etc.
    When a problem arises I understand there are times when it would be appropriate for the pharmacist to call (MD, insurance rep.,etc.) and rectify the matter themselves but other times it would seem more appropriate and easier for the patient to call instead (ex. calling in for medicare info or something the patiend should know). My question is do you typcailly acquiesce to the patient and do the work they should be doing for themselves to rectify an issue or do you typically ask the patient to rectify the matter themselves ?
    True, I know it is retail and the customer is always right but coming from a prospective pharmacy student I don't see the merit in being on the phone for an hour to rectify an issue that could be more easily solved if the patient did it himself.

    PS: Please don't bash me for my ignorance in this matter.
     
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  3. pharmacazoid

    pharmacazoid Member
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    oops posted to wrong forum...sorry
     
  4. ForcedEntry

    ForcedEntry Lilo got stitched
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    The customer is not always right, but they are the always the customer.

    Sorry I had to clarify your statement.
     
  5. WVUPharm2007

    WVUPharm2007 imagine sisyphus happy
    Pharmacist 15+ Year Member

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    It depends on how I feel and how much I like you. For typical crap problems, we just auto-fax the physicians' office and that's that. Sometimes insurance companies give you guff. If you ask real, real nice, I'll call your insurance company. Not because I'm nice, but because I want to sit on hold and take a break from real work. Rational Drug for WV medicaid and PEIA has nice hold music. I usually get Spring from Vivaldi's Four Seasons.
     
  6. rxlynn

    rxlynn Senior Member
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    Maybe it's not nice to admit, but I'm with WVU - if you are being an a**, then you are less likely to get me to want to sit on the phone with your insurance company. Now, having said that, here's what's typical in my pharmacy.

    For a med requiring prior auth, if the insurance bothers to tell us what they will pay for (usually doesn't happen, but I can fantasize) we will offer to recall the MD for a new Rx. If they don't give us an alternate, then my store has a one-page fax template with all the prior auth info. that we fax to the MD's office, and we tell the patient to check back in 3 days or so. We only call on those if we can't get or use a fax number (for some reason, we seem to have some MD's stuck in the 70's who don't want to use their fax machines :laugh: )

    If it's an easy insurance issue, then the patient usually waits and we call. With the exception of January when the Part D stuff was just kicking in, it's relatively rare that we would be on the phone for anything approaching an hour. Most of the insurance problems are things like cards that don't have the correct (or any) group number on them, people giving us a card that is expired and insisting that it should be valid, questions about why is their co-pay $60, etc. If the patient seems impatient or offers to do so, then we will try to let them call from the store phone. I sort of try to make a judgement call if I think they will be able to get the info. I need, or if it will just be easier for me to do the calling.

    If patient can't provide us with a card or the relevant info, we do not waste time calling insurance at all. For example, one of the large employers in our area went to a separate pharmacy card this year (before, med/pharm in one card). I don't think they told anybody on their staff - it's been months, and we still have people coming in insisting that they don't have a separate card. I know that the new one is Express Scripts, but we don't call on something like that - we tell them to call their benefits office and get the new pharmacy info.

    My answer to the OP is that, in retail, you will encounter multiple people everyday who have NO IDEA how their prescription benefit is supposed to work, and/or have no idea what their current coverage is. So, I think the irritation from the pharmacy staff's point of view is that we simply have to spend so much time explaining insurance plans to patients, because it's quite likely that these patients couldn't resolve the problem by themselves. Some of the fault, too, lies with the employers, who change insurance every year and do a piss-poor job of communicating with their employees.
     
  7. WVUPharm2007

    WVUPharm2007 imagine sisyphus happy
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    I love it when people agree with me it's always accompanied by something along the lines of, "I know I'm going to hell for agreeing with WVU here, but...."

    I'm doing something right.
     

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