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Re: [IP] Pharmacies

As a pharmacist myself, I hope I can shed some light on this subject.  It is 
true that most insurance companies keep a tight leash on how soon a script 
can be filled, and also that many times a pharmacist can only dispense part 
of what the doctor writes for to accommodate the limits of days supply the 
insurance plan will cover.  However, in the case of someone going out of town 
and needing a refill a couple days early, usually there is a phone number on 
the rejection sheet that prints out when the claim is filed online (nowadays 
I don't know of any pharmacies that still hand write all their claims-they 
are all submitted via computer and the pharmacies know within a minute or two 
if the claim was perfect enough to suit the insurance company and is paid).  
That phone number should put the pharmacist in touch with someone on the 
insurance's end who can either give an authorization for an override or if 
they themselves are not in a good mood can decide to not authorize it.   This 
also goes for when directions and dosage are changed (in which case really 
the only 'legal' way to get around it is to have the doctor write a new rx), 
or when meds are spilled/ lost/accidentally destroyed (as in Humalog getting 
'cooked' in a hot car by accident).

In any of these cases, you can always ask the pharmacist to call the help 
desk number for the online submissions that they have for that insurance and 
ask for an override authorization.  Many times the pharmacist may have 
already tried if they know the exact situation (like if they have already 
been told that you are going away, or that the med was spilled/destroyed etc) 
and may have gotten an insurance person on the other end who may have been 
having a bad day or something and wouldn't override it for them.  

It is often very frustrating for the pharmacist themselves trying to get 
claims to be paid, if there is one keystroke wrong it will be rejected.  I 
had a case this week where the insurance plan actually had the child's date 
of birth listed as 1898 instead of 1998, and it took over a half an hour on 
the phone with the online submission help desk to get it figured out- I had 
to submit it with the wrong birthdate and the parents had to then call their 
benefits person to get the correction made in the insurance files.  

What I am trying to say is, if the pharmacist has already tried to call the 
online submission help desk for you, their hands may very well have been 
tied, and it is not fair to lay all the blame on them.  On the other hand 
there are some pharmacists out there who are rude and may try to just get you 
to let it go without trying to get an override for you, and if that is truly 
the case then shame on them and I apologize on behalf of those of us who are 
willing to make the call and try for you.  I can honestly tell you all that 
myself, my husband and most of the pharmacists that I have worked with have 
usually made many calls that you may not have even been aware of to get 
something covered, or try to find out what was wrong and get it fixed and 
paid for before you even come back to pick the rx up just in the course of 
one typical day in retail pharmacy.

I didn't mean to write a book, but hope that I've been able to shed some 
light on the subject!

aka Mouse
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