8.8 Helping with Insurance Issues
As you can imagine, patients (and pharmacy staff) are often confused by the myriad insurance issues. Here are some common insurance questions that a technician may encounter in the community pharmacy:
Why isn’t this drug covered by my insurance?
What do you mean, my insurance is expired?
Why isn’t my new baby covered on my insurance?
What do you mean, my insurance plan has changed?
Why is my copay $60 for this antibiotic prescription instead of $20?
How come my medication costs more this month than last?
What is a prior authorization, and why do I need it?
Why do you have to call the physician to clarify my prescription? I am in a hurry!
What do you mean you cannot fill my narcotic prescription today?
Why did you give me a 30-day supply when my physician wrote a prescription for a 90-day supply of my medication?
What do you mean, you do not have my medication in stock?
Why have you filled my prescription with only a five-day supply?
Why can’t I use the coupon I received from my doctor’s office?
If I am on Medicare Part D, why can’t I use a store or drug discount card?
I am out of my heart medication and the physician’s office is closed. What can I do?
I forgot my medication and I am on vacation from out of state. Can you help me?
Practice Tip
Be careful not to share any personal information about a client to third-party payers beyond what is necessary for the claim or resolution of a claim. Any other information would be an infringement on privacy and HIPAA regulations.
As a technician, you will need to be a problem solver and also a great communicator to help your customers with these questions and concerns. This list can serve as a great review for you. Go through each question and consider one possible answer for each based on what you have learned. In some of these cases, you will have to imagine the circumstances in which it could happen and how you would respond.