October 23, 2017
Are you paying too much for healthcare items or other important necessities?
Today, I had a very eye opening experience that I wish to share with my readers. I went to my CVS to pick up one of my routine prescriptions. The cashier told me the total was $64.50. I stated, “That’s odd, it is usually $47.00. She said, “I guess it went up in price”. I asked to speak to the pharmacist, but she was madly filling prescription requests, so she sent “Chris”, the Pharmacy Technician to assist me. He said, “I’ll run it through again”. He quickly ran it through the insurance system and turned to me and stated, “Nope, it’s right on our end, it must be an insurance increase”. I asked him if we could call the insurance company and he told me that wasn’t possible. I took my medication and told him I would be back. He stated, “You have 14 days to dispute the charge”.
Since we live less than a mile from the CVS, I had the time to go home, check which “SilverScript Plan”, the Part D plan I am paying for now that I just turned 65 and have Medicare, a supplemental and my SilverScript drug plan.
I went on line and saw the mistake immediately. Since I receive 90 pills of this one medication per month and take three pills per day, the Pharmacy Technician put the prescription is as if it were a 90 day supply, thus showing $64.50. But the prescription is three pills a day which translates to 90 pills per month, $47.00. I knew I needed help so I called the insurance company and bypassed the automated system to speak directly to an insurance agent. This is easy for me, because for the past 22 years I have been earning my income primarily being paid by insurance companies, so I know the ins and outs of successfully solving an insurance issue. The key is to be “nice”!
The insurance agent confirmed that I was correct, and asked me if I would not mind holding while she call the pharmacist at my CVS. Of course I stated that I would hold, and was very appreciative of her time. About 10 minutes later, she comes back on the line and 3-ways me into the call with the pharmacist. I could tell the pharmacist was a bit disturbed by my persistence and stated over the phone, “Your refund is processed and waiting for you”! I asked the insurance agent if she wouldn’t mind remaining on the phone, because at this point I was walking into the store. She was more than willing to remain on the line while I received my refund. The Pharmacy Technician and the Pharmacist were genuinely nasty, and both stated, “We have to process a refund and rebill for the $47.00 dollars, give us your receipt”! Luckily I had the insurance agent on the phone because I believe I left the receipt in my den by the computer. I stated, “I don’t have the receipt, I have the medication in the bag with the prescription pharmacy receipt”. I could see I might be in for a battle so I stated, “The insurance agent is still on the phone with me, and I have my debit card used for the initial purchase, so clearly that should be adequate”. Chris processed my exchange, but was extremely unpleasant. I asked the Pharmacist and Chris, “I wonder how many times this happens, to older people, or people who don’t know how to solve insurance problems and/or self-advocate”? I got the “look” from both of them and stated that I would be sending all my prescriptions to another CVS close by where the staff is helpful and kind. I also told them that this was the second time in two months that they have been incorrect and less than kind and professional.
I called my husband, and we both agreed that this could lead to a new part of my business of Family Wellness Coaching, being an advocate for the elderly, families with disabled children and/ or adults, and anyone else who needs assistance navigating their way through the healthcare system. Since I have dealt with insurance for 22 years, was a dental hygienist for 20 years before receiving my Masters in counseling psychology in 1991, and have both advocated for clients and family members, and teach self-advocacy, I feel I am well qualified to be an advocate for those who need this help. The healthcare system is always changing, and many times, like today in the pharmacy, they want to make it the consumers problem, don’t want to be bothered with solving problems since the majority of healthcare workers are overwhelmed with either work and /or patients. Most people, including my husband and my aging parents when they were alive, would just accept what they see and assume there was no problem. Others become over whelmed with the automated systems and give up, instead of demanding speaking to a customer service representative or a supervisor if necessary.
As always, REACH OUT! And remember;