Annie: "Dr. Grumpy's office, this is Annie."
Mr. Call: "Hi, I just got a letter that my Snotziva-XR pills won't be covered starting next week, on the first."
Annie: "Yeah, we got the same fax. I already sent in the form requesting an override for your case."
Mr. Call: "But how long will that take to get reviewed?"
Annie: "Well, it says 10 days, and last year it took... let me see... exactly 10 days for the same thing. So I'll guess 10 days until we have the override."
Mr. Call: "But the 1st is five days away!"
Annie: "But you just called for a refill last week, looks like we approved it."
Mr. Call: "You did, I picked it up. It was for 30 pills."
Annie: "Okay, so you've got enough for a month. We'll have it cleared before then."
Mr. Call: "But what do I do on the 1st?!!! If it's not covered, don't I have to stop taking it?"
Annie: "No, take the ones you just refilled."
Mr. Call: "Am I allowed to do that? I won't get in trouble?"
Annie: "Um, no. You'll be fine."
Mr. Call: "But it says they're not covered after the 1st. They don't send a repo-man to take the pills back?"
Annie: "No, I promise."
Mr. Call: "Oh, good. I was really worried they'd come for the bottle."
Pill repo-man. Wouldn't that make an interesting reality show? I know there's a clever title for it, I just haven't had enough coffee yet this morning to think of one.
ReplyDeleteRe-pillage
DeleteHe could blame Obama-care.
ReplyDeleteObamacare? Hell, medication denials and authorization forms were common when I began practicing over 20 years ago!
ReplyDeleteDefinitely agree....27 years of "prior authorization required" !! Big insurers with deep pockets have been charging more for less all my years in practice. Wish I had all the stats on how many people received less care due to this crap.
DeleteThey get my pills... when they pry them from my cold dead hands!
ReplyDeleteNo, they just send out a radio signal that turns the pills into cyanide.
ReplyDeleteTake them all before the first, as a matter of fact I think you should take them all now !
ReplyDeletePoor fellow. New to the "modern" health care system, is he? Don't scare him any worse than he's already scared.
ReplyDeleteSeriously, I am glad you and my docs can get a laugh out of this. I got a "you can save money now" letter from my insurance company a few weeks after a previous doctor visit. This doc has prescribed the same well-tolerated drug that has given good results for years. The insurance company sent me a "save money now" letter suggesting a different drug. I showed it to my doctor last visit, five months after the letter came, and she laughed.
Seems she tried the "save money" drug when I first presented. I had a reaction to it. I did not recall the rxn, but it was there in the chart.
Gee, I guess the insurance company would save money if I land in the hospital.
I am glad she thought it was funny, and I am glad she was not angry about me showing her the letter.
Thank God for charting, esp. when the pt. has memory issues.
It is funny, yet sad at same time with regards to Health Literacy.
ReplyDeleteToo bad the insurance company doesn't have a pharmacist license. If they did you could debate constructively. But, it's just pills, so what does it matter?
ReplyDeleteWhere I work, a hospital pharmacy, we have to dispose of outdated medications routinely. A company handles it nowadays, but long time ago we had a variation of the nurse dumping them out (in the toilet hopper) and the pharmacist witnessing or vice versa. EPA is involved, as well as DEA nowadays.
But, before that, the pharmacist where I used to work, would keep the non-controlled (that is, the drugs that are not narcotics) in a big clear glass gallon pickle jar. The red transparent docusate sodium gel capsules looked so pretty in the sunlight when he'd take out the jar to dump a new lot of tablets and capsules into it.
It was kept out of direct light so that the gelatin didn't all melt and clump together, but when the state inspector came through, it went into the safe after someone asked if they were 'real pills'.
I've always wondered what pharmacists used to make the rose and purple colored water in the apothecary globes displayed in the corner drugstore.
Seriously, how does Annie keep from laughing (snickering) outright in these snafus that Annie is involved? Mute button on the phone?
"I was really worried they'd come for the bottle"
ReplyDeleteAnd that's exactly what you did in the next story :D
It should shock me that people actually think this way. It doesn't. Had a couple whose premature baby went to the NICU. They were pleasantly surprised that their baby was "whole". They thought babies grew limb by limb. The head grew first with the legs growing last. They were simply expecting the baby to have no legs and they'd grow in later. The joys of patient education.
ReplyDelete@Holly- Cephalocaudal, proximodistal. Sounds about right to me! Isn't that what you're teaching your patients, too? ;)
ReplyDeleteCareful now, if anyone from a major insurance company is reading this you might give them new ideas lol.
ReplyDelete