It started the way so many of these things do, with a phone call to get the ball rolling on a prior auth. “I’m not sure that’s the strength the doctor meant to prescribe,” the lady at the group medical practice said. “I’ll have to check and call you back.”
That was on Friday morning. On Saturday morning a friend of the patient — who was seriously ill and having trouble breathing — came in to get the prescription. No one from the group practice had called us back. You know exactly how this goes.
Step 1: The doctor is out
First, a test claim. The far-more-common strength of this nebulizer solution would go through the patient’s insurance just fine. Actually, it would also be easier to use; the only difference between what we were told “was probably wrong” and what was covered was that the paid-for med didn’t require predilution. The solution to this problem was in sight.
You can guess what happened next.
“Well that doctor’s not in today. If the patient’s really ill, they should go to the emergency room.” This, of course, was delivered after a lengthy hold. Evidently the concept of paging a physician was long forgotten at this practice, along with asking the doctor on duty for his opinion.
Step 2: My life on hold
One thing they can’t teach you in pharmacy school is when not to take no for an answer. Fortunately, I knew the doctor on duty this day had a good helping of common sense in his head. It took a while, and I had to sit through another lengthy session on hold — which I suspected the staff made longer than necessary to penalize me for being a pain in the neck — before the doctor got on the line. Our conversation went something like this:
Step 3: Work with me here
Me: “Can we do the commonsense thing here that everyone knows is best for the patient, and give her the easier-to-use, far-more-common strength of this nebulizer solution, which most likely was what was meant to be prescribed in the first place?”
The end was in sight. Just some quick phone counseling with the patient, who was at home and gasping with every word, to make sure that original prescription wasn’t what the original, unwilling-to-be-reached doctor really wanted.
Step 3: What machine?
“When they were going over how to use your nebulizer machine, did they say you would have to dilute this medicine first?”
They had sent this woman out the door with a prescription for medication to go in a nebulizer without ever mentioning that she would need a nebulizer.