Pharmacy dropped the ball....great

[Midnight12]

short history, got in to see my dr YAY she prescribed me cymbalta and i dropped it off at the pharmacy the same day. this was wednesday of last week the 26th. for two days i waited on the pharmacy to get the preauthorization done. /end

Well by friday i said eff it and called my insurance only to be told this was the first they knew of it. so now because insurance didn't know insurance is having to bother my dr for the dosage and amount because pharmacy dropped the ball and did not call.

Which means i get to wait possibly another week. I am about to call the pharmacy and ask for a manager and ask WHY did no one call my insurance and keep going around saying you are waiting you are waiting. waiting on what for a magic fairy to contact my dr when that is YOUR or your employee's job?


i have not called my dr yet but have called insurance and gotten a case number. i hope i am doing the right thing. beyond that its the waiting game

[Andara Bledin]

Based on what was said in the OP, the pharmacy never contacted the insurance in the first place for the insurance to come back requesting the pre-auth.

And even then, there's still work the pharmacy has to do; it's not only between the doctor and the insurance.

^-.-^

[Heksubah]

If the script required a prior authorization it could be that your pharmacy is waiting on a response from your doctor. There are a lot of reasons why the insurance might not have heard of it directly.

[Midnight12]

true. i am frustrated because of the wait period but since i don't fully understand the rules and regulations behind it all I was also made to realize that maybe the pharmacy employees could not contact my insurance so....from the start up to now I have done my best to be courteous and hold my tongue.

still frustrated but figured i'm doing ok if i am not being mean. feel dumb for not knowing...i dunno anymore

[foxytales]

I work for a major (not Blue) insurance company and when it comes to prescription drugs and pre-authorizations--it isn't the responsibility of the PHARMACY to obtain the auth. They just got a script. It's the responsibility of the ordering physician to obtain the auth. Why? Because the ordering doc has all the necessary medical documentation that we are going to be looking for. Your pharm doesn't.

They probably put a call in to your doc telling him it required precert and they were waiting on that.

Sucks being stuck in the middle, though..i'm sorry, Midnight

(edited to note i do not know who insures Midnight, thus use of "the insurance" was incorrect)

[fma_fanatic]

It was my understanding that pharmacies will verify the script from the doctor and if the insurance wants more info, like Heksubah said, the doctor has to give that info.

I went through hell when I started my CPAP therapy and I spent 4 nights with no sleep; I just couldn't relax. I was a mess when I went back to work, essentially having a mini-meltdown. My sleep doctor prescribed me Ambien, but my prescription insurance wouldn't allow the full script, just 10 pills, citing that it would be more than enough to get me through and fix the problem. Even with my doctor's info, they still refused a full script. But I was more than welcome to pay out of pocket for it if I wanted.

It sounds more like someone didn't explain at the pharmacy what needed to be done in order to get your script filled properly.

[Sapphire Silk]

A lot of times this becomes a back and forth game with the insurance company and the doc. They overwhelm the doc with paperwork for non-formulary medications and generally make it difficult for the patient to get them.

I've been through this. Usually I end up giving up.

[Midnight12]

I work for a major (not Blue) insurance company and when it comes to prescription drugs and pre-authorizations--it isn't the responsibility of the PHARMACY to obtain the auth. They just got a script. It's the responsibility of the ordering physician to obtain the auth. Why? Because the ordering doc has all the necessary medical documentation that we are going to be looking for. Your pharm doesn't.

They probably put a call in to your doc telling him it required precert and they were waiting on that.

Sucks being stuck in the middle, though..i'm sorry, Midnight

(edited to note i do not know who insures Midnight, thus use of "the insurance" was incorrect)

i have blue cross blue shield ppo. if that matters. meh
i went back to the dr for samples since the pharmacy/dr/insurance are still talking
been in and out of sleep thus not focused enough to get online i apologize but doing very well.
I did not realize i was wrong, however during this entire saga i have not yelled at anyone or even shown i was remotely angry in my tone and honestly thought it was someone in the pharmacy's job to call insurance or my dr. When i called my insurance to ask what was going on the first time the person on the line said this was the first that they had gotten word/note of it thus not in the system. Shrugs. at this point i have to wait until next pay day to get them anyways.
not any any more just frustrated as insurance had to get info from my dr that pharmacy had via the prescription which was dosage and quantity which the pharmacy had.
So at least I didn't yell at anyone and at the least its been a learning experience.
now if i could figure out an in between to level out the drowsiness this causes. thats my only complaint. i do function well enough that i can take care of daughter but thats about it