Calling Mrs. Kafka
(An old classic…)
“Prior Authorizations, Mrs. Kafka. May I have your name and the patient’s policy number.”
“My name is Country Doctor, and I don’t have the patient’s number but I have her husband’s – it is 123456789”.
“Thank you, Doctor. This is for Harry Black?”
“Well, no, it’s for his wife, Harriet. We asked for a PA for Lyrica for her, but it was approved for him instead, even though the forms we sent you clearly stated her name.”
“I see that Harry is approved for one year.”
“Yes, but he doesn’t need it. He has no diagnosis and no symptoms. Someone at your end reversed the names, because the application was for Harriet. I have a copy right here in front of me. So can we just get this approval switched over to her name instead?”
“I’m sorry, we can’t.”
“But why?”
“She’s a different patient.”
“But everything we sent in was on her. You were the ones who put it under his name instead. It was your mistake and I’m asking that you correct your mistake.”
“I’m sorry, but we have to process Harriet’s Prior Authorization separately. What is her diagnosis?”
(Sigh)
“Postherpetic neuralgia.”
“Is she currently taking Lyrica for this?”
“Yes.”
“I don’t see any pharmacy claims for Lyrica in her profile.”
“That’s because you don’t pay for it. That’s why you and I are talking right now, isn’t it? She’s been using samples.”
“Lyrica is not covered for that diagnosis. Studies have shown that other drugs usually control symptoms…”
“Now, wait a minute, your company already approved it for that indication when you looked at the paperwork we sent in before, all that happened was that you misread the name of the patient! And if you didn’t read her papers and still approved it for her husband with no diagnosis at all, you can’t exactly say you’re following any firm principles there at MegaScripts!”
“I’m sorry, Doctor. We have to process her request from the beginning.”
“This woman has suffered for two months and has taken several other drugs before getting any relief -amitriptyline, gabapentin, and she’s on Effexor, so there is no point in trying Cymbalta. If you can’t or won’t correct your own mistake, and if you can’t accept what I’m telling you now, I just can’t sit here and argue any longer with you. I’ve got patients waiting. Just tell me where to fax the information.”
“The number is 1-888-000-6666. Now, did you say she had tried ga-ba-pen-tin?”
“Yes, that’s what I said, and that’s what I wrote on the form we already sent you!”
“All right, hold on, Doctor. I’m getting an approval here. O.K., I have a number for you. It is 9921465. And it’s good until August 12, 2015.”
“Thank you!”
(Sigh)
“You’re welcome. Is there anything else I can do for you?”
“No, that’s all I have time for today, even if I needed anything more from you.”
“Then, you have a nice day and thanks for calling MegaScripts.”
(Click)