Scenario question

Started by Charcoales
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Charcoales

Charcoales

Full Member
10+ Year Member
(Walgreens) What do you do when u try to refill test strips but get cmn form rejection and it's a Friday night and the person says they need them right now, and they cant afford them otc (they had been getting them every month for last like 6 months, never early, for 0 copay)... Do You essentially just tell them too bad cant do anything because even if they got an emergency rx for them, it would still reject so there is no point telling them to go to an urgent care, etc?
 
Charcoales said:
(Walgreens) What do you do when u try to refill test strips but get cmn form rejection and it's a Friday night and the person says they need them right now, and they cant afford them otc (they had been getting them every month for last like 6 months, never early, for 0 copay)... Do You essentially just tell them too bad cant do anything because even if they got an emergency rx for them, it would still reject so there is no point telling them to go to an urgent care, etc?
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Tell the patient to purchase a house brand machine. Walgreens, Walmart, CVS and others have their own brand of blood glucose monitors that have strips which are pretty reasonable. This should get them through the weekend.
 
Charcoales said:
(Walgreens) What do you do when u try to refill test strips but get cmn form rejection and it's a Friday night and the person says they need them right now, and they cant afford them otc (they had been getting them every month for last like 6 months, never early, for 0 copay)... Do You essentially just tell them too bad cant do anything because even if they got an emergency rx for them, it would still reject so there is no point telling them to go to an urgent care, etc?
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We tell the patient after the first drop off we will need the form after this first fill before Medicare will pay for it again. We tell them their doctor will be faxed many times but it's a good idea for them to also check in.

If they come in and we don't have the form, yes we offer our brand. Unfortunately it's not our fault, every office should know at this point that we need the form.

I'm curious how other companies deal with this. Walgreens Medicare team faxes like four times before they send us the form to try.
 
Most pharmacies are not charities. Nor are test strips a life saving drug. Are you seriously suggesting you would recommend someone go to an Urgent Care to get a prescription for test strips??? If you are, be aware these patients will be showing up at the ER at 1:00am, driving up taxes and healthcare costs for all of us.

Correct answer to your predicament...."I will call your doctor on Monday to let him know the CMN form still needs to be filled out. Unfortunately, unless you are willing to pay cash for your test strips, I will be unable to bill insurance for them until we receive the CMN from your doctor."
 
BidingMyTime said:
Most pharmacies are not charities. Nor are test strips a life saving drug. Are you seriously suggesting you would recommend someone go to an Urgent Care to get a prescription for test strips??? If you are, be aware these patients will be showing up at the ER at 1:00am, driving up taxes and healthcare costs for all of us.

Correct answer to your predicament...."I will call your doctor on Monday to let him know the CMN form still needs to be filled out. Unfortunately, unless you are willing to pay cash for your test strips, I will be unable to bill insurance for them until we receive the CMN from your doctor."
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Yeah just said only thing they can do is pay cash, the insurance simply wont pay unless the doctor fills out the form.
 
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