I'm getting myself adjusted to my actual work schedule here at MOP#1 (we're #1, yay!), so I haven't had a lot to say in the last week or two... I'm working four 10 hour days - Wednesday, Thursday and Friday from 6 AM to 4:30 PM and Saturday from 9 AM to 7:30 PM. Yes, that's 6 AM. As in, in the morning. As in, the bane of my existence.
And yes, as I confirmed to my boss the other day, I did pick this work schedule. I like 4-10s, and I couldn't work on Sundays, so this was my best alternative over the Sunday-Weds late shift and the Monday-Friday with rotating Saturdays.
Having worked it for 3 weeks, I have to say the Monday-Friday shift isn't bad. I'd probably actually pick that shift if I had to pick all over again, because it gave me time to work out every day before work, as opposed to stumbling out of bed at 4:45 AM and rushing to get ready, pack a lunch, and leave the house by 5:30 at the latest to be at my desk and ready to talk on the phone at 6.
But, as Adam Again used to sing, "It is what it is (what it is)". (That's a great song, btw. Watch that video.) And for better or worse, I'm getting adjusted to early mornings, albeit reluctantly. This is why I'm writing a blog post before 6 AM on a Saturday, and why I tend to be utterly exhausted and ready to go to bed around 9 PM most nights. On off days, I find myself staying up until 10. Whee. For an avowed night person, you must understand how much I hate this. Normally I'd be feeling rather alive and alert in the evening hours, and it thoroughly sucks to be yawning at 8:00. Just sayin'.
In any event, there haven't been a lot of customer stories that stuck with me enough to compel me to write lately, at least until the last couple of days. Today's stories involve Ms. I'mNotCrazy and Ms. VeryInformedConsumer.
A few days ago, I had a call that started out relatively normal... The customer wanted to order a couple of refills - she had several other medications on her profile, as I recall, but only needed her Amitriptyline and her Zolpidem refilled that day. When she told me which medications she needed filled, I confirmed with her the strengths of the medications I was seeing on her Rx list at that time - the Zolpidem (or Ambien, the brand, which was easier for her to remember) was 10MG. I distinctly remember confirming that with her.
Then she launched into a story about how her last Ambien order was lost in the mail - we shipped it with delivery confirmation, as we are required to do for controlled medications, but not a signature requirement, which is only required for Class II controlled meds. We had a tracking number which proved that the post office delivered it, but the customer insisted she never got it. She supposedly tried to file a missing package report with the post office and got the run-around, and since we had delivery confirmation, we couldn't re-send it, and she had to go without her Ambien for 3 months or pay full price at the local pharmacy.
I was not unsympathetic... at least not until later, when the woman became slightly unhinged. I placed her refill order, and as I am required to do, read back to her the name, strength, and form of each of the medications on the order. I specifically had to say we were ordering her Zolpidem tablets ten milligrams. I gave her the order confirmation number. I read back the shipping address we were using for the order. I hit the "finish" hotkey to send the order off through its process. I asked the lady if there was anything else I could do for her.
And then she said "Wait. I'm taking Ambien 20MG." I pulled up the scanned in prescription from the doctor and confirmed that what the doctor sent us said 10MG. She told me she's ALWAYS taken 20MG in the past. I looked at her past order history from us, and the previous Zolpidem prescriptions also said 10MG.
She then began freaking out and demanded that I cancel the order because we were ordering the wrong thing. I tried to reason with her - her doctor was giving her the 10MG tablets in a quantity of 180 for 90 days, so she was technically taking 20MG per day, but apparently she thought she was taking two 20MG tablets. She insisted every time she's purchased Ambien it's been 20MG.
I pulled up her claim history, which lets me see the insurance claims against her prescription plan, and every single claim for the current year, both from us and from her local pharmacy, has been for 10MG. "Well," she said, "there's something wrong here!"
Again she asked me to cancel the order, which was by this point already being dispensed by the automated filling stations at one of our dispensing pharmacies. At that stage, I have to get a technical coach on the phone to e-mail what they refer to as the "expedited folder" to try to catch the order before it goes out and pull it back. Anything that we have to change this late in the game we can't actually guarantee will get caught and changed, but with cancellations I guess they can make sure they don't actually ship, even if they get bottled and packaged up. This is a major hassle, which requires extra manpower outside of the normally computer driven automated process, and we try to avoid it.
OK, I came back and told her, we've put in a request to cancel the order. I informed her that my system was not yet showing the order as canceled, and because it would take some time to reflect that cancellation, we wouldn't be able to put her Amitriptyline on another order until the person who got the e-mail to cancel the order physically went down to stop it from going out and updated the system, so she'd have to call back later to order that medication.
In the meantime, I advised her to talk to her doctor about which strength of Ambien she was supposed to be taking, because everything I saw in the insurance system said she's been receiving the 10MG tablets since at least the beginning of the year. And then she told me that maybe it was a problem with the insurance! Our records are clearly inaccurate! Asserting that she was not, in fact, crazy, she said she was going to go down to her local pharmacy and have them print out the records of everything she's received for the last 4 years, which would conclusively prove of course that she has ALWAYS gotten the 20MG strength.
