pharmacazoid

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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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pharmacazoid

pharmacazoid

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bananaface said:
It depends on the specific issue.
If you don't mind me asking what are some exampes of various issues ?
 
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imperial frog

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The major thing is the time that the problem arises. If it's slow or there is enough people working I can take the time to call someone to get something straightened out while they wait. If they drop off a prescription at noon or on their way home from work, they are going to have to either wait a bit or take matters in their own hands to get me the insurance information I need or call their doctor themselves to find out why a script hasn't been called in.
 

baggywrinkle

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pharmacazoid said:
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.
.

This depends on the individual pharmacy manager. Walk into any Walgreens
and look at their Intercom que. In most cases it will be pages long filled with
third party issues, most being refill too soon. The paper prescriptions will be
tucked away somewhere. Heaven forbid you should lose them.

But the manager at the slamming store on Bevel Road in Daytona Beach had a different style. Her que was as empty as the day they booted the computer up. She decided she was too busy to babysit all those prescriptions and set a policy to immediately give them back to the customer to keep until
the next fill date rolled around. No doubt the customers squawked, but they came around. This is a good example of educating your customers.

Much foolishness wastes precious time and effort because the staff will not take the time to educate. At my store they wanted to drop off at the drive through then sit and wait. My manager told them the drive through was for dropoff only, that waiting had to be done inside the pharmacy only. When they protested saying at xyz pharmacy they could sit and wait MacDonalds style. He suggested that they go to xyz to do that, at his pharmacy it was dropoff only.
 

pharmdgto

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baggywrinkle said:
.

This depends on the individual pharmacy manager. Walk into any Walgreens
and look at their Intercom que. In most cases it will be pages long filled with
third party issues, most being refill too soon. The paper prescriptions will be
tucked away somewhere. Heaven forbid you should lose them.

But the manager at the slamming store on Bevel Road in Daytona Beach had a different style. Her que was as empty as the day they booted the computer up. She decided she was too busy to babysit all those prescriptions and set a policy to immediately give them back to the customer to keep until
the next fill date rolled around. No doubt the customers squawked, but they came around. This is a good example of educating your customers.

Much foolishness wastes precious time and effort because the staff will not take the time to educate. At my store they wanted to drop off at the drive through then sit and wait. My manager told them the drive through was for dropoff only, that waiting had to be done inside the pharmacy only. When they protested saying at xyz pharmacy they could sit and wait MacDonalds style. He suggested that they go to xyz to do that, at his pharmacy it was dropoff only.
That is interesting because due to Waglreens use of scanned prescriptions, there is no reason to worry about losing scripts anymore. Instead of just leaving them as TPR's in the work que, you can just store them in a patients profile. They can then get them once its time for the refill.....

Most pharmacy managers have policies that don't allow TPR's to sit in the que longer than a few days. If that happens, you just delete it. A good store generally has morning techs who clear up the TPR's and WCB's.
 

BME103

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pharmacazoid said:
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).
You are right but pharmacy is a very competitive business and the retails try to out do each other with better customers' service. The people who make the policy (e.g. 15 minute wait) are not pharmacists but business executives. They have no experience in pharmacy so a lot of their policy is just idealistic. That is the problem. You also have to realize that many people, including many health care professionals, are just ignorant about pharmacy. That only adds to the problem.
 

Shmy2008

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The ONLY thing that I ask of my patients is that they PARTICIPATE. If you want to ask me about something related to insurance or your refills/called in prescriptions, thats terrific... but you'll be participating in the process. I need INFORMATION from you (when is your next appointment? have you seen this doctor recently? do you even still see this doctor?) and you need to be aware that this isn't a buffet bar where you pick what you want when you want it. As far as insurance goes... I used to make patients call their doctors for prior authorizations. It was glorious. If you want a drug that the contract you've signed with your employer/insurance provider won't cover, PARTICIPATE in the process and find out what YOU can do to expedite the process. Once you condition your patients to be responsible for themselves, you'll be surprised at the results.
 

