Nutjobs and druggies.
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 | |
