r/talesfromcallcenters • u/Total_Campaign_1028 • 4h ago
M I Lost My Meds!
Used to be a sup in a call center for pharmacy processing. If you haven't heard of what goes on when a pharmacist runs your insurance at your local store, I highly recommend you take the time to learn about your plans and how they work. One of the biggest things is lost medication coverage and what a customer has to do to get coverage (if any) to allow for the insurance to provide a discount. A lot of the time they will call a processor to oversee the override that allows payment but we would first have to see if the drug is permitted under the plan to be excused for an early fill.
It was a bit of a laugh to get customers who had lost their erectile dysfunction pills. From time to time the wife would be in the background. It was my job to see that I could get my stranded soldiers to high ground. I'm sure I have saved some marriages.
Other times, it was more controlled substances. These types of therapies have no coverage under most insurance policies if lost or stolen. While we gave no attention to a customer's use of the medication, there were sometimes red flags that one personally could see from someone's behavior.
I had to put a message out one night about someone trying to request early refill for stimulants. All calls were to be forwarded to me because earlier the customer had called to my floor and was escelated to me. Since the state where they resided would not early refill such a medication, it should have been crystal clear that we would have no say in the refill. The customer would call a few more times to try and get some leeway, but would be met with me.
There were some very wholesome interactions where we were the front line in getting coverage for life-saving medications to a customer who did not understand how their coverage worked and were met with a high price after the claim was denied. One time I spent three hours after the end