crossjb

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Shmy2008 said:
The ONLY thing that I ask of my patients is that they PARTICIPATE.
When they're thick as bricks and angry to boot, that tends to make it tougher... :D
 

letjin

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Shmy2008 said:
The ONLY thing that I ask of my patients is that they PARTICIPATE. If you want to ask me about something related to insurance or your refills/called in prescriptions, thats terrific... but you'll be participating in the process. I need INFORMATION from you (when is your next appointment? have you seen this doctor recently? do you even still see this doctor?) and you need to be aware that this isn't a buffet bar where you pick what you want when you want it. As far as insurance goes... I used to make patients call their doctors for prior authorizations. It was glorious. If you want a drug that the contract you've signed with your employer/insurance provider won't cover, PARTICIPATE in the process and find out what YOU can do to expedite the process. Once you condition your patients to be responsible for themselves, you'll be surprised at the results.
People at the pharmacy I work at thinks it's not their problem...they think it's our (pharmacy staff's) problem. In fact... we had a lady who yelled at my co-worker because her coverage expired... :rolleyes:
 

BackeyWackey

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letjin said:
People at the pharmacy I work at thinks it's not their problem...they think it's our (pharmacy staff's) problem. In fact... we had a lady who yelled at my co-worker because her coverage expired... :rolleyes:
EXACTLY! I like how it's "my" problem that this one lady's perscription formulary changed at the first of the year and her prescription copay became the non-formulary price. :rolleyes: Her response: "Well you guys should have told me that my copay would be going up." :smuggrin: :smuggrin:
 

All4MyDaughter

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My favorite phone call:

"No, sir. I do not know what your copay will be for (insert random drug) on your (insert insurance) plan. I cannot tell you that unless I see your insurance card (so I know how to process it) and I have an actual prescription in my hand to process. You can call your insurance company though. Oh, so you've gotten this drug before at (competitor pharmacy)? And your co-pay was $20? Then your co-pay at this pharmacy should also be $20 unless your insurance coverage has changed. Co-pays are set by the insurance company and are generally the same at any network pharmacy. No, sir. I don't know if your coverage has changed since the last time you got (random drug that I have never filled for you) on your (random) insurance plan (that I've never heard of). So just go ahead and bring your prescription and your insurance card down here and I'll be happy to take a look at it. Sure, call around to some other pharmacies first (I'm sure they have a magical, mystical way of accessing this information for you so you don't have to leave the house). Thanks so much!
 

rxlynn

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All4MyDaughter said:
My favorite phone call:

"No, sir. I do not know what your copay will be for (insert random drug) on your (insert insurance) plan. I cannot tell you that unless I see your insurance card (so I know how to process it) and I have an actual prescription in my hand to process. You can call your insurance company though. Oh, so you've gotten this drug before at (competitor pharmacy)? And your co-pay was $20? Then your co-pay at this pharmacy should also be $20 unless your insurance coverage has changed. Co-pays are set by the insurance company and are generally the same at any network pharmacy. No, sir. I don't know if your coverage has changed since the last time you got (random drug that I have never filled for you) on your (random) insurance plan (that I've never heard of). So just go ahead and bring your prescription and your insurance card down here and I'll be happy to take a look at it. Sure, call around to some other pharmacies first (I'm sure they have a magical, mystical way of accessing this information for you so you don't have to leave the house). Thanks so much!
OMG - so those people live in Kentucky too!! That is my most hated question EVER - followed closely by the people who walk up to the pharmacy window, hand me a prescription, and then (before I even put my hands to the computer keyboard) say "Do you know how much that is going to cost?" Oh, and the people who don't understand why we can't just find their information from their last fill at an entirely different pharmacy chain. I like to call that problem the "the great pharmacy computer in the sky" problem :laugh:
 
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All4MyDaughter

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rxlynn said:
OMG - so those people live in Kentucky too!! That is my most hated question EVER - followed closely by the people who walk up to the pharmacy window, hand me a prescription, and then (before I even put my hands to the computer keyboard) say "Do you know how much that is going to cost?" Oh, and the people who don't understand why we can't just find their information from their last fill at an entirely different pharmacy chain. I like to call that problem the "the great pharmacy computer in the sky" problem :laugh:

I talked to a lovely gentleman who was shocked, !SHOCKED! that I did not have a list of every Medicare part D formulary and how much the co-pay was for each drug on each formulary. I wish there was a computer in the sky!
 

sdn1977

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Aaaaahhhh......pharmacists can be their own worst enemies! & all in the name of customer service!

What's the worst that can happen if you say no....or 30 minutes....or tomorrow......the only valid answer would be if you owned your own pharmacy. Otherwise....if it would be some kind of disciplinary action - in which case...would that be a favor in disguise?
 

