A Patient has been Sheisted by the Pharmacy Since 2014.
Fellow pharm friends. Especially those in some sort of supervisor/department head position (pharmacy manager, lead technician, etc.). Have you ever thought youâve seen just about every scenario of someone billing something improperly that has costed a patient (or the business) in some way/shape/form that you think, âNothing else could be worse?â
I understand that some employees donât really think about the cost of medications or the cost on the pharmacy when a billing error is made. And itâs understandable in some cases because it may not necessarily be your job to really think about it. But when someone catches a billing error that, of course, then has to be resolved, it can be a major loss to the pharmacy. More importantly, that error is a major loss to the patient.
I have been at this new pharmacy as a supervisor for less than 5 months. A customer, that I have never interacted with, comes through the drive thru to pick up some prescriptions. Before I go to get the prescriptions, I let her know that one of the medications has gone up tremendously due to the elimination of our low-cost generic list (and drug manufacturers, but I wasnât going to get into that). The patient, understandably, wasnât cool with it and said she was going to switch pharmacies after this fill. I said âI can always just bill it to your insurance, and I can get you the price.â Little did I know that this suggestion was going to open up the largest can of worms.
âHavenât you guys always been billing my insurance? Itâs Medicare-D.â
I said I had to look at her history, so I looked at the last two months of transactions. Nope, we havenât. âDo you have your insurance card on you so I can take a look at it?â
She hands me the card. I look at her file. Yup, we have it. Itâs been in here for years (her card is one of the very few where the billing numbers havenât changed by a digit), but weâve just decided to bill a discount card for the hell of it. I went back 3 months and looked at all the transaction notes just to see if there was a reason as to why we were doing that. No explanation.
âMaâam, looks like we do have it. For some reason weâve just been billing a discount card.â
âYOU MEAN TO TELL ME THAT YOU HAVENâT BEEN BILLING MY INSURANCE AT ALL?!â âNo, maâam.â Now, I have a pissed off customer on my hands. I fixed the prescriptions that she had ready and the bill dropped by $35-40. She was very appreciative of my efforts (thankfully) and asked âWhy did it take you to realize that something was wrong this entire time?â I didnât want to answer the question bluntly so I just said I wasnât sure, but I told her I would take the time today to re-bill all her claims and call her with the refund. She left frustrated, yet happy, and was expecting my phone call.
So I got to work on my âprojectâ, thinking it was just the last 3 months that we didnât use this card.
Nope. All of 2016. Okay, I can manage that.
And 2015. Iâm breaking out in hives.
And 2014. Are you fucking kidding me. Where are ya, Ashton?!
The insurance would only let me re-bill the claims back to March 2016, and that by itself was $345 we owed this woman. I felt that at this point honesty was way more important than keeping our sales numbers up, so I manually did the math on all of her other claims. The amount was so huge I had to give an explanation to my store manager and coordinator, get their approval, then get permission from corporate to give this woman her money (which they did).
In total, the pharmacy has sheisted this woman a little over $1,200. And we had to give it back to her in cash. Happiest woman Iâd ever seen. And she even gave me a card to show her gratitude (even though I wasnât expecting anything out of her. I was expecting her to transfer out). Rightfully so, we had to take a major loss on sales. And the company inadvertently gave this woman free money (dollars off the gallon with the excessive amount of fuel points she shouldnât have received. So, Anti-Kickback Statute also breached. Let me digress). My pharmacy manager was off work until the day she came in for her refund, so they now hate me (more than they did initially) for making our numbers look bad, but I donât care. Having an honest relationship with patients is more important than the money.
So, take this as a lesson, folks. If you see that your pharmacy has been billing some generic-ass coupon instead of their insurance, speak up about it. Ask the patient if they have a primary insurance. If they do, fix it, get rid of the stupid discount card, and rectify any previous errors. Your boss could possibly despise you for it, and if they do, they shouldnât have that position.
âHow do you keep your customers?â âHonesty.â