|
Take down medical insurance
Here're the options:
1) do away with medical insurance
2) stick with medi-cal
3) lower prescription costs
Insurance companies are the scum of the earth. yoo try and work in a medical field. Try anything: pharmacy, ward, or clinic. Almost everyone will have some kind of terrible experience with insurance. PPOs are ok, they don't get on your nerves as much.
The worst insurance companies are HMOs, the small ones, and the large ones. HMOs...obvious reasons, small companies are not as professional as the big ones. They don't have the staff power and they don't run as snappy. Large companies enforce their policies like mad. It's especially irritating when we have common drugs that they don't cover, top that off with a pt who's feeling like crap because of their infection or whatever.
I still remember that one guy that stopped his truck in the middle of the freeway. He waited until all the cameras of every single TV station was pointed at him. Cops and choppers and all this crap was centered around him. Then he took out a banner, it said something like "down with HMOs". He took out a gun, and shot himself. Right on national TV.
I can't find any other place/site that doesn't like insurance companies, except this one.
"A few days ago, a pt brought in a script for a Workers' Comp claim. The WC was through PPS, which was odd to me, because 99.9% of the WC claims we see are through the Ohio Bureau of Workmen's Compensation, or something like that. This was the first time I'd ever seen a PPS card. I wasn't even sure we accepted it, but the pt showed me her "enrollment" or acceptance letter and we were listed. Well sure enough, her Rx for ibuprofen and Vicodin rejected. Oh Gawd, I thought, what the hell. Good thing it was a slow night so I had time to call the lovely people at PPS. Dammit, they had me on hold for like ten minutes. Who is PPS? I never heard of them. Are they that busy? Geez, I bet they had just one guy working and it was so dead at the call center that he went walking the halls for coffee and donuts or something. PAID handles like a gazillion scripts and they answer their phones much faster. Anyways, when I finally get a representative, he told me the claim was rejecting because the injury occurred in June 2002 and the pt had never used the card until now. Since she didn't use it during the 3 months after the injury, her case was closed. Wow, that really sucks. She was really upset. Good thing I handed her the phone so the guy could tell her the wonderful news. I hate when the insurance carriers refuse to talk to the pts standing right by the counter. I always say "Look, that's a lot of info, could you please tell the member that personally?" And usually they say "Oh noooo, we are the processor. If the member has questions, please refer them to their benefit manager." Weasels. But since this was a Workers' Comp claim, the guy had to talk to the pt. Boy was she steaming mad. Rightfully so. After she hung up, she told me she needed the pain meds because she just had surgery. I bet PPS won't pay for that either. Insurance companies are like the bane of society."
"The people at NPA are such asses. Today, a guy came with 2 scripts: Percocet and Augmentin. He had a cast on his hand and looked to be in some pain. I wanted to give him prices for both brand and generic (it was Labor Day and kind of slow, so I was in a generous mood) I filled the Percocet as brand, then reversed to the generic and got both co-pays. I then did the Augmentin, then tried to reverse it to the generic. Well, the brand had authorized, but for some reason, the generic was giving me a reject "Duplicate Claim, Paid Claim - Filled at another pharmacy - Today's date" Hmmm. Strange. Was NPA seeing my fill for the brand and not reversing it? Maybe that's why the generic was rejecting? Well, I called my good friends at NPA (now a division of Express Scripts, those winners) The help lady asked me what kind of reject I was getting. I told "Duplicate Claim, Paid Claim" and that the brand had gone through, but not the generic. She said just to try rebilling it in five minutes. Well, when the store is slow, and a guy is standing at your counter in pain, 5 minutes is an eternity. I waited rather impatiently and kept rebilling and rebilling. Reject, reject, reject. I called my friends at NPA again and luckily go the same help lady. She asked "What was the reject again?" And I told her "Duplicate Claim, Paid Claim - filled at another pharmacy" She said "Ohhhh, filled at another pharmacy, you didn't say that before" Well, duh, what do you have a computer for? Do I have to tell you everything? So she said it was filled at another pharmacy with today's date. I asked the pt if he had gone elsewhere and he replied Walgreens, but they didn't have the generic Augmentin, so they'd have to order. He wasn't able to wait. I told the help lady that Walgreens probably filled it then reversed it. She said the reversal wasn't showing. I asked her if she could reverse it at her end, but she said Walgreens would have to call. Grrrr. So I hung up with her and called Walgreens. It was now about 15 minutes after he had dropped it off and shouldn't taken more than 6 minutes to fill. But now I had to call Walgreens. Luckily the RPh answered right away (what are the chances?) and I am on good terms with her and I asked (begged) her to please call my friends at NPA and tell them that the reversal didn't process. As I hung up with her, I rebilled and rebilled every 20 seconds or so, because I hate patients watching me while they wait! It gets me so nervous and anxious! Finally it went through and I was able to get the poor guy out. Funny, I asked NPA what his co-pay would be on the generic Augmentin, and she said probably $2. (The brand was $19 with his co-pay) Well, when it finally authorized, the generic came out to be $10! The guy spent like 20 minutes to save $9. I think had he known it'd be only a $9 difference, he would've stuck with the brand and gotten out of the pharmacy 15 minutes sooner. He probably thought I was a moron for making him wait that long just to save $9."
http://www.xanga.com/home.asp?user=RainDrop
If you're wondering if she's the only person with insurance problems, don't worry. I've worked in a pharmacy for 4 months, and already have had a few annoyances. oh oh, and my two bosses were both pharmacists for 17 years. Think of all the wonderful stories they can share 
__________________
good, morning
|
12-23-2002 07:40 PM
