Third party rejection: mail order

[robin2nightwing]

So I work at c/vs and I came across a third party reject that had something to do with mail order. This customer wanted to get his bp mediciation refilled, but when I processed it, it rejected.

I just want to know how to properly explain that to any future customer.

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[owlegrad]

"Your insurance company is cheap and will only pay for refills from mail order. They explained this to you when you signed up for the insurance. You were also mailed a letter last time you filled this medication explaining that future refills would have to come from mail order. I can fill it for cash now if you want to pay for it. Would you like me to get the pharmacist for any further questions?"

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[Lnsean]

"I don't get it...it was covered last time. You sure you're billing the correct insurance? It says here I have 0 copay on all prescripts. SEE!!!!???"

 

[SmallCapPharma]

Is it just me, or is this much more frequent than it was last year?


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[imcallingcorp]

So I work at c/vs and I came across a third party reject that had something to do with mail order. This customer wanted to get his bp mediciation refilled, but when I processed it, it rejected.

I just want to know how to properly explain that to any future customer.

my first reaction is haha cvs getting told what to do . this is the game they mastered. i mean cmon. local pharmacies are only for acute meds and your meds are in lala land 14 day supply overrides

 

[fcrc]

Sometimes they can argue with their insurance about it and get it paid at a retail location. Sometimes all they need to do is check off some boxes on the internet. Sometimes it's cheaper for the patient (and more profitable for the pharmacy) to just fill it for cash since the insurance charges for their "service."

 

[Stripe15]

Just tell them optum or caremark or whoever allots you a certain amount of fills at a retail store, and then wants you to switch to mail order. There's a number they can call for more information, and they can try and call to see if their insurance will keep allowing them to fill at a retail store.

 

[Rukn]

your plan requires mail order

don't ask me to call them to allow them to fill it here, call yourself

it's your medicine

you take responsibility

 

[CMUchicka]

your plan requires mail order

don't ask me to call them to allow them to fill it here, call yourself

it's your medicine

you take responsibility

Seriously, i said something similar to two patients yesterday. First, they don't remember names their own meds and can't keep up with dates on refills. Then comes in and hands us stuff to deal with it for them.

 

[lane one]

...wait for Caremark to call and orchestrate an incredibly complicated "bridge fill" that must be processed through a different third party plan that you have to add while on the phone with Caremark. All while showing no regard for your time and moving as slowly as possible through each step.

 

[Swishers]

"Your insurance company is cheap and will only pay for refills from mail order. They explained this to you when you signed up for the insurance. You were also mailed a letter last time you filled this medication explaining that future refills would have to come from mail order. I can fill it for cash now if you want to pay for it. Would you like me to get the pharmacist for any further questions?"

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I'm convinced most people toss their important letters in the trash without opening/reading them. The number of people that have no clue about their insurance plan details is insane.

 

[ldiot]

...wait for Caremark to call and orchestrate an incredibly complicated "bridge fill" that must be processed through a different third party plan that you have to add while on the phone with Caremark. All while showing no regard for your time and moving as slowly as possible through each step.

I'm pretty sure they sit there literally reading from a script what to say on the phone.