Is the insurance company telling the truth?

This is a comment by a “Med Student” to that 4-degree doctor comment. I love getting emails from students.
— Part 1 —

I completely understand what this Dr. is talking about. I always have problems with insurance at the end of year, start of new one. I have chronic pain and also am on a maintenance drug, I take daily for my heart. I went to refill both as I normally do on day 28-29 since the last refill and of course I get the dreaded “It’s too early” from the insurance..but no problem right?

That right there tells me that something is up. Most insurance companies will give a 5 to 7 day window before it kicks back the “refill too soon” error.

Because they tell me to pay cash, and send them the receipt, so I tell this to my pharmacist. Well now, even though I have been going there for over a year, same meds, same amount, same Doctor..she parrots the insurance company (who doesn’t realize there is a HUGE difference between the meaning of THEIR “too early/soon” and a Pharmacies “too early/too soon”) and I ask her, how is it too soon? It’s been 28 days since I last picked up my meds? She wouldn’t answer me. She instead says that she would fill it next week (which btw is at day 33, which means, I’m without my meds for 3 days, which is HUGE, if I miss even one night without my heart med, I start getting some major palpitations..) but it seems she’s made up her mind. She decided to make her OWN medical decision without knowing my complete medical history, as my own personal doctor of over 7 years knows.

To be honest, you are giving me only the information that you wish to give me and I’m sure there is a key bit of information that would make sense that you aren’t giving me. There could of been an ER script in there for a week supply thats throwing everything off, another pharmacy involved, etc. Something however really doesn’t jive with what you are saying. I’m not saying that you are at fault, but with all of the insurance companies I have never heard of one that will kick back a ‘refill too soon’ error when its 2 days remaining on a 30 day supply. Even if you had no coverage, it would say ‘patient not covered’ not ‘refill too soon’.

So, tell me, why is there NO recourse for me for Pharmacists like this when I assure you, I’m no crack addict. I’m a normal person who unfortunately got JRA at 13 with horrible joint damage and chronic pain that I have been living with all my life. Instead of collecting disability like most would, I instead went through school (honors) and now am in my 3rd year of Med school getting my MD/PHD while also working with Congressional members and House members on a daily basis.

Dont take this the wrong way, but if I had a dollar for everyone assured me that they didn’t have a problem as I am looking at their state narcotic report and seeing 4 doctors, 3 ER’s and every Walgreens in town I think I could retire. When everyone and their brother lie to you day in and day out, you tend to not believe everything at face value unless compelling information states otherwise. I hope you would actually read the study on a new drug rather than take at face value what some drug rep tells you, right?
You may think this is bad medicine, but wait until you get out and get a visit from the DEA because you are shoveling vicodin out of the door to everyone who gives you a half-assed sob-story. Its amusing to see new Dr’s backpedal from their ‘we must treat everyones pain’ after I tell them that their patient is going to 3 different pharmacies and 2 other doctors for their narcotics. Its like a real-world shock that there are people who lie and deny to get what they want.
I deal with tons of legitimate pain patients every day, and you know what? I never deny them their pain pills if they are a day or so early. However, this being ‘The Angry Pharmacist’ it doesn’t make for a good read to tell how much I help people. People want to read what pisses pharmacists off, and I know that I have been extremely clear stating this in the past.

There is WAY too much stigma attached to ANY type of pain killer. If it’s for legitimate pain, one shouldn’t be denied healthcare.

Yeah yeah, save me the ‘chicken for every pot’ story. There is no stigma unless you make it a stigma, and in your example above something red-flagged that pharmacist. Vicodin + “Refill Too Soon” = something is going on. Now if your insurance company would not have given that error message back, do you think this would be even an issue? I dont think so. I would also like to hear your definition of ‘legitimate pain’, because last time I checked people don’t go into the doctors office saying “Hey, I need a vicodin Rx to make my car payment or to deal with my bitchy ass wife”.

