Got into work. Pharmacist went to fill a script for Prilosec OTC. None on the shelf.
Asked our inventory person. Said they had just filled it yesterday.
500 bucks worth of Prilosec OTC stolen. Cosmetics girl says she saw two guys hanging out around her section messing with item tags. (They sometimes move tags around to demand the sale price on non sale goods)
Say she later sees em rush out with a backpack and the alarm goes off. They cleaned up and found tags for a brand of backpack the store sells.
I hate shoplifters…
Second was an insurance reject. Insurance company says it was filled at a pharmacy in Puerto Rico. I live in New York.
Called patient. She used to live in Puerto Rico with her sister, until she moved up here. Her sister, lives in Puerto Rico.
Here’s where it gets interesting. Her sister shares her first and last name. Just different middle ones. The insurance company has our patients address on file Puerto Rico…
Apparently they only overlap on one medication, and her sister has been using her card for almost a month without anyone noticing…
I love insurance companies….
Tags: Frustrations, Insurance, People | |
January 29th, 2008
Posted by
lb969cpht |
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That describes half my customers right there.
First is a druggy. Comes in for CII painkillers. RX has been stickered on the back by a local competitor and has the markings “NYMed Restricted” on it.
Wonderful. Allow me to explain
The Recipient Restriction Program (RRP) is an administrative program whereby selected recipients with a demonstrated pattern of abuse or misuse of Medicaid services may be restricted to one primary medical provider (physician or a medical clinic), one inpatient hospital, pharmacy, and/or to one dental provider and one DME provider.
This program has two major objectives:
1. To provide recipients with coordinated medical services which in turn improve the quality of their care; and
2. To reduce the cost of health care through the elimination of inappropriate utilization behavior by Medicaid recipients.
There are medical and non-medical reasons for a recipient to be placed into the restriction program.
The medical reasons include the receipt of health care services or supplies that are:
* duplicative,
* excessive,
* contraindicated, or
* conflicting.
The non-medical reasons include:
* forged prescriptions or fiscal orders,
* the possession of multiple Medicaid cards,
* card loaning and/or sharing, and
* the selling of drugs or other supplies obtained from Medicaid.
So the guy has been double dipping, and finally got caught. Well we’re just glad he went to the competitor first, as we’re not online with Medicaid yet due to “clerical errors”, and wouldn’t have been caught by the system.
He was good about it, didn’t get mad, just took it and left to go to another pharmacy. Apparently he does this with new pharmacies in the area often. He’ll go to multiple doctors, and get multiple painkiller scripts, and fill them at multiple pharmacies. All cash of course.
Second was worse. Lady is Hispanic, and doesn’t speak fluent English (imagine that).
She’s had prescriptions here before and they were covered on her Medicaid. But “happy birthday” she now has part D. Well, she swears up and down that she doesn’t. I even dialed the number and let her listen to the message. “Medicare Part A, and B, ad D”.
No, no she doesn’t. She just wants to take her medication and go. I tell her, sorry, I have to bill Medicare Part D, I can’t just bill Medicaid anymore. She proceeds to throw a temper tantrum for the next 15 mins while I attempt to get her plan figured out. She has no card (that she wanted to show me) and is generally rude. Interrupts me frequently while I try to contact the insurance, and chews me out for calling while I should be giving her her meds.
Finally she gets fed up and demands the scripts back. I can give back 2 because they’re new and haven’t been filled. but she has 6 refills worth about $800 cash. (they had been cashed out the day before when we verified eligibility)
So she goes to our competitor and tries to get it there. They call to transfer the Rxes. Then they call back a few mins later asking if I knew what her part D plan was, I gave them the info that I had managed to get from the system, and wished them luck. I managed to get her plan working in about 10 mins on the phone with the insurance company. Why bother? Because some are controls, so she’ll have to come back sometime if she wants her good stuff.
Tags: Druggies, Frustrations, Insurance, People | |
January 13th, 2008
Posted by
lb969cpht |
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Yeah right.
Starts off first thing in the morning. Computers are in local mode. no connection to Central.
Also no internet.
So no electronic adjucation with insurance companies. And no copays.
Oh joy.
I get a call from the help desk. Now there’s a misnomer. She calls and says “We recieved an alarm overnight that your stored went off the grid, and we can’t access your network remotely. And you Sat-backup isn’t working.”
Well yes, the DS3 line is out. No bypass on that, its a dead end. As the the Satellite backup? Its in a box in the closet. No, not a server box, a cardboard box. Its never been installed. I’ve opened a number of complaints about them never installing it when we built the store, and every time Tech support has been on site to hook it up they never know anything about it.
Now comes the rush. Busiest day of the year for pharmacy or so they say. I don’t think they mean in sheer numbers, its all the crap the customers pile on you.
First, everyones new insurance takes effect on Jan first. Well since thats New Years day, we’ll all go tomorrow. (yesterday was SLOW despite the fact we were open. I did all my inventory out-of-dates, and still had free time)
Next is the fact than many don’t bother to inform you that the insurance has changed. So you go and bill it and it gets rejected, then their mad at you that its not done when they get there.
So about 11 I get back online. Finally copays are generating. Well now all these claims are coming back rejected, or with errors.
Oh joy.
So I get this woman from Texas with a Blue Cross Blue shield card. Looks simple right? TXBC as the planID. Nope.
Its Express Scripts. and the card doesn’t have a bin or PCN number on it. Just a phone number for pharmacy services and the ESI/Perx logo. So I put in the ID number and bill to ESI/Perx.
Rejected.
Messed around with it for a while and then called the company.
Yeah, the member# on the ID card? Not the same as the Prescription one.
Takes this woman 10 mins of searching to tell me this. Takes her another 20 to actually FIND the number I need. This is all after spending 5 mins working through all the freaking phone prompts to get to a live person.
Lastly this old guy comes in. Speaks very little English. one of my techs handles him as I am getting ready to leave. This tech is rather new to pharmacy, and tries to fuddle her way through things she doesn’t understand.
So after her muddling through and not having any success, I take over. Yeah, its Medicare part D. Yeah he doesn’t have the new card.
He gets pissed and leaves because as he stated “It take too long, come back tomorrow, better not have problem”
Finally get it to go through. Half are too soon. The other few are rejected for various reasons.
Finally about 15 mins after I’m supposed to have left, I finally tell her to just put them in a bin and I’ll worry about it tomorrow.
I just LOVE the new year.
Tags: Frustrations, Holidays, Insurance | |
January 2nd, 2008
Posted by
lb969cpht |
Uncategorized |
2 comments
