Hm.... gotta wonder if I worked for the same place. I definitely worked for a place that does the same thing.

My personal favorite is, "I'm not angry - I'm disappointed." Like you're their grandchild or something. Close second are the people that don't know that you can see that they've filled their Vicodin prescription at 3 different local pharmacies last week, but it "never came in."

OOOOOOOH YES
I love that

Why can't I fill my pills?
It's too early
But I'm on time! I filled it exactly one month ago!
Ma'am according my records you've been filling it 4 days early, each time, for the past 4 months. According to my calculations that should give you enough medication until the end of this month. Medicare keeps a running tally.
But I only have two pills left!
Me: *looks at screen, seeing a controlled substance the member is talking about and I roll my eyes* Unfortunately ma'am medicare will not agree to pay for that again. You'll have to pay out of pocket, or wait another week.

Oooooooh they don't like that answer.

Heh, when I did training for doing emergency supply overrides in the system, they showed us an example of a patient that you should hard-reject just to give us an idea of what to look for and how to read the information we get back from the database. The example they showed was in Hawaii, and this particular patient visited different pharmacies on different islands to fill their Xanax prescription. Tallying them up, this person in particular got away with 90 days worth of medication, when 30 is the maximum at once. Clever, but you know... they were done as claims to the insurance company. I don't know how they got that far without anyone catching on. It was... kinda sad, now that I think back on it.

Aaaaaaaah yes. Xanax. Everyone's favorite

Yeah that sounds about right. At least with the way the claims worked in our system I Find it hard to believe they COULD Get away with that. More often then not, at least with medicare) they track how much a patient had gotten in a time period and it should be flagged whenver they attempt to file a claim at a new pharmacy, it should reject as refill too soon. We did have early refill overrides, which we as call center agents had NO control over. We farmed that off to a Pharmacy Help Desk which were the ones who decided yay or neigh. Even then, for controlled substances medicare wouldn't "forget" the previous fill. More often then not they'd have to buy out of pocket to bridge the gap.

Insurance, what a mess. At least medicare insurance. I can't tell you how many times we'd get calls from people getting rejected for filling their controlled substances. Saying they had no idea where the extra supply went...

Which company did you work for? My call center was contracted out with Express Scripts for their customer service.

Ah we worked with Express Scripts from time to time. My company was contracted out to Optum RX.

But I know what you mean about Medicare - the poor customers on that plan get so confused because it's never explained properly to them. Even the basics can be confusing - there's so much call volume where people don't realize that they have a coverage gap, which is a rather sad thing to have to explain to someone who just got a $1200 bill for insulin. :/

Aaaah Optum. I am aware of them. XD We lost several clients to optum, and gained a few others. from optum.

What's so frustrating about the coverage gap is just EVERYTHING that goes into it. Drug spend gets em in, TrOOP gets them out... what's troop? Oh thats how much you spend and how much the manufacturer discounts the medication in the gap!

...what?

And boy oh boy that insulin. Thankfully in the gap I haven't seen them get THAT much. The cost share in the gap for brands has fallen to 25% this year so the USUAL prices I see are between 600-900. Still a LOT. Then there's the other brands many patients have to take, the blood thinners, the inhalers... None of them have generics and all of them have doubled in price this year (1000-1500)

It's so nice to talk to someone about this and not have them just turn and walk away XD

Oh yeah, I know the feeling.

Though, because of insulin, I did learn some new things. One lady called in - really British sounding. She orders insulin, needles, test strips, you know the whole diabetes package - even though it puts her into the catastrophic phase of her plan, she still had a $1600 bill at the end of it because she had some other medications. Things started to make sense when I struggled to read an abbreviation on her address. Apparently "MNR" is the abbreviation for "Manor". So it made a lot more sense for her to just calmly and cheerfully say, "Oh, just charge it to the card, dearie," when she was checking out on one of the most expensive orders I've ever seen.

Oh boy I have seen some orders. Not just insulin but I've seen seveal GENERICS members have ordered (it was for a specific genetic disease) It was 1000$ on its own! I think THAT was the copay, because this guys' plan didn't have a CG, it was one of those enhanged EGWP plans. There's also some specialty medications that are just woof, really expensive.

In fact there's been some major shake ups at express scripts we've been made aware of. The National Preferred Formulary is changing beginning July 1, and they're dropping a lot of major brand names. Express Scripts is also kind of refusing to fill medications like Praluent and Rapatha through the mail, likely due to costs. Costs I imagine is a motivating factor in the forumlaties dropping several other brands too. Things are gettin hairy right now.

blergh, i keep hearing stories about like these and now you too? xD
must be a total pain when people cant jsut admit they are wrong and just go full retard and angry instead. xD

Yeeeeeeeeeeeeeeeeeeeeeeah

That happens a lot XD

As a person who works in customer service, I can sympathize.

haha doesnt matter what field of customer service we've worked in, we ALL know what this is like