- Jan 26, 2000
- 50,879
- 4,268
- 126
So...
Patient comes in with an Oxycontin RX. Under Medicaid that requires a prior authorization. That means that not only does the prescriber have to call Medicaid but I do as well. Typical duplication of effort. I make the call so I'm not doing anything else for 20 minutes (by using health care providers as free labor they "save" money).
I speak to this guy who is obviously under the gun to get this done to move onto the next call. He tells me to wait 5 minutes ant process it. Nada. 20 minutes later. Nada.
So I spend another 20 minutes on hold because we need to waste more of my time. I'm then told that the prior auth has already been used. WTF, of course it was. I just activated it. Nope, done by another pharmacy (it wasn't). Now the good part. I ask what pharmacy activated it and she said she couldn't tell me. BS. I asked if she can't or won't. She says she's not allowed to give that information out. Well they did and private insurance companies still do. Its perfectly legal. HIPPA doesn't apply with either providing services or billing. We used to catch a lot of drug abusers this way, but my guess is that they complained because they were getting arrested.
So were at a stalemate. I can't fill her prescription and no one else can. She's in chronic pain and there's a good chance that before Tuesday or so before this gets fixed she'll wind up in the ER from withdrawal.
No they won't help when its needed but think of the cost savings!
Patient comes in with an Oxycontin RX. Under Medicaid that requires a prior authorization. That means that not only does the prescriber have to call Medicaid but I do as well. Typical duplication of effort. I make the call so I'm not doing anything else for 20 minutes (by using health care providers as free labor they "save" money).
I speak to this guy who is obviously under the gun to get this done to move onto the next call. He tells me to wait 5 minutes ant process it. Nada. 20 minutes later. Nada.
So I spend another 20 minutes on hold because we need to waste more of my time. I'm then told that the prior auth has already been used. WTF, of course it was. I just activated it. Nope, done by another pharmacy (it wasn't). Now the good part. I ask what pharmacy activated it and she said she couldn't tell me. BS. I asked if she can't or won't. She says she's not allowed to give that information out. Well they did and private insurance companies still do. Its perfectly legal. HIPPA doesn't apply with either providing services or billing. We used to catch a lot of drug abusers this way, but my guess is that they complained because they were getting arrested.
So were at a stalemate. I can't fill her prescription and no one else can. She's in chronic pain and there's a good chance that before Tuesday or so before this gets fixed she'll wind up in the ER from withdrawal.
No they won't help when its needed but think of the cost savings!
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