You Won't Commit Fraud For Me?...Bad Service!

[RxBoy]

This happened today while I was working on some rejected insurance claims. A woman had called in a refill on her prescription for insulin pens. Her insurance rejected it claiming that it was too soon to refill. The next refill would be available to her in 13 days, indicating that she should have about an 18 day supply left at home.

Before I call her, I go back and double check the data entry from the last time it was submitted. I wanted to make sure that we had submitted it with the correct days supply based on the doctor's written instructions. Everything looked good. So the next step was to call her and let her know.

She answers the phone and right away I know I'm going to have a difficult time talking to her. In the background there are a man and a woman arguing with each other and at least two kids screaming. But I try to talk to her anyway.

I explained to her that we had received her refill request for the insulin pens but that her insurance was rejecting it saying that it was too soon. I told her that the earliest we could fill it was 13 days from now. She told me that she was out of her insulin and needed it today.

I then asked her if she was using it according to the instructions on the label, because if she was she should still have about 18 days worth left. She told me that the reason she didn't have any was because her fridge broke down and it had spoiled. I told her that I would call her insurance company and see if they would let her get it filled early under the circumstances and then get back to her.

I call her insurance company and explain the situation to the rep I spoke with. The rep informed me that her insurance plan does not have coverage for lost or damaged medications and therefore that they would not allow it to be filled until 13 days from now.

I called her back and let her know this. At this point her only option is to either wait until the insurance will pay or buy one package and pay cash. Unfortunately the pens she uses come in a package of 5 and cannot be sold separately. The cost for one package was about $250. I told her this and of course it didn't go over well. She wanted me to give her one of the pens from the package today and then bill her insurance in 13 days and give her the rest then. I explained to her that I could not do that because it would be insurance fraud and I could get in serious trouble as well as cost my pharmacy a lot of money. What did she do next? She demanded to speak to the manager.

The pharmacy manager wasn't in today, so I passed her to the pharmacist who basically told her the same thing I did. The insurance won't pay for it for 13 more days and her only option was to pay cash for one package if she couldn't wait. She tried asking him about giving it to her now and billing it later. He told her the same thing I did. We were not going to do anything fraudulent and get ourselves in trouble. That was when she told him we were not a very customer-service oriented store and that a store who cared about their customers would not treat them this way.

So in other words since we are not willing to either give her a free $250 box of insulin pens or submit a fraudulent insurance claim to get it early for her, we have bad customer service? I sympathize with the fact that she lost her medicine when the fridge died, but what else could we really do? If I were in that postion I'd have to pay it. I wouldn't like it, but I wouldn't blame the store for my problem. The fact is I tried to get her insurance to pay for it early but they refused so I did what I could. It's her problem.

Even if we had done what she asked and give her one pen until we could submit the claim in 13 days, that would just be postponing the problem. She would run our early again the following month too. The only thing she can do is buy a package with cash.

[Sapphire Silk]

Insulin no longer has to be refrigerated. It is good for 30 days at room temperature.

I'll be she'd been "adjusting" her dose based on her blood sugar (which actually is not necessarily a problem).

She'd have less problems if she'd simply learn to draw from a vial and self inject. It's actually not as hard as it looks (I do this with Imitrex, it's really not bad at all).

[EvilEmpryss]

You know, I'm not an advocate of non-emergency use of the emergency room, but since she clearly has insurance she should be monitoring her blood sugar levels and if she gets in a pinch she can head to the ER for help. They may even be willing to give her a few doses to tide her over.

That, or she should call her insurance company and explain to them that they'd be better off paying for a replacement prescription than paying for her to go to the ER a half-dozen times in the next two weeks when her blood sugar crashes. There may be someone at the insurance company who can approve an emergency refill if an ER doc requests it.

[Sapphire Silk]

The ER won't give her replacement insulin, especially not an insulin pen. If her sugar is up, it'll be a one time dose at best, and a script for insulin by the vial.

She could try your suggestion, but the insurance company won't bend. They'll pay for the ER visits before they fill a script before it is due. I tried that line when my insurance company wouldn't pay for my Imitrex before it is due. No dice.

Of course, I did end up in the ER on my next migraine. Yeah, it's stupid.

[bainsidhe]

I feel for anyone who's left in a bind and needs medication. $250 is a lot of money, after all. But I have to wonder, why didn't she mention the fridge when she placed the order? This is something I'd be talking about with my pharmacist and doctor immediately, since this would be medication I had to have. Call me cynical, but I wonder if she's lying?

[EvilEmpryss]

I might think she was lying too, but insulin isn't exactly a high-value street drug... is it?

I would think it's more likely that she is either telling the truth about her fridge (whether or not it *requires* refrigeration, she may *think* it needs it and assumed that the batch was bad) or as Panacea mentioned she's just not dosing herself according to the prescription. Both possibilities could be straightened out by educating her on her meds.

[TheComputerError]

I might think she was lying too, but insulin isn't exactly a high-value street drug... is it?

I would think it's more likely that she is either telling the truth about her fridge (whether or not it *requires* refrigeration, she may *think* it needs it and assumed that the batch was bad) or as Panacea mentioned she's just not dosing herself according to the prescription. Both possibilities could be straightened out by educating her on her meds.

