I am not always open to hugging, especially if I don’t know you.
I received the best hug this week. From a stranger. It was one of those bear hugs…All in…And it felt great.
This person had called about his wife who has a blood clot and had been released from the hospital. She was sent home with a blood thinner that is not covered on her insurance.
Have you ever had a life saving medication that was not covered by your insurance? Unfortunately, she had been discharged from the hospital. Have you ever had to get a prior authorization from an insurance company that required documentation from a hospitalist MD? Not an easy task.
The prescription had been taken to a Big Box Pharmacy (BBP). BBP didn’t even have the medication in stock (too expensive to keep on the shelf) and did not order it in for the patient because the insurance hadn’t authorized it yet.
So Bear hugger called the pharmacy where I was working that day. “What can we do? She has a life threatening blood clot, and if she doesn’t get another dose by 7pm, I am afraid of what will happen.” His anxiety was palpable. It was 4pm. He had been on the phone with the insurance company and BBP for 4 hours, with no results.
I called BBP to get the prescription transferred to my pharmacy since the medication was on the pharmacy’s shelf. Bear Hugger just wanted to purchase enough medication at our cash price to get her through the week while the battle between pharmacy, insurance, and MD waged on. The cost of 1 week of the medicine is $160.00.
In the meantime, my team was able to circumvent the insurance company, and tap into the manufacturer and fill the prescription for no charge…for a month. Hence the bear hug.
Having a good pharmacist on your team can be priceless! We want to help!
at one time, we had an investment in a coampny that did this for many sort of medical treatment and worked through insurers, splitting the savings.eg:there there may be 15 places to get an MRI in dallas. the hospitals tend to be most expensive. imaging centers in strip malls tend to be cheapest. the difference in price was literally ofter $800 vs $5000.the coampny would provide the insurer with “preferred” centers and pricing and the insurer would then offer reduced deductibles/copay to patients to encourage them to use these centers.this attempts to emulate the consumer behavior you get when they actually face costs.if you have a $500 deductible, you may not care at all if it’s $5000 vs $800. you go to whatever’s close/has a good appointment time.but if you were spending your own cash, you’d think hard about driving 15 minutes to save $4000.the medical industry (particularly high cost hospitals) is very much opposed to such cost comparison and try to make it as difficult for insurers as they can while trying to block the entry of low cost providers to the field.the incentives in the health care industry as such a mess it’s a wonder that it’s not worse than it is.