Coverage Terminated: PBM nightmare
Ok, The pharmacy Chick was hoping for a quiet Friday. It was not to be. A coughing gagging person comes in with 3 prescriptions with card from Biggest-PBM-on-Planet (BPOP for short). It came back Coverage terminated. No, not non-match ID, (which leaves open a minute possibility that we had something inputted wrong), but Coverage Terminated. I broke the news to one defiant female. “NO its not!”. Uh, yes it is. She whips out her blackberry and calls BPOP customer service who tells her her coverage is valid, and she smugly tells me that I am wrong. She hands me the phone that she has coughed on to talk to BPOP customer rep. I tell Mr. Rep: “Have YOU checked with your processing division to check her eligibilty?” Uh, no he hadn’t. He gives me a run around to try this (nope), try that (nope, again)and then he says “well, I don’t know what to tell you”
ARE YOU FRIGGIN KIDDING ME? I am transmitting the correct BIN, ID, GROUP, and PCN number. It comes back Coverage terminated. CALL YOUR PROCESSING DEPT AND UPDATE HER ELIGIBILITY, THATS WHAT YOU CAN TELL ME. Because until I get a paid claim, she has to pay for these.
Coughing lady disappears for a while, and I assume she is calling her HR and trashing me to everybody she knows. She shows up about 4 hours later and says she wants me to transfer her RX to my competitor up the street (Things are looking up, I think) BUT she wants to make one more phone call (darn). While she was on the phone I called that pharmacy to see if we had the same insurance (we did) and asked them to run ANYTHING thru to check if it worked: Coverage terminated (oh yea, things are REALLY looking up, as I hope she is about to become somebody else’s problem).
I make a visit to the wait room and she is on the phone, on hold. I tell her that I am ready to transfer her rx, but I called her other pharmacy to check on her coverage and they also said she is terminated. The look on her face was priceless. I wasn’t deaf, I could hear what she was saying to her PBM: the pharmacy won’t give me my drugs(I offered her all 3 if she paid cash), the pharmacy computer says I am terminated (correction, My computer has no mouth, it doesn’t say anything–your insurance “says” you are terminated).
Finally she hands me that blackberry (where’s the sanitizer?) again and same Mr. Rep is on phone, and we go round and round again. I tell him under no uncertain terms that I have no more time for this. Either get a conference call with himself, me and the processor or hang up, because I have wasted enough time with his suggestions. BPOP is so big that one part is failing to confer with another and the customer is confused into thinking that if one person at BPOP says she is eligible that every part of the “system” is up to snuff. Sadly it is not.
Finally they take MY advice and the two parts of BPOP confer. AND they call me back. Other than the same BIN number, I have to change the PCN, the ID and the group number. It finally works. I do a print-screen and give it to Coughing lady. I tell her “KEEP THIS, because nothing on your card works, and THIS does. ”
I ask BPOP rep, if this will work from now on–she says yes.
I don’t believe her.
And I didn’t get even so much as a Thank-you.
May the fleas of a thousand camels infest her bed.