Rejection Is Never Fun
Boys can be cruel but being rejected by your prescription plan can be wose. There are a few little trick that can help.
Let's say you call up your local pharmacy and give them your insurance information. The customer service representative usually tells you that they will call you back to let you know if your insurance goes through. And of course when the calls comes, they tell you that your insurance rejected your request for coverage. The customer service representative proceeds to tell you that if you want to pay out of pocket the cost is $100.
Pharmacy technicians deal with insurance rejection constantly. Calling that sweet old lady to tell her the $100+ prescription isn't covered is possibly the worst part of the job. As we are a compound pharmacy, sometime insurance companies do not cover compound medications. Our pharmacy does its best to work with the patients and the insurance companies to find the best possible solution. It always helps to understand the full process when there are so many parties involved. Here's what we do in a few easy steps.
Once the pharmacy receive the prescription from the doctor's office we call the patient to get more information. We alway need to have:
Once we enter their insurance information into the system, we will get an acceptance or rejection. Depending on the reason for rejection, we either call the patient or the insurance. If our rejection states it is because it is a compound there is nothing we can do and the medication will have to be paid out of pocket. Patients often have the misconception that pharmacy technicians do not care if a patient's medication is covered. We know the importance of having the proper medications to treat illnesses and diseases. And it's in our best interest as well as our patients' to try to get the prescription covered. We strive for a good relationship with our patients and we don't want you to pay more than you have to. I know first hand the importance of having the right medications because I have struggled to get my medication covered as well. It's infuriating when the medication to make your life so much better is only accessible at a very high price. One of our pharmacy technicians has explained to me that she never enjoys telling a patient their meds won't be covered.
Once the pharmacy receive the prescription from the doctor's office we call the patient to get more information. We alway need to have:
- name(confirm spelling)
- phone
- date of birth
- physical address
- allergies to medications (if any)
- BIN
- PCN
- ID
- GROUP
Once we enter their insurance information into the system, we will get an acceptance or rejection. Depending on the reason for rejection, we either call the patient or the insurance. If our rejection states it is because it is a compound there is nothing we can do and the medication will have to be paid out of pocket. Patients often have the misconception that pharmacy technicians do not care if a patient's medication is covered. We know the importance of having the proper medications to treat illnesses and diseases. And it's in our best interest as well as our patients' to try to get the prescription covered. We strive for a good relationship with our patients and we don't want you to pay more than you have to. I know first hand the importance of having the right medications because I have struggled to get my medication covered as well. It's infuriating when the medication to make your life so much better is only accessible at a very high price. One of our pharmacy technicians has explained to me that she never enjoys telling a patient their meds won't be covered.
 |
| Karli Klar CPhT |
Karli emphasized when I asked her how she deals with rejections
"Every patient's insurance plan is different, it is very difficult to tell whether any particular plan will covered non-formulary drugs or compounds or a lot of our specialty items... I hate to see a customer upset because of a high deductible or difficult insurance representatives."
"Every patient's insurance plan is different, it is very difficult to tell whether any particular plan will covered non-formulary drugs or compounds or a lot of our specialty items... I hate to see a customer upset because of a high deductible or difficult insurance representatives."
At our pharmacy, we pride ourselves on serving our patients well and making sure they have the right medications. We do the best we can at working with the insurance companies to ensure our patients they receive the medication they need. Rejection is not an easy task and not something we enjoy here at our pharmacy. So, the next time you get rejected for a pharmacy please know that it is not always easy for the pharmacy technicians to deliver the bad news.
Jennie-Undercover For Your Everything Pharmacy
No comments:
Post a Comment