New Year...New Insurance Cards

[RxBoy]

It's bad enough that it gets so busy at the end of the year while people are trying to get as many prescriptions filled as possible, it's even worse when the calendar rolls over to January and suddenly we have new plans, new deductibles, and new cards that people don't bring us.

Here's some of the typical situations I'm running into...

- A person who switched to a new insurance plan came in to get a refill on a prescription. I bill it to the new insurance and it is rejected. They require a "prior authorization" meaning that the doctor needs to do a lot of copious paperwork before they will approve the drug. The customer proceeds to yell at me about how ridiculous this is because they've been taking the drug for years with no problem. But the new insurance doesn't want to pay for it...nothing I can do. I'm not denying you. If you want to pay the $300 for the drug I'll let you have it right now. If you want to try and get your insurance to pay for it you'll have to wait and do what they say.

- Another person is mad because their insurance is rejecting it saying that their coverage expired on Dec. 31. They claim this is not true that they still have the same insurance. I ask for the card, and do you think the person has it? Nope. Again, nothing I can do without their card. They get mad at me for it. Apparently it's my fault is someone doesn't carry their insurance card. I have the feeling most of the people in this group have some new card sitting home in a pile of mail they haven't opened yet.

- How hard is it to understand the concept of a deductible? I can't believe how many people act shocked when their first few prescriptions of the year are expensive because they have to pay out of pocket. It work this way every year in January, but they just never seem to get it. Just like the people on Medicare who think it's our fault when they hit the "donut hole" in their coverage.

- People who bring in a medical card and insist that it is for their prescriptions. I know it says the name of a medical insurance plan on it, but if their isn't an RxBIN number on there, it is not a prescription card. No matter how much you insist that this is your prescription card, there's no way that it could be.


I have hundreds of insurance plans to keep track of. Most customers have one or two at most, yet they seem to think that we should know everything about their plans and be able to explain why each thing is denied or not covered. I would love to just tell people to read their damn book that came with the plan. You'd be surprised just how much information you could learn by doing that.

The insurance game is a real headache. I get so tired of people yelling at us because their old insurance covered a drug that they've been "taking for years with no trouble" and now the new plan won't cover it or wants them to take a cheaper generic, etc.

The worst part is the long lines at the pick up area because nobody thinks to give us their new insurance beforehand, so we are rebilling everything to new insurances when they pick up. And of course since it's new insurance we're having all kinds of problems that we could have solved before they got there if they had given us the information before they came in to pick up their stuff. But no, they wait until they come in and it makes everything go slow. We go through this every January, when will people learn?

[Sonoma]

- How hard is it to understand the concept of a deductible? I can't believe how many people act shocked when their first few prescriptions of the year are expensive because they have to pay out of pocket. It work this way every year in January, but they just never seem to get it.

I work for a health insurance company. I lose track of how many times a day I have to explain the concept of "Calendar year". One lady was irate because she'd called in Dec. 30 to get her benefits. She was given them, told the deductible, which had been satisfied, would reset back to $0 on Jan. 1. She never indicated WHEN she was going to be using the benefits. All of a sudden, after the 1st, she's upset because nothing has been put towards her deductible.

For the last few weeks, we have been strongly emphasizing 'calendar year' concepts to people.

[South Texan]

My company just switched insurance on me again. I hate it because the new plan is going to require exactly the amount of paper work and verification you just described for my family's prescriptions that we have been taking for years. It is easier to get the doctor to write all the prescriptions over again and to have them handled as if they are new ones.

[Sightings Reporter]

Ugh! New Year - New Insurance. I used to work in the front office of a Medical Office. I hated that time of year. I hated the people who "didn't" know that their insurance rolled over at the first of the year. (Mostly people who worked for the local university, they thought their insurance rolled over in September. Uh, okay, then wouldn't you have had to full price sometime between Sept and January?)

[aurelemsrealm]

Myself, I only have one prescription for an allergy medication named Astepro. My doctor gave me a special rebate card activated through the manufacturer. Normally, my Astepro prescription is fairly expensive. I know the copay under my wife's insurance coverage on me puts it at $75 out of pocket for a nasal inhaler of Astepro which last me about a month. The rebate card works alongside my insurance to reduce our out-of-pocket cost to $25 per bottle. Even though the Wal-Mart pharmacy has everything on file, I still make sure to have the insurance card and rebate card ready when I go to get a refill. Then, I go do the rest of my shopping while waiting, and it's usually ready to go 20 minutes later. I pay for my stuff without too much trouble, and I'm on my way. The only time I've ever encountered an extended wait was when they were short on help.

[seigus]

We go through this every January, when will people learn?

<raises hand> Oh! Oh! I've got this...
Never?

[Pagan]

I have been having the exact same conversations!

Another one is when they're insurance provider hasn't changed, but has changed how much they pay for X drug. And person is now pissed, even though they were probably sent this information well before the start of the new year.

The worst part is the long lines at the pick up area because nobody thinks to give us their new insurance beforehand, so we are rebilling everything to new insurances when they pick up. And of course since it's new insurance we're having all kinds of problems that we could have solved before they got there if they had given us the information before they came in to pick up their stuff. But no, they wait until they come in and it makes everything go slow. We go through this every January, when will people learn?

Why, why, why, oh why do they wait until getting to the damn pick-up window to tell us about insurance? If I've got a long line, guess what Sparky? You're going to be sent over to the drop-off window to get that fixed. Pissed? Tough. You should have said something earlier.

BONUS: I had a woman last night that thought I could see her prescriptions in Walgreen's system. Except I don't work at Walgreen's.

[SuperRTL]

Yay for having a prescription that's $4 everywhere! I just qualified for the good managers insurance (in contrast to the crappy team member insurance) and it starts in February. Yeah, don't ask, I don't know. The minute I get my cards, I take them around to the places where I get my scripts filled so they can work out any glitches or whatever before I actually need anything. I've always done this and now I'm kinda glad.

