The Tale of the missing medicine

Heyo TFCC!

Just found you guys and as a 3 year veteran of Medicaid/Medicare Call centers i have plenty of stories but today i’ll post my favorite.

It’s midday and the calls have been pretty normal for the day “What’s my account ID#” “How do i use your website” “Why did you call me? i don’t want to schedule an appointment with Doctor because he’s an asshole!”

Well then Stavy gets on my line (Stacy wasn’t her real name, but here we go:

Stacy: Yes i need to talk to a supervisor. Me: Oh i understand ma’am, can i please ask what it is in reference to? Stacy: Yea, none of you people know how to do your fucking jobs. Supervisor. Now. Me: Well ma’am they won’t be much help if i can’t give them a bit of a brief.

At this point i’ve already pulled the notes from her last few calls. Popular opoid inhibitor is being perscribed for a once-a-month fill and she wants to know why the pharmacy won’t refill her RX with it being ~15 days since last fill.

I butt in:

Me: Ma’am i pulled the notes for the other calls and i see you’re having issues getting your RX filled. Have you spoken to your doctor about this? Stacy: Yea and he’s a fucking idiot too. They say i can’t have my meds because i already got them this month. They are lyin’ and i need it NOW. I will have my lawyer contact you and SUE YOUR ASS TODAY. Click

I put myself into my holding code and flag down my supervisor to let them know what’s going on.

a couple calls later my super comes by and lets me know he’s transferring HER LAWYER to me to speak about the case.

‘Lawyer’: Yes, my client called earlier about getting her Medicine name filled. She was spoken to very harshly and the refusal to give her the RX authorization is grounds for a lawsuit. Me: Sir, as a Lawyer you should know that medicine has a highly controlled schedule for refilling and can only be refilled once per 28 days. Your “client’s” last fill was ~15 days ago. 17 max. ”’Lawyer”’: Please let me have your Legal team’s phone numbers and please put me through to your DIRECTOR.

I mute and laugh off the demand to speak to the director (never met the person, don’t even remember their name. they weren’t at my site.)

I pass him on to a manager and hear nothing back for the rest of the day.

Two Weeks Later

I get a call and I take the callers information. Name of caller: Stacy.

she waited her two more weeks and was calling to the confirm that the authorization had gone through. it had.

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