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Tuesday, May 28, 2013

Another Insurance Rant...

How to tell the insurance companies are just messing with us...
CP: Hi, CP calling regarding a rejection I am getting.
Insurance Gal: Ok. I can help you with that. And this call is being recorded for quality assurance and training purposes.
CP: Lovely. Hopefully someone will listen to this call.
IG: I'm sorry?
CP: Nothing. I have a lovely gent here who is trying to fill a prescription for Androgel and the rejection tells me it needs a prior auth.
IG: It does.
CP: Is there a preferred alternative?
IG: Maybe.
CP: Do I have to guess?
IG: Yes. I don't know any. I just read this little computer script.
CP: Ok. How about Axiron?
IG: Nope.
CP: Testim?
IG: Uh. Nope.
CP: Androderm?
IG: Huh-uh. All Testosterone products require prior auth.
CP: You could have said that first.
IG: It's not on the script.
CP: Ok. But will they be covered?
IG: <this is verbatim> "Yes. Absolutely. As soon as the doctor faxes us the prior auth form, it will be approved."
CP: So...If I have been paying attention and I have this right, let me explain. No, there is too much. Let me sum up...
I spent 2 minutes trying to fill this. Then 7 minutes dialing you, typing in prompts on the phone, entering, reentering and telling you my NCPDP number and name and first initial of last name, then 5 minutes talking with you to find out you will fax the doctor a request for a prior auth which he will fill out and fax to you so the drug that requires prior auth will immediately be covered?
IG: Sounds about right.
CP: And it doesn't matter which product he picks? Wouldn't it make more sense if, when I processed this the first time, I simply received a Paid Claim?
IG: Perhaps.
CP: But then you and I could not have engaged in this witty tete-a-tete.
IG: Indeed.
CP: And I'd have nothing to complain about next week and all of my customers would be less grumpy because their wait times would be less and the doctor may actually be able to remember to sign his prescriptions because he wasn't dragged away for some stupid prior auth form for a drug that you're going to automatically approve anyway.
IG: Correct. Is there anything else I can help you with today? I do have the time.
CP: Alas, I do not...
...Despite all my rage I am still just a rat in a cage...

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