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Monday, January 31, 2022

Stupid Is. . .

CPP What's one of our favourite sayings about people?
CPP: Never ask "How dumb can people be? They'll take it as a challenge". 
CP: Right.  
CPP: Why do you ask? 
CP: I have a new loathing for insurance companies. 
CPP: Do we need another reason to abhor, detest, execrate, despise them?
CP: Very vehemently vilified, verily. And yes. Yes we do. 
CPP: What did they do now?
CP: Ask us to commit insurance fraud. 
CPP: The insurance company?
CP: Yes. 
CPP: ASKED us to commit insurance fraud?
CP: Yes. 
CPP: However did this take place? 

CP: CP's Paradise where we'll do anything phor prescriptions but we won't do that. How may I help you?
Actively Seeking Insurance Fraud: I have a mutual patient of ours on the line who would like to get credit for his prescription. 
CP: You don't have to say "of ours". 
AS IF: What?
CP: You don't have to say "of ours" as in "mutual patient OF OURS". That's redundant. Like 6am in the morning. 
AS IF: Um. He'd like credit on his prescription. 
CP: Ok. Which involves what on my end?
AS IF: We need you to rerun his claim. It wasn't covered and he paid cash for it. We have since approved the claim so you need to reverse it and run it for a paid claim. 
CP: That all sounds like a good plan. When did he pay cash?
AS IF: Last Friday.
CP: Uh-huh. And when did you approve the prior authorisation? 
AS IF: Today. 
CP: Today being Thursday, 6 days later?
AS IF: Correct. 
CP: And, just to satisfy my own curiosity and perform my own due diligence, did you happen to backdate the claim to last Friday? The day he actually received the medication?
AS IF: No. 
CP: I see. Can you do that?
AS IF: No. The prior auth was approved today. 
CP: But you're the insurance company. You're supposed to do insurance-y things. I only do pharmacy-y things on my end. 
AS IF: No. We just need you to reverse it and rebill it so he can get a refund. 
CP: I cannot. I filled it on Friday. Today is Thursday. 
AS IF: You could change the date to today?
CP: I CAN!!!!???? Wow. Why didn't I think of that first!?
AS IF: I know. It's pretty easy. Happy to help.
CP: Except that's insurance fraud which legal people define as: "... any duplicitous act performed with the intent to obtain an improper payment from an insurer." You're asking me to change a fill date to satisfy your obligation to your patient. Since you, the insurance, wrote the contract, and determined this medication needed prior auth and have the power you granted yourself to change the fill date (called backdating), would it not be in your patient's best interest to do all of this yourself? And then, maybe, cut your own beneficiary a check directly from your own company? I'm sure the patient would appreciate this approach without unnecessarily involving other parties who, let's face it, don't really need to be part of addressing the problem you created. In fact, I don't think you need me anymore. I can give you the phone number to the patient's insurance for you to call for help if you like.
AS IF: No. I think I have it. 
CP: Good. Hope it works. If not, it's on the back of the patient's card. Good luck and go fraud yourself!

CPP: Damn. 
CP: Right? They wanted me to go fraud myself! 
CPP: To which you said Fraud That!
CP: Fraud off!
CPP: That's enough. People will question our sanity. 

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