[Primer]

I was 38 before I ever had health/Rx insurance. I have to admit, I was ignorant about deductibles, and one time I did get upset in front of a pharmacist, but I really did try not to take it out on him! I learned very quickly, though! The only "problem" I have this year is that name-brand meds (no generic available) have gone from $35 for 90 days to $65 for 90 days, but that's still a lot cheaper than not having insurance at all, and probably still cheaper than other insurance plans!

[Andara Bledin]

Another one is when they're insurance provider hasn't changed, but has changed how much they pay for X drug. And person is now pissed, even though they were probably sent this information well before the start of the new year.

Actually, there are probably quite a number of times where this isn't the customer's fault. Most of the time it probably is, but others, it isn't.

I know that I don't get a new packet when things change. Hell, my employer doesn't even get a new packet. If something changes, our broker gets a new packet, which they don't pass on to us.

The bosslady has to specifically ask if things have changed so that she can pass that information on to the employees.

^-.-^

[sixums]

- People who bring in a medical card and insist that it is for their prescriptions. I know it says the name of a medical insurance plan on it, but if their isn't an RxBIN number on there, it is not a prescription card. No matter how much you insist that this is your prescription card, there's no way that it could be.

I had a pharmacist nearly yell at me because of this. I was in Maine at my university and needed a prescription filled because I had a kidney infection. I had no idea I needed a prescription card, because all the places in MA and NH I'd filled prescriptions with had only asked me for my insurance card. I handed to her and she very snottily said, "no, your prescription card." I got confused, and tried to tell her that was it (thinking it was the same thing), and she went OFF on me. In retrospect I know that she was probably just fed up with hearing that sort of thing a million times a day, but at the time I was so distraught. I had to schedule an appointment with health services around classes, had to call out of my work (which went over awfully with my professor), and drove myself across the city to some place that would fill my prescription while feeling like death. My back and side were on fire, I had an awful fever and every part of me ached. I lost it after she said that, I sat down in their waiting area and on the phone to my best friend.

She wasn't any nicer to me when they didn't call me and I tried to ask about it nearly an hour later. It really wasn't my fault, I had never ever heard of a prescription card and never needed one before.

[thegiraffe]

I work for a large benefits administrator on one of the largest accounts in the company. Deductibles can be kind of complicated to explain, as can coinsurance (mainly for medical).

However.... Explaining how a medicare supplemental plan works with medicare and that the deductible in the comparison chart reaaally isn't the deductible for real-life purposes but that the out of pocket maximum is really kinda the deductible and then it doesn't pay their 20% unless it covers 100% of that benefit and etc etc.... Those are fun calls.

Oh, and as far as the 'donut hole'? Retirees like to think that having MULTIPLE insurances makes them more covered.... So they try to have their medicare supplemental plan (which includes creditable rx coverage) PLUS medicare D, then wonder why their rx through whatever vendor they have doesn't work. Well, it doesn't work both ways. If it's Medicare, it's automatically primary. Period. Dot. End. The other rx vendor won't pay. And let's be honest - do you REALLY need 4 different insurances?

Yeah, insurance can be fun. I start taking pension calls in a week - things are really gonna start getting interesting then!

[auntiem]

The insurance game is a real headache. I get so tired of people yelling at us because their old insurance covered a drug that they've been "taking for years with no trouble" and now the new plan won't cover it or wants them to take a cheaper generic, etc.

Or the formulary for their current plan has big changes, or medicare decides not to cover a particular drug anymore, or they have to do a pre-auth and they can't get their doctor to call it in...
I feel your pain.
*auntiem who just looked at her new card (which is in my wallet already) and it has the Rxbin # and PCN and looky looky on the back, no less that 6 phone numbers - one for each department I would need to contact to find out all about my bene and coverage - you know before I call in an Rx.

[SG15Z]

Oh I know exactly what your going through. Thankfully the people giving me their cards at the pickup window still get out pretty quickly, because I finally know what I'm doing and enter the info, run the scripts through insurance, and bam they pay and are gone. It's weird but most people who give me their cards then didn't have problems. Though I should probably knock on wood when saying that.

[Shalom]

- People who bring in a medical card and insist that it is for their prescriptions. I know it says the name of a medical insurance plan on it, but if their isn't an RxBIN number on there, it is not a prescription card. No matter how much you insist that this is your prescription card, there's no way that it could be.

Unless it's some variety of Blue Cross and/or Blue Shield, which tend to omit that vital datum even when there's Rx coverage on the card, and you then have to guess if it's Argus, Wellpoint, Caremark, NextRX, or some other PBM that I've never heard of. Why can't they give you all the information you need?

(Americhoice of NJ was one of the worst offenders in this respect, you just had to know that it was handled by Prescription Solutions with a group number of AMNJ, even though there was never any such info on the card and the patients never got any other card. Fortunately this year they finally started listing the RXBIN and so forth on the card; in fact, first time I saw a 2010 Americhoice card, I thought it was Medco at first glance, as the layout was identical.)

I remember a few years back when there was a proposal to require all the PBMs to use a standard layout on their cards, with all required info (RXBIN, PCN (sometimes), ID, person number, RX group) in the same places on each card. The industry screamed so loudly at this that you could hear them in NJ from Washington DC. This would cost the industry millions of dollars, etc. I failed to see why it would be so expensive, given that they seem to change the layouts of their cards on a whim from year to year anyway, until it dawned on me that the real loss of money to them would be from claims that they'd now have to pay out which would have previously been rejected for missing info, or never filed in the first place for lack of knowing who the hell to bill. Sorry, but I'm just a bit cynical when it comes to PBMs.