WVUPharm2007

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And thus we arrive at the reason corporate control over pharmacy practice is destined to kill the quality of the profession. Sure, our salaries are more then they used to be, but is it worth it? It's also why my stint in retail pharmacy is going to end with my current internship.
 

JMH5145

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All4MyDaughter said:
My favorite phone call:

"No, sir. I do not know what your copay will be for (insert random drug) on your (insert insurance) plan. I cannot tell you that unless I see your insurance card (so I know how to process it) and I have an actual prescription in my hand to process. You can call your insurance company though. Oh, so you've gotten this drug before at (competitor pharmacy)? And your co-pay was $20? Then your co-pay at this pharmacy should also be $20 unless your insurance coverage has changed. Co-pays are set by the insurance company and are generally the same at any network pharmacy. No, sir. I don't know if your coverage has changed since the last time you got (random drug that I have never filled for you) on your (random) insurance plan (that I've never heard of). So just go ahead and bring your prescription and your insurance card down here and I'll be happy to take a look at it. Sure, call around to some other pharmacies first (I'm sure they have a magical, mystical way of accessing this information for you so you don't have to leave the house). Thanks so much!
I think I had about 10 of those conversations with people today (and it was an easy day). The next step is explaining to seniors that they have entered the "donut hole" of Medicare D and will now have to pay out-of-pocket for their scripts until they hit the upper limit of the donut hole. They will then only have to pay 20% of the cost of the drug for the remainder of the year. OUCH!
 

rxlynn

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pharmacazoid said:
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.
For a practicing pharmacist's perspective on this type of problem, see
http://www.drugnazi.blogspot.com/

I don't agree with everything he has to say on his blog, but the Aug. 6 post is right on target.
 

mortpes

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Sometimes the insurance is looking for information only the patient can provide. Sometimes the pharmacist can provide some service. Often the insurance requires contact by the doctor. Frequently in many cases all three groups must be involved.
 

monsterbrain

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I will offer to call insurance companies if:

1. A drug that has been covered for years is no longer covered and can't be explained by new OTCs.

2. I am holding the new insurance card with correct information in the system, and I get a rejection "member not on file."

3. Any other oddball rejection.

In the above scenarios, I will only call if we are not busy. If we are slammed at the time, I will offer to call the insurance later in the evening when it slows down and call them at home with the information.

I WILL NOT call insurance companies for clear cases of formulary changes, drug not covered situations, or increases in co-pay. When those types of problems occur, I simply tell the patient that they will have to contact their insurance company or benefits coordinator to determine why/when their plan changed.
 

RxWildcat

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I usually don't call if its the pts fault that I have to call (ie failed to bring in new card) unless we are slow and then I usually don't care. A lot of the time though, the pts can take care of a lot of the problems and we shouldn't have to babysit their insurance for them.
 

Pharmavixen

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The 3rd party stuff is one of the major reasons why I largely don't work retail any more. I have been called every possible nasty name over 3rd party issues. It's almost as bad as the abuse you get from the drug-seekers and their dodgy scripts.

The store where I work one day a week delegates all the 3rd party issues to a couple of experienced techs who actually enjoy doing this kind of thing. One tech dislikes filling prescriptions when it's busy (!) and complains all the time, but loves sitting on the phone, so she's more than happy to call the insurance companies while we count pills.

But really, this is something that should be delegated. No pharmacist should ever ever ever ever ever have to call an insurance company. Isn't that what technical staff are for?????
 

Kyra

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Can you work for more than one retailer?
 

Aznfarmerboi

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Way to bring back old topics. . . i was happy to see sdn too. . .

Most companies have policies stating that you cannot work for another competitor.
 

Kyra

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how can you find out their policy without asking?
 

Quiksilver

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i was actually given the finger today after she changed her prescription coverage to medicare part D and her costs went up $3 more a month for her medications.
" i will not be doing business here ever again."
"well ma'am, thats your insuranc.....*her finger is in the air as she drives off*
a little part of me died today at that window.
 

RxWildcat

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:laugh::laugh:

At least it'll be a different pharmacy that she goes to and finds out its the exact same.
 

monsterbrain

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:laugh::laugh:

At least it'll be a different pharmacy that she goes to and finds out its the exact same.
I know! Wouldn't you LOVE to be a fly on the wall to see the dumbfounded look on her face when they check her out? :laugh:
 
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