A short time ago a medication was on backorder. A real surprise, I know. At the time the only version available was a single manufacturer supplying blister packs. While they are a pain to deal with, at least we could provide the medication to our patients...until the pesky insurances got involved.
We received many "NDC not covered" rejects.
We called for overrides.
Some insurances were obliging, others were not.
This is one of those conversations:
Insurance Guy: How may I help you?
CP: I need to request an override for an NDC not covered rejection.
IG: For what reason?
CP: It is a blister-pack NDC and, unfortunately, the only one available.
IG: It's not covered.
CP: I know this, hence the rejection. Since we care about our patients, unlike their insurance companies, we were able to find the product for them and now are trying to dispense it to them.
IG: My computer shows this is not the only NDC available.
CP: But it is. We have been ordering this for 2 weeks and this is the only one we cold procure.
IG: The insurance won't pay for it since these others are available.
CP: Fine. Give me the NDCs your "magic computer" says are available.
<gives me 3 NDCs>
CP: Great. Those are 3 of the ones we have been ordering from all of our suppliers and, guess what? Not available.
IG: My computer shows they are.
CP: Well since your magic computer shows they are out there, can it also tell me where I can find them? Can it order them for me? Does it have real-time data that shows the inventory of every warehouse in the country?
IG: "No. It's not a magic computer." (Yes. I actually got him to say this.)
CP: Since I call and look online at the warehouses every day, and have been trying to order this for 2 weeks with no success, I think I would know better than your broken "magic computer" what is and is not available in the marketplace.
IG: "I don't have a magic computer." (He did it again.)
CP: Can you just please allow an override for this patient so I can get on with my day?
IG: No. My computer says it's available.
CP: Ugh. Okay. I'll call back and get someone who'll just put in the override with his magic computer.
IG: It's not...
Called back. Got someone else. They put in the override. He agreed he doesn't have a magic computer either, but he also knew there were supply issues. It may have been exhausting, but it was fun.