My family's not big on doctor visits - once I got past the mystifying illnesses of my younger childhood, I can't recall my mom even dragging me to a yearly checkup. Unless we're actually feeling poorly for an extended period of time, or in severe pain, mostly we just take advantage of home remedies, common sense and prayer, and wait and see if it goes away.
I've certainly been healthy enough to avoid taking anything we in the mail order pharmacy business refer to as "maintenance medications". The only time in my teenage or adult life I have been taking any prescription medication longer than a few days or weeks was the first two years I was married, when we decided on hormonal birth control pills as our solution to giving ourselves some time to get adjusted to married life and recover from the financial impact of the post-9/11 job situation. Come to think of it, at the time I believe I got those through mail order, 3 months at a time.
So I haven't had a lot of personal experience with doctors and ongoing prescriptions and the like. I've only been on the phones at MOP#1 (we're #1, yay!) for a month now, and already I'm accumulating baffling stories of doctor-patient interaction. I'm sure the customer service reps who have been doing this job for a year or more could come up with some real doozies.
One of our policies at MOP#1 (we're #1, yay!) is to require payment on any order placed with a representative. When our outbound sales types make their calls to convince people to set themselves up with our program, sometimes they gloss over this fact, although there is one new outbounder who did the inbound customer service job for a year or so and is very careful to make it clear when they offer to send out the first order without payment that they'll be asked for a credit card or debit card to use on future phone orders, or they'll have to mail in their order with a check.
In fact, we do try to get payment on every order, although it doesn't always happen. Credit card numbers fail now and then, and if the customer's payment due is under a certain amount, we'll go ahead and release the order with a statement of balance due. When a customer calls in, one of the customer service rep duties is to check the balance on the account and inform them if they have a balance due. Most people freak out when they hear they owe us money and we have to figure out where the balance came from.
Occasionally it's because a credit card failed multiple times and we released the order... and sometimes it's due to a mailed-in order where the customer has multiple credit cards on file and they didn't specify on the order form which card they wanted to use for the order. We have a voice response system on the telephone that they can use to place refill orders, and now and then someone will get mostly through the order process and disconnect or hang up after they have the medication on the order but before they select payment. If the customer doesn't call back in and have us finish the order, it'll hang out there for a day or so, and then the system will automatically finish it and send it out without the method of payment.
The vast majority of the time, though, the balance due on the account is because the customer's doctor called or faxed in a prescription to us. When they call it in, the employees who enter the order can be a little more conscientious about checking for an auto-charge credit card on file, etc., but with faxes, those come all grouped together with the faxes that are in response to orders we initiated, that already had payment on them, so usually the order goes out without charging the customer's card.
Some customers like this fact... and some of them get frustrated because they assume we're always going to make sure they're 100% paid up because they have that card on file. Those that get upset we try to mollify a bit by pointing out that if the card on file is a debit card tied to their checking account, and if they weren't aware that the doctor was faxing in a new prescription to us, they might find themselves short of money unexpectedly.
When we were learning about the balance screen and how to find where a balance due is coming from in our training class, TrainerT would imitate the patient's response, in a suitably aghast tone of voice: "MY doctor would NEVER do THAT!"
You would be surprised what some doctors would do. I had one customer call in whose doctor had faxed in prescriptions for vitamin capsules that were available over the counter (and likely were cheaper for the patient that way) even after being firmly told the patient did not want the prescription sent to us. He had us cancel the order right away, and after ranting and raving a bit about his incompetent doctor and his bad-mannered staff, he announced he was going out to find a new doctor ASAP.
One consumer-conscious customer had been price shopping on his two maintenance medications, and discovered that he could get a 90-day supply of one of them at his local Target for half the price of his insurance copay for mail order meds. When his doctor renewed his prescriptions, he very specifically asked for the doctor to send in the 90-day supply of MedicationA to MOP#1, and the 90-day supply of MedicationB to the Target pharmacy. And the doctor promptly did the opposite. Well, he first sent them both to us, and then called us and canceled the order for MedicationA, and then called both of them into the Target pharmacy as well for good measure. The patient picked up his mail a few days later and discovered his package from MOP#1 with the WRONG MEDICATION, and was rather irritated. I was able to get approval for a credit for the price difference with the wrong medication since we wouldn't be able to accept a return on it and he was still going to be using it anyway... and ordered his refill on the one he DID want to obtain through us... but he left the call muttering about how he was going to have to stand over his doctor's shoulder and watch what he was doing when he sent in his prescriptions in the future.