I do want to point out that:
A. This has never been a “problem” for the Pharmacist before, until insurance denied my claim for a week or so until coverage kicked in
B. The amount, doctor, strength has NOT changed and it IS a legit script, so you cannot argue that she may have denied it on basis of some sort of “suspicion” that it may be fraudulent, etc..

Blame the insurance company, not the pharmacist. They are the ones who threw back a “refill too soon” message. As I said before, if the insurance company wouldn’t of thrown that back, would we even be having this debate now? So, lets break this down a bit more.
Something happens and DEA gets on your case for something. DEA officer comes in and asks to see the hard copies. DEA also has subpoenad your insurance company. DEA asks pharmacist “When you filled this Rx, it came back from the insurance company as ‘refill too soon’. Why did you fill it?” Whats the pharmacist supposed to answer? “Because shes in legit pain and says that she isnt a pillhead?” Yeah, that’ll fly like a turd on a birthday cake.

THOSE are the types of Pharmacists that are trying to practice Medicine without a degree. There should be some sort of consequences. *I* was ticked off at the fact that she “offered” to call my doctor to see if it was ok to “refill early”..MY argument here was, it was NOT early. 28-29 after getting the original fill is NOT early, ESPECIALLY NOT when your on maintenance medication in which you must take it every day.
My doctor is a nice guy, but he REALLY is busy, he spends 12 hours at a busy ER and the rest of the time at the practice, he does NOT have time to get on the phone (which can be backed up by his wife!) to be questioned about nonsense!

I think you should nail your insurance company for practicing medicine without a degree. If the insurance company is kicking back an early fill error, then something else is going on. I would call your insurance company to see who possibly stole your identity or your insurance card and is running up some vicodin scripts with it.
— Part 2 —

I’m sorry, I forgot to add a little more background.
I had been at Walmart Pharmacy last year and the same thing happened then. At the end of year, my insurance changes because that’s what the company forces us to do, they LOVE making life miserable. Well, Aetna has 2 numbers, the business number for customer service and the PHARMACY number the pharmacies are supposed to call. Well, when I needed my refill, the computer denied the claim and the tech called the BUSINESS line, which BTW they are completely useless. All they said was basically it was “too soon”

Wait, so this has happened with 2 pharmacies? Something now is really fishy especially if its coming back ‘refill too soon’ both times.

Well, at THIS point, I had been EXTREMELY busy, I was the campaign manager for a House member and forgot to call in my refill, so I called at day 30! (I almost NEVER do this..or at least try not to..with my luck, something comes up and I forget to pick it I always give myself 2 days wiggle room)

Filling your Rx on day 30 when you have a 30 day supply should go through with no errors. Unless you are getting it filled somewhere else, the Rx was mistakingly put in with a days supply higher than 30 (doubtful with Aetna, it would of gotten rejected), or someone else is using your card.

Well now, I get there and the pharmacist and I literally get into it, she starts screaming that it’s TOO Soon! I KNOW this is wrong, so I sit there and call the CORRECT number for the Pharmacy portion of the insurance and I actually am able to get the DIRECTOR of Aetna on the phone, she tries to speak with the Pharmacist, but the pharmacist will have NONE of it. the director feels bad for me and apologizes and says, I’m sorry, but she just wont listen to me. (The director tried to explain it’s all about the coverage and end of year etc..that it’s NOT too early for the refill)

You got the Director of Aetna? I’m sorry, but I’m having a hard time believing you. The pharmacist has to go by what is on his/her screen, and if Aetna is claiming its too soon then tell them to fix their shit to give back accurate error messages.

So, my DOCTOR calls the pharmacist (keep in mind, Im standing there at the pharmacy for 2 HOURS watching all this) and he tells her, you HAVE to fill this refill! The pharmacist REFUSES, quoting the comment of the clueless wonder at the insurance company the very 1st time, “Insurance is saying it’s too soon” which at THAT time, everyone in line almost faint FOR me because the director actually called and the pharmacist would NOT listen to her. So, my doc calls me on MY cell phone and boy, is he pissed! He’s like, I dont know why she wont listen to me, I’ll go ahead and call a new script at a different Pharmacy because this is ridiculous.
THATS when I go to this new pharmacy, I explain what happened and even though I feel as if I dont HAVE to or need to, I actually go through all my medical conditions, etc. MY thinking is, this is a smaller Pharmacy, I want a more personalized interaction. I want to feel like a person and NOT a refill number, ya know? My Physician even went as far as to stop in and introduce himself! Seriously, we have gone above and beyond here.

