A Few Things Today

1) Yesterday was my first day back at work since being hit with the dreaded influenza. It's going around our chain's local area right now, apparently. One of the first things I had to deal with was a woman who was so impatient, she told the pharmacist on duty (who got the drive-thru for me yesterday out of pity, since I was barely able to stand up, a week after my flu) everything she needed was written SOMEWHERE on the blank from the local emergency clinic. We got her name, address, date of birth, allergies, insurance ... no phone number.

Pharmacist on duty enters the insurance info. No go. It says there's a problem with the cardholder id. I take over. It's entered correctly, but in pharmacy, you usually need to drop the 3 alphabet characters at the beginning of the ID. I drop 'em, and still, no go. I do everything I can think of before I call Anthem for help. What happens when I finally get through, after a possibly 10 minute hold? My new Mexican friend at Anthem tells me he won't give me the date of birth (which is apparently the problem -- NOT the ID, as their rejection told me it was) for my patient, because she's recently moved, and I don't have her old addresses, nor her phone number. She had a very unique last name, and I'm sure she was the only one, since he told me she was, but since I couldn't give him anything else, he told me it was a violation of HIPAA to tell me any information without verifying where she lived or her number. I told him she'd recently moved here (true story), yet he wasn't having any of it. I'm not racist, in any way, but you have to think -- with outsourcing and everything, do these people REALLY know the US laws? I mean, we have to follow them to the letter every single day. When they leave their job, they don't have to think about it at all, nor is it relevant. My point was that I'm a healthcare provider, and it's not a violation of HIPAA to tell me her information. When the patient's mom came in later, I asked for any old addresses, and got a handful, and got a recent phone number, too. I call Anthem back, sit on hold for an agent, pass the mom's insurance problem (different carrier and everything) to the pharmacist on duty as I'm working on the daughter's, and when I get a lady (still slightly foreign), and give her all the precious information, she said if I'd've called right back, she was sure anyone else would've cooperated with me, without needing all that extra information. My patient's care got delayed, and I was really irritated that I'd spent a good 20 or so minutes on hold between the two calls. If I would have been feeling better, I would have asked for the first guy's supervisor and had it taken care of on that specific call, but I was feeling like crap and just didn't feel up to fighting.

2) A patient got mad at us today, because she called a prescription in for us to phone her doctor on Friday. We sent an electronic request, as that's the doctor's preferred method of receiving refill requests, and we sent another one yesterday. The lady neglected to tell us she also had a new prescription on file. She comes in and tears me a new one, and I just filled her new prescription from on file. She had the worst attitude I've seen in a long time, and she said we should've called to tell her the doctor wasn't responding quickly enough for her liking. They were out of the office by the time she'd sent the request in Friday, and that doctor doesn't work weekends. Is it my fault we waited an appropriate time for a non-essential medication to be sent back to us? No. It was not fun.

3) A regular came in today. He's not been around too much since his wife sadly passed away, but he's still a regular. He hands me 3 prescriptions, and tells me he wants them submitted for 5 month supplies. First problem -- 2 of them, cholesterol and blood pressure meds, are written for just 3 months at a time, and the 3rd, a sleep aid, was just one month at a time (with 11 refills for a C4 ... when will they learn?!). I explain these restrictions if I'm billing his insurance, then I see in his file he has Caremark. Anyone who's dealt with insurance knows Caremark's stringent 30 days only rule. I run them, and of course, it comes up 30 days only. I tell the man, and he freaks out, and tells me he always gets 90, then realizes he's been doing mail order, then changes his mind and insists to me that they'll pay for 90 at retail. I explain the situation, and he gets mad and takes all 3 prescriptions back, even the sleep aid. I explained that his sleep aid needs to be re-written for #90 with 1 refill if he wants to be able to use it through mail, but he brushed me off since I guess my answer of Caremark only allowing 30 days at retail was not good enough for him.