Wednesday, December 22, 2010

End of the year insurance tips

It started yesterday at my pharmacy. Medicare Part D patients started bringing in their new cards and wanting us to bill their new prescription plan for their prescriptions. Of course, all of the claims came back to us saying that the coverage was not in effect yet. And then the pharmacy staff had to spend a minimum of five minutes explaining to the patient why the claims would not go through. Then another five minutes telling the spouse/son/daughter the same thing.

So in an effort to save all of us some headaches as this benefit year winds down and a new one gets ready to ramp up, I've decided to share a few tips for the pharmacy patients out there to make the year-to-year transition go a little bit easier.

Tip #1

If you a currently in the donut hole and have enough medication to carry you into the new year, please wait until the new year to get your refills. You will save yourself money. Any expenses in December do not count towards your deductible in January.

Every year it happens. Sometime between Christmas and New Year's Eve I have a patient call in for a refill on their Plavix. Of course it's written for a three month supply. The patient will pick-up the medication and pay the $400+ copay. Then on the first Sunday of the new year, their adult child will call in to complain that we charged their mother or father such a high copay, and that we should have known and just filled enough to cover them until their new coverage/benefit year goes into effect. You need to be responsible for yourself/your parent. It's not my job to watch out for that. Personally, I don't even look to see what the copays are when I'm checking the prescriptions. It's my job to make sure the right medication is going to the right person at an age-appropriate dose. It's my job to make sure that there are no drug interactions or contraindications for therapy on the prescriptions. It's my job to educate and inform the patient about their medication if they accept the offer of counseling. It's not my job to pay attention to your/your parent's finances. When the cashier tells you what the price is for your medications, that's when you should say something. Waiting for a week, then calling in to complain about the price isn't going to change anything.

Tip #2

This one goes hand-in-hand with the first one. If you call ahead for a refill and don't plan on picking it up until after the start of the new year, it's still going to be billed to the previous year's coverage. In pharmacy, we bill your insurance on the day that we fill the prescription. We don't wait until you come in to pick it up, then file a claim. Every year my pharmacy wastes hours and hours of labor unfilling prescriptions that were billed to the previous benefit year and refilling them under the current benefit year.

Tip #3

Don't come in to the pharmacy during the first week of the new year unless it is absolutely necessary.

I've been at this for a long time and there is one thing that you can bank on every single year. The insurance companies do not have all of the eligibility information loaded into their computers at the start of the year.

I agree with you, they should have the information updated.

But they don't.

It creates the proverbial clusterduck.

It's not the pharmacy staff's fault, so don't gripe at us about it. Call your insurer and make sure that your eligibility has been updated. Or stand there and stare at the pharmacy staff as we make the phone call that you could just as easily make. Just don't gripe while we are trying to help you and a dozen other people who have the same issue.

And if you decided to wait until the last day of the Medicare Part D enrollment period (December 31) to sign up, don't expect your coverage to be updated at 10 AM on New Year's Day.

Tip #4

If you have your 30 day supply of Vicodin filled on December 20th and want us to refill it on January 3 using your new insurance, it's not going to happen. We're going to make you wait until the refill is due. Don't waste my time. I'm the Vicodin/Xanax/Tramadol/Percocet cop.

Tip #5

If you managed to stay out of the donut hole for the previous benefit year and have your prescriptions refilled in the middle of December, don't try to squeeze in one more refill before the end of the year, before your copays go up.

The insurance companies know that you will try this. They aren't going to pay for an early refill. Ever.

Hopefully these tips will help ease the transition into a new benefit year for you.


Anonymous said...

May I add to #3?
Don't come in on Jan 1, and expect us to be able to call the insurance company to even get your info if you don't have your card yet. It's a holiday- no one is working the phone lines to answer.


(My ver. word is fooking. Yup- the first week of the year is a fooking mess!)

pharmacy chick said...

I remember January 1, of the first year of medicare D. I think I still need therapy. Everybody waited til Jan 1 to fill their med, and nearly NOBODY was loaded properly..but I sure wanted to be after work each night...

lovinmyjob said...

This relates to tip #1. I had a lady this week screaming at me that it was her "doctor's job to know what was covered by her insurance." My response, "Uh,'s your doctor's job to diagnose and treat. He is not an insurance agent nor am I. My job is to make sure you don't die from inappropriate drug therapy." Why do people not read the stuff the insurance company sends them about their plan?