Yeah. You're not crazy. Good luck with that.
Then yesterday, the Very Informed Consumer called. She suffers greatly from migraines, and was wondering exactly how early she could order her refill of Sumatriptan. I informed her that the next fill date was September 4th, but we technically could put the order through a few days before if it was more convenient for her to call earlier in the week.
She then launched into a discourse about how her doctor had prescribed a quantity for her greater than the insurance plan would pay, and had tried to get an authorization put through for her. She asked me what the status of that authorization was, so I did a little looking around. I saw that the plan allowed a quantity of 27 for the 90 day supply, which was what they sent her, and the doctor had actually requested twice that quantity. Then she mentioned that she'd called a few minutes before, and I started checking the notes from her previous calls.
We got into the first clue that this was going to be a difficult call: The note from the representative she spoke to just before she reached me indicated that she hung up while the rep had her on hold trying to get an answer on the authorization issue. My customer told me that this was a bold-faced lie, she recalled specifically being told that since she was not the doctor, they could not give her that information, and they said goodbye to her and ended the call.
And she gave me the first taste of her "I'm the CONSUMER" rant. "Why don't I have the right to know what's going on with my prescription? I'm the CONSUMER!"
I didn't see any reason why she shouldn't be told, so I read to her the note on what the rep she hung up on (or whatever) had discovered. The authorization was denied, and the doctor was sent a letter with paperwork to appeal the denial. Additionally, the doctor could request a peer-to-peer review with the medical director.
Ms. VeryInformedConsumer then began to ask me very pointed questions about the process - apparently she had some previous experience in some aspect of the medical field, because she thinks she knows more than her doctor does about how this is supposed to work, and was going to have to walk him through the process. She told me that in her experience, the only thing that was going to work was the peer-to-peer review, and she wanted me to tell her how the doctor was supposed to begin that process. I told her I did not have that information, but I was absolutely sure the doctor would be provided that information with the denial letter and the appeals paperwork.
I tried to get her to understand that I worked for the PHARMACY, not the INSURANCE side of the operation, and we have a group of Pharmacy Service folks who interface with the insurance more directly if needed, especially for things like authorizations. I gave her the direct 800 number to reach them.
She started thinking outside the box a little and asked me if her doctor were to prescribe a different medication for the same condition if the insurance would cover it in addition to the Sumatriptan. I told her I could check if she gave me the name of a medication to look up. She had me run a test claim for Zomig. I ran it through a few times and determined the maximum the plan would allow, and told her that quantity and the cost to her, which caused her to go off on another rant about cost and how little her insurance was helping her. Apparently she has a combined medical and pharmacy deductible of $1500, and she's about $300 away from meeting it, and she insists she's never going to meet it because she can't afford to pay that much. So in the meantime, she has to pay full price for the Sumatriptan when she orders it. Luckily for her, Sumatriptan is super cheap compared to a lot of other drugs. Oh, and there's no generic for Zomig available yet.
So she asked me what other generics would be available in that class of drugs. Not being a pharmacist, I had to call one to tell me, and he gave me the name of one other medication that came in a generic I could test for her. I ran through Naratriptan, which she was shocked to discover even as a generic was about as expensive as the brand Zomig. So, she told me, she was just going to have to SUFFER for two more weeks until she could get her Sumatriptan.
And then, the topper of the conversation. She asked me if she could pose a serious question. I agreed... and then she asked me how the insurance company could justify not giving a patient what the doctor says she needs. I told her I couldn't really answer that, and then she asked me - in all seriousness - "How can you go to work every day at a job where you don't understand the ethics of it?"
About a thousand responses ran through my mind, not the least of which was "Lady, have you never needed to have a job to keep the bills paid?" I mean, if I seriously disagreed with the ethical practices of the insurance industry, I might question whether I could work as a claims processor, or even an insurance salesperson... but my job isn't really to deal with their insurance. My job is to get them their medication. And this job was the ONLY one that came up when I was down to my last $200, so I'm happily working here and keeping the roof over my head and food in the refrigerator, which has electricity, because of this job.
But, wanting to keep the job and be a good customer service do-bee, instead I deflected the question by telling her that was a bit of a deep topic for late in the afternoon on a Friday, and finished up giving her the price quotes. I gave her the Member Services phone number to call if she wanted to have a deep philosophical discussion on the ethics practices of the insurance company. She asked me my name again, for about the 4th time over the course of the call, I suppose so she could complain about my lack of answers to the next person whose ear she decided to bend. She then tried to allege that I refused to give her the phone number for the Pharmacy Services people, which I refuted and reminded her that I had given it to her already, and repeated it.
After we agreed there was nothing further that I personally could help her with, we both hung up, and I took a deep breath and prayed very hard that this woman never, ever, ever reaches me again when she calls our customer service number.