Mysterious Voice - "Thank you for calling Argus, my name is Cletus can I have your NPI, DEA, Social Security number, State registration number, Astrological sign, turn ons, turn offs and your favorite color please?"
Me - "Gives them all the info they want plus the last time I took a piss just as a little bonus for them"
Cletus - "And what can I do for you today ma'am?"
Me - (That's a good way to piss me off) "I'm trying to process a claim for a Humana member but am getting a DUR reject that I cannot clear"
Cletus - Asks for patient info and drug
Me - "... drug is Lunesta 3mg, 20 tablets for 20 days. Patient had been getting 30 tablets for 30 days for the last nine months with no issues."
Cletus - "Well let's see here...." (Page's flipping) "Well I think you... I think you need to get a prior auth on that drug"
Me - "But we have had no issues in the past with it, and I just filled a similar one for another patient under the same plan today. Has it gone off formulary?"
Cletus - "I can't tell you that, the member would have to call us."
Me - "Ok... if it needs a PA then, why is my reject saying 'Suboptimal Regimen'?
Cletus - "Uh...."
Me - "Seems to me that it would be helpful if you needed a PA for that script to have the reject say, oh I don't know, 'PA Required for this drug'?"
Cletus - "Well... uh... the patient's just going to have to call to find out."
Me - "So you want me to have a 93 year old woman with dementia call you because you can't give me a proper reject nor give me a single replacement option?"
Cletus - "That is correct. Is there anything else I can help you with today?"
Me - *Click*
First who gives you a reject that isn't actually the reject? I mean we have one insurance that will occasionally reject saying 'Drug not covered for sex' when all it wants is a new NDC. This was just crazy.
Second, why the hell couldn't they at least give me an option. Shit they usually give you various options with the reject.
And that's how my week started...
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