Its always good to explain yourself even though you don’t HAVE or need to. You know, we’re just stupid pill dispensers and don’t need to know ANYTHING about you. Give me a fucking break, you must really be a med student with an attitude like that.
Pharmacists tend to get a bit pissed when you withhold information especially when the words “another pharmacy” and “refill too soon” are in the same boat as your narcotic Rx.

So, That is just another reason why I’m sooo ticked that I’m having this problem. Is it so difficult for her to look at the dates?
I’m thinking (in both cases) it’s a matter of their pride, they were wrong and don’t want to admit it. But *I* am paying the price for that while they have absolutely NO consequences for their actions.

Blame Aetna, didnt they give back the refill too soon message that started this whole thing?

After reading quite a few posts of yours, I know you have this thing about thinking everyone is a “pillhead”, but I’m guessing even you would be able to put aside pride or ego and not actually DENY a patient legit care…afterall.. isn’t that why you became a pharmacist? One has to wonder about these pharmacists, is it an ego trip that put them in this field or is it helping people.

No, I dont think everyone is a crackhead or an addict. I however dont take people’s word for anything now days unless I have good and solid evidence that they are being legit with me. Its not pride or ego, its doing our fucking job to control narcotics and to manage the medications that multiple doctors prescribe because its impossible to call each other to see what the others is giving. Amazing how stories change when I get a refill too soon error, ask the patient if they received some at another store about 4 times, call the insurance company to find out what store filled it, then ask the patient point blank if they got it as that store. Then I asked why they fucking lied to me when I have to crowbar out of them that they did get some at another store. Get this done to you (which is a complete waste of my time) about every other day, then you’ll realize that its not “pride” or “ego”.
Lets face it, Aetna probably gave that pharmacist some bum information. If it would have been me, I would of called Aetna and had them give me the pharmacy that last filled it. If you had no idea about this other pharmacy then I’d ask for a copy of the sign-out log and inform the police about narcotic/insurance fraud. You would not believe the amount of shit dropped in pants when I threaten to call the police. Amazingly they manage to remember that they got 30 from an ER doc YESTERDAY. Must of slipped their mind.
However from what you have wrote, you don’t really sound like the easiest person to get along with or work with to get this sorted out. You probably just started screaming at the pharmacist which really doesn’t help anything. Screaming isn’t going to get your pills filled when there is documentation (from the insurance company) that it was too early to be filled (something had to trigger that message).
Of course I will also entertain the fact that you gave me everything and the pharmacist is just being a dick. It happens just like there are asshole doctors in the world who think their shit is worth as much as Zyvox and their farts smell like Warrick Albuterol MDI’s.
So good luck in Med school. When you get out you can rant to me about that mean ole asshole pharmacist who wont fill the Rx’s you write for yourself.

Medicare Part D – 1/1/2008

Did it go smoothly? No.  Was it a complete clusterfuck? Yes.  Am I suprised? No.

Today was a diaster.  I had some insurance companies publish the completely wrong information on the cards, bunch of stuff that isnt formulary, “card? what new card?”, and a shitpot full of people whom a deductible = rocket science.  Lets not even get into how fun it was to try to get through to any helpdesk.  The only shining moment is that Argus did not go down, and to be honest most of the big processors were not down for any length of time.  They had 3 years to figure this shit out, good job boys.

Yes, please bitch at me a bunch because you have a $0.05 increase in your copay for your $100 medication.  Plus, just to show how much fate hates TAP, it made one of my printers blow up today, and our pharmacy software glitch like mad.  Wonderful.

I barely have the ambition after a good night of drinking Jack Daniels to even write more.  I’m just so happy that today is over.