Insulin, along with other diabetic supplies, are actually quite sought-after on the streets, mostly by diabetics without insurance.

As far as the refrigeration of insulin:

Recommended Insulin Storage Opened In-Use* Insulin
Room Temp. (59°F to 86°F)

*In-use is defined as when the stopper or seal has been punctured with a needle, and should be stored at room temperature. In-use PENS should NOT be stored in the refrigerator.

[Sliceanddice]

you know i think my mom uses the same pens, they are very shelf stable as long as your house is held at least 78 degrees. she only refigerates around the summer cause the power can go out during the monsoon.

oh and insulin besides being a sought after black market drug, is also considered a sex drug for S and M sex... you know a tempura y coma... hot coma sex with the unconscious woman.

[Miss_Stress]

My fiance is a diabetic and he NEVER has his insulin pens in the fridge, except an orange one which is only there for if he goes into a coma and is already packed full with what can best be described as liquid sugar. The only thing he puts in the fridge are the pen refills, and even then it's only when the stuff needs to be stored for a month so he can use the rest of his insulin. My fiance never gets free pens either, just the refills for the pens, unless refills is what the OP meant by "pen" of course, please forgive my ignorance if this is so

So yeah, the lady was a rude ass, and more than likely not being entirely truthful about the insulin being spoiled, as it is more than capable of surviving at room temperature

[smileyeagle1021]

oh and insulin besides being a sought after black market drug, is also considered a sex drug for S and M sex... you know a tempura y coma... hot coma sex with the unconscious woman.

It is also popular for committing suicide. Just take a large enough dose and you will pass out and never wake up again. I've heard it is one of the less painful ways to kill yourself. Sadly I know all this because my grandma attempted an OD once Giving the method credit, my grandma's medical knowledge actually worked against her (she apparently dosed herself with just enough to be lethal... drawback being that just enough is also very easy to overcome with a glucose shot), an amaeture is more likely to just fill the entire syringe and inject... there is no way to counteract that in time.

[EvilEmpryss]

Okay... wow... I just learned waaaay more about insulin than I ever needed to know.

[Argabarga]

I don't miss this part of pharmacy at all.... people arguing that they're out before their RX says they should be out.

If you're following your Doctor's orders, you should have a week left, and trust me, when insurance denies a claim, you're better off trying to get meds by barking at the moon until the cops pick you up than trying to re-submit it. It's just NOT going to go through the all-knowing all-powerful friend-computer at the insurance company.

[kpzra]

It is also popular for committing suicide. Just take a large enough dose and you will pass out and never wake up again. I've heard it is one of the less painful ways to kill yourself. Sadly I know all this because my grandma attempted an OD once Giving the method credit, my grandma's medical knowledge actually worked against her (she apparently dosed herself with just enough to be lethal... drawback being that just enough is also very easy to overcome with a glucose shot), an amaeture is more likely to just fill the entire syringe and inject... there is no way to counteract that in time.

Yup, first person I ever intubated committed suicide this way. Ended up working the code for 45 minutes until we called it, no transport.

[bsaana]

There is a type of pen that my mother gets that HAS to be refrigerated. I don't know how many per pack, but it has a pharmacy sticker, and notes on the box that say it needs refrigeration.

[Shalom]

My fiance is a diabetic and he NEVER has his insulin pens in the fridge, except an orange one which is only there for if he goes into a coma and is already packed full with what can best be described as liquid sugar.

The orange one is probably glucagon, which is a hormone similar to insulin, but with the exact opposite effect. (And should be stored at room temperature, according to the one on my shelf. Check the label on yours...)

The only thing he puts in the fridge are the pen refills, and even then it's only when the stuff needs to be stored for a month so he can use the rest of his insulin. My fiance never gets free pens either, just the refills for the pens, unless refills is what the OP meant by "pen" of course, please forgive my ignorance if this is so

Well there are two types of pens. One type has the entire pen as a disposable unit already filled; the other type has a reusable pen and an insulin cartridge that gets plugged into it like the old Schafer fountain pens. Sounds like your fiance has the second type.

So yeah, the lady was a rude ass, and more than likely not being entirely truthful about the insulin being spoiled, as it is more than capable of surviving at room temperature

I just checked the fridge in my store; every type of insulin pen that we stock, both the old-style insulins (Humulin/Novolin), and the new modified insulins (Novolog, Lantus e.g.) say to store at room temperature once they've been opened; in fact the paper from Novo Nordysk, the first one I grabbed, specifically says not to refrigerate in-use Novolog, and to discard it after 28 days. (Levemir is good at room temp for 42 days. Novolog Mix 70/30 is the exception: 14 days.) Even Byetta, which is not technically insulin, is stored at room temperature once started.

If she's putting her in-use pens in the fridge, she's doing it wrong.

Of course once the stuff comes to room temperature, it still needs to be used within 28 days, but if she only had 2 weeks worth left, then it's irrelevant.

There is a type of pen that my mother gets that HAS to be refrigerated. I don't know how many per pack, but it has a pharmacy sticker, and notes on the box that say it needs refrigeration.

We recommend refrigeration of insulin until the pen is started, which is why that sticker goes on; thereafter it's good for 28 days at room temperature. I believe this is because refrigerated insulin is absorbed more erratically.

Do you know what type of insulin it is, or if it's another drug that comes in the same form factor?