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- Nov 15, 2006
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I would like to thank all of you who responded to my post in "What Woud You Do" part 1, you all contributed great ideas/comments. Now, this situation that I have faced several times may be less extreme than the methadone case but at the same time equally annoying.
A patient who brings in the script for a non-formulary drug refuses to accept/understand the reality and to cooperate with the staff for a solution.
For instance, a patient brought me an RX for Nexium which is not covered by her insurance (prefers to pay for Prilosec). Despite my vain effort explaining to her how similar they are and even my offering of calling the Dr right on the spot to make the change, she still insists on Nexium. Her reason: I need it. It's the only one that works for me but guess what, I won't pay for it.
Our conversation went in a circle like this.
Me (after several attempts to explain): M'am as I just explained your insurance will not pay for Nexium. Prilosec is the only choice they give you. It is very similar to Nexium, just like Coke and Pepsi (my favorite analogy), and I'm sure you will experience all the benefit of Nexium with Prilosec.
Customer: But it wont work for me. Nothing works for me but Nexium.
M: If you want only Nexium, then I'm afraid you will have to pay out of your pocket.
C: I cannot afford it. That's too much. Insurance will have to pay.
M: Your insurance already makes their decision not to. But you can always call them and see what they will do.
C: No, you do something. I need it.
M: The only thing I can do is calling your Dr to make a substitution.
C: Then they will pay for it, right?
M: M'am I just explained to you three times that...
What would you do in situations like this?
A patient who brings in the script for a non-formulary drug refuses to accept/understand the reality and to cooperate with the staff for a solution.
For instance, a patient brought me an RX for Nexium which is not covered by her insurance (prefers to pay for Prilosec). Despite my vain effort explaining to her how similar they are and even my offering of calling the Dr right on the spot to make the change, she still insists on Nexium. Her reason: I need it. It's the only one that works for me but guess what, I won't pay for it.
Our conversation went in a circle like this.
Me (after several attempts to explain): M'am as I just explained your insurance will not pay for Nexium. Prilosec is the only choice they give you. It is very similar to Nexium, just like Coke and Pepsi (my favorite analogy), and I'm sure you will experience all the benefit of Nexium with Prilosec.
Customer: But it wont work for me. Nothing works for me but Nexium.
M: If you want only Nexium, then I'm afraid you will have to pay out of your pocket.
C: I cannot afford it. That's too much. Insurance will have to pay.
M: Your insurance already makes their decision not to. But you can always call them and see what they will do.
C: No, you do something. I need it.
M: The only thing I can do is calling your Dr to make a substitution.
C: Then they will pay for it, right?
M: M'am I just explained to you three times that...
What would you do in situations like this?