I've had people call me who have received a package with a medication they didn't order, and had to clarify for them that their doctor faxed us with this prescription. One lady had placed an order with us for what she thought was 7 different medications - turns out the person who took the order only put two of them on the order, the ones that we needed to fax the doctor for - and neglected to order the 5 refills. When she received the order, she had 3 medications - two of the 7 she called for, and one that she'd never heard of that her doctor had added to the order because he wanted her to start taking... without telling her. I had to place the order for the 5 refills she didn't get, and convince her to call her doctor about the other new medication because the doctor specifically did order it for her. Boy, was she mad.
One hairy situation came up when a woman called in with a huge balance on her account that she was in the process of appealing. It seems she had a neurological condition that required Botox treatments, and her insurance was denying the cost of the medication. In that case, the doctor had ordered the Botox for her from our specialty pharmacy division, and reordered it twice AFTER the insurance denied it without her permission. Poor lady.
Just yesterday I had two "my doctor did WHAT?" calls. The first was an angry woman who had used our service before and stopped because there were too many billing mix-ups, in her words. This was her first order since returning to using MOP#1, and she was through the roof because she'd had us fax her doctor for a renewal of an old prescription for insulin and gotten the wrong amount.
Previously, she'd ordered a 90-day supply as 12 vials of insulin. Interestingly, when the pharmacist I consulted with on this call and I looked up her past ordering history, and her insurance claims for pharmacy, we saw very large gaps between her insulin orders, so either her doctor was giving her samples during that time, or she was running them through a different insurance company (or paying cash price, which is unlikely because that crap is ex-pennnn-sive)... or her doctor was conspiring with her to get her a year's supply of insulin at the price of her 3-month copay. This time when she had us fax the doctor, the doctor sent back a prescription for 4 vials for her 3 month supply. She blamed us entirely for the incident and was ready to send back what we'd shipped to her and refuse the charges on her credit card.
The thing is, when a doctor sends us back a prescription, they usually give us both the directions on how the medication is to be taken AND a quantity for a 90 day supply. The screening techs add up the directions to make sure they match the quantity, and if there's any discrepancy, the call the doctor to clarify it. They'll normally dispense whatever is the greater of the two - and in this case, the doctor's directions for the customer's insulin use didn't even add up to the 4 vials the doctor indicated to dispense. And the doctor didn't indicate any refills on the prescription, so we couldn't have sent her more than 4 vials without a new prescription in any case.
Nevertheless, the customer screamed at us that someone should have called her to tell her that the quantity the doctor approved was incorrect. No way was 4 vials going to be enough! She needed the 12 vials she ordered, doggone it! The pharmacist calmly pointed out to her that nowhere in our order notes did the person who placed the order indicate what quantity she was requesting, so nobody who was processing the order could have caught the discrepancy. We tend to trust that the doctor knows what they want to give the patient when we get a prescription from them in any case. We don't question every little change they make in a patient's dosage or quantity. We don't have the staffing or the time to make all these phone calls that customers seem to think we ought to be making.
In the end, we ended up approving a credit for the customer for 3/4 of her copay amount, and since she was going to be seeing the doctor on Monday instructed her to have the doctor send us a new prescription for the correct quantity, with dosage directions that added up properly to indicate why she needed that quantity. She would be charged her full copay again, but the 3/4 credit for the previous one would be going back to her credit card on file, and she'd end up with more than her 3 month supply for that price. She was still a bit grumpy but marginally a little more accepting of the matter by the time we got off the phone with her.
The funniest story was right at the tail end of the day, though. We had a new customer who wasn't 100% clear on how our service worked - a lot of people think we auto-order their refills until they call in and have a representative educate them a bit. I spend a lot of time educating people - nothing gets sent to them unless either they initiate an order (by mail, phone, or internet), or their doctor calls or faxes us a prescription. This customer, a female, had received two packages from us, neither of which she had ordered. At the start of the call, she was wanting to vent but she was at least conscious of the fact that I personally wasn't at fault, so she told me she'd try to take it easy on me. I checked and verified that sure enough, her doctor's office had faxed us both prescriptions. She was upset about getting hit with the $40.00 copay for both prescriptions on her debit card, when money was tight, so she was actually pleased when I informed her that neither prescription had been auto-charged and there was an $80 balance on the account that she could wait to pay after she got her paycheck.
The funny part was when she informed me that she really didn't need one of the medications yet - but she was content to keep them on hand for future use and not send them back... turns out her doctor had faxed us for her regular Rx of birth control pills... and also a new prescription of prenatal vitamins. ;)