The *ONE* thing they can't teach you in Pharmacy Tech school...

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Comments (10)

jgalyean in San Jose, California

25 months ago

Third-Party Billing is the most difficult task retail pharmacy technicians will face once they are in the field. Due to patient privacy issues, the ever-changing requirements of PBMs (Pharmacy Benefit Manager) to accept a paid claim, it's unfortunately not a subject that can be taught appropriately in a classroom setting. However it is the third-party billing rejections you receive once adjudication has been submitted, that can impose a delay in therapy for a patient, lead to the patient paying exceeded out-of-pocket costs, or even lose a patient's business if a resolution cannot be reached within an appropriate amount of time.

I know far too well how stressful it can be to explain to a patient the (usually, ridiculous) reasons why their prescription claim is not being accepted by their insurance, and what actions can be taken to resolve the issue. I've been a retail pharmacy technician in California for the past twelve years, and in that time I have gained a thorough knowledge of pharmacy billing software and the quickest ways to remedy a rejection from various insurance plans and carriers.

So with that being said, I am preparing to launch a website that will work as a "PBM Cheat Sheet", to provide my fellow pharmacy technicians with an online reference that they can access and review --before making a call to a representative at the insurance company. Most rejections that I have experience with in California, either can be over-ridden by simple coding and notation that you take care of on your own without any third-party support. Others can be resolved quicker than you would expect, if you know the right thing to say to the representative when calling for third-party support.

I am prepared to launch this site soon, but in the meantime I wanted to inquire you other technicians out there, if..a) do you think this website could be helpful for you at your job? and, b) what billing issues do you usually have questions about? I would be happy to answer!

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jgalyean in San Jose, California

25 months ago

***if you are going to post a questions about a billing issue you have had recently, I remind you to stay within the bylaws of HIPPA and don't provide me with any patient-specific information!***

But I am sure you already knew that. :)

I look forward to hearing from you!

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Steven in Dallas, Texas

25 months ago

Man, this sounds like a great service. I run a Pharmacy Technician online video study guide for the PTCB and I try to add a few lectures over pharmacy workflow. In those lectures I cover insurance cards and third party billing.

Since the PTCB doesn't cover this important part of retail pharmacy - I don't spend as much time as I could on this. Your website could be a real help to new and even experienced technicians. I am interested in seeing your website when you get it completed.

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KJasko in Mesa, Arizona

25 months ago

I think that it would be an incredibly useful and resourceful tool for all CPhT's. It would have been especially helpful for me when I was doing my externship. I would love to see your website when it is up. Please keep me updated on when it happens. My email is kristin.jaskowiak@gmail.com. Thank you

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Becca Blackwell in Valdosta, Georgia

24 months ago

There is no true insurance I know your website will be extremely helpful to many!!If you have any insurance code cheat sheets my email is BeccaLB75@yahoo.com Thank you for all of your hard work to help others :)

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Becca Blackwell in Valdosta, Georgia

24 months ago

Becca Blackwell in Valdosta, Georgia said: There is no true insurance training I know your website will be extremely helpful to many!!If you have any insurance code cheat sheets my email is BeccaLB75@yahoo.com Thank you for all of your hard work to help others :)
RLB

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jer in Des Plaines, Illinois

24 months ago

Hello, I would love to hear more about this. I'm a 17 year old tech who only works literally 10-12 hours a week in retail pharmacy for about 8 months now (got the job through volunteering and only filling). The lack of experience really hinders the workflow in the pharmacy. The most trouble I have is getting familiarized with all the insurance cards and entering them correctly. Any tips? Thanks so much

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intergalactic in san fran, California

9 months ago

Hello yes, thank you it be very helpful. Please launch the site and can you please email the info aswell my email wavelight11@gmail.com. I'm very suprised big chains like CVS and Walgreens dont invest time and money into Third party billing training, if they did I'm sure they could easily double their earnings. Kind of a joke, that they dont.

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Mitzi in Fort Lauderdale, Florida

8 months ago

Hello yes, I want to gain knowledge on this. If u have already launched the site please let me know.
Thank you so much

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ex-Meijer "Team" Member in Aurora, Illinois

6 months ago

I too had a problem with these insurance rejections when I was working at Meijer. Although personally my problem was not getting enough practice while off duty. Does anyone know how I can get more practice?

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