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Thursday, July 2, 2020

This Is The United States Calling. . . Are We Reaching?

. . . he keeps hanging up.

CP: Thank you phor calling CP's Pill Paradise where we may not be the patient's pharmacy of choice, but we aim to lower their expectations all the same. How may I help you?
Patient's Insurance That Always Passes It Through: I have a patient on the line and I need you to resend a claim for her.
CP: Sure thing. Did she receive her medication?
PITAPIT: Yes, she did.
CP: Can confirm. I do see she picked it up 4 days ago.
PITAPIT: And she now needs reimbursed; her prior auth was approved.
CP: Was it?
PITAPIT: Yes. I ran a test claim and it's covered.
CP: You didn't, by some strange chance, happen to backdate that test claim to the day she actually retrieved her medication, did you?
PITAPIT: No. I ran the claim and it worked.
CP: Cool story, bro. But I'm not going to rerun the claim.
PITAPIT: <startled quaver in voice> Um, why not?
CP: Allow me to ask you a few questions, and paint a scenario. Are you married?
CP: Since when?
PITAPIT: 2010.
CP: Congratulations on 10 years. How long did you date before you got married?
PITAPIT: 4 years.
CP: I see. And did you know each other prior to dating?
PITAPIT: Yes. We were friends for a few years.
CP: How sweet. So you've been married for 17 years?
PITAPIT: No. As you said, it's 10 years, this month.
CP: I see. So you knew each other for 3 years, dated for 4 years, and have been married for 10 years. Got it. So this patient has had her new insurance for 3 months, picked up her non-covered prescription 4 days ago, and received approval for the prior auth today. Can she claim her medication has been covered since she started her insurance 3 months ago? Or since she picked it up from my pharmacy? Or only since today?
PITAPIT: I guess it would only be covered since today.
CP: Right. As you can only claim to have been married for 10 years, she can only claim to have this medication covered for a few hours. Unless you can get someone to backdate your marriage date to the day you two met, you can't claim 17 years of marriage. Phollow? The same rules apply here. Unless you backdate her claim to the date she paid for them, she cannot get reimbursed for her out-of-pocket expenses PRIOR to coverage being approved. Capeesh?
PITAPIT: What can we do?
CP: Well, you ARE the insurance company. And YOU are the ones who required the prior auth. And YOU are the ones who have the power to backdate the approval from the date the prescriber submitted it instead of leaving it as today. And only you can prevent phorest phires.
PITAPIT: Can you change the fill date?
CP: How did I know you would ask that? Well, as I explained before, YOU are the insurance and YOU are responsible for all of the patient's misery this past week. As I explained to her when I offered to find her a discount card to help lower the out-of-pocket cost for her very necessary medication, unless YOU, her insurance, backdated the claim, she would assume the risk that YOU, her insurance, would not reimburse her. ME? Helping. YOU? Not so much.
PITAPIT: Why won't you just change the date?
CP: You're phunny. It must be why you've been married for 17 years. First, this is a controlled medication. If I change the date, I alter her refill date AND the date on file with the State PDMP. But the greater question is, WHY. WON'T. YOU?
PITAPIT: <audibly shrugs> It's not in my script. Usually the pharmacy gives in.
CP: I shall capitulate to no insurance, nor anyone who expects me to do their job for them. I will, however, remind the patient that her insurance is the bad guy.
CP: Good luck explaining that to her. I already did for you. . . 4 days ago. Oh, and good luck on your next 17 years of marriage.

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