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How To Deal With Health Insurance Companies

how to deal with insurance company

By Amanda Baltazar. Pharmacy Expert

Dealing with health insurance companies takes up a large part of a pharmacist’s day and is typically not something you enjoy doing. It’s an unavoidable part of doing business, however, so the best thing is to learn how to make this part of your job easier and faster.

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Read the card thoroughly to ensure the insurer pays for prescriptions.

3. Be Prepared

Before you call the insurance company, make sure you have basic information ready:

For the patient: Their date of birth; the ID number from their insurance card; and their group number. Sometimes you will also need details of other drugs the patient is taking and their medical history.

For the pharmacy: The phone number and identification number.

For the prescription: The prescription number and the day you first tried to process it.

Highly important is communicating with the patient, the physician, and the health insurance company, according to Heather Free, PharmD, pharmacist and pharmacy manager, BioScrip, Washington, DC. so everyone knows how the prescription process is going.

5. Conference Call

Learn how to use the conference call function on your phone, so that you can conference a doctor in to a call with the health insurance company if needed. He may be able to provide more information on what he prescribed.

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You may even need to conference in the patient, too. “By doing that, the patient can see the difficulty you (the pharmacist) have,” says Joel Zive, PharmD and the owner of Zive Pharmacy in New York City.

6. Prior Authorizations

Handle prior authorizations as quickly as possible. For drugs that require prior authorization, the insurance company will go back to the prescribing doctor. Some physicians don’t tell the pharmacist once they have given their authorization, so follow up frequently with them and/or keep trying to put the prescription through. If you don’t, it means the patient waits longer for

his or her medicine.

“Don’t rely too much on the doctor and the health insurance company and try to put the prescription through daily because the patient could be losing days—or even a week—of medication,” explains Free.

7. Pen and Paper

Keep a notebook and stick in the Xeroxes of cards—one for each health insurance company. This will help you decipher an unusual card or a card from and insurer you don’t come across regularly. This will become your Bible of health insurance cards.

8. Standard Phrases

Have a standard phrase you repeat to patients to shift any blame they may direct towards you for high charges. A sentence as simple as “This is what the insurance company told me to charge you,” will help out. Or, “If you have any questions, you can call the phone number on the back of your card.” Let customers know the pharmacist has no control over charges.

9. List it!

Keep a list of all insurance companies’ phone numbers. It will likely appear on your computer screen, but have a back up. Technology does fail sometimes.

10. Fastest and Best

And speaking of technology, when possible, have your employer invest in the latest technology and the latest programs. This will mean you have the best tools at your fingertips, and faster processing times for insurance.

11. Timing is Everything

Don’t wait for several prescriptions to come in with the same insurance. Make calls as each prescription comes in, otherwise your customer might have an unnecessary wait for medication he or she needs urgently.

12. Cross Train

Don’t rely on just yourself or one member of staff. Train everyone in your pharmacy so they know how to deal with health insurance companies, even if it is just the basics. This way, your pharmacy can be a 24-hour operation, and the ball can always get rolling for new prescriptions, no matter what time of the day they come in.

Category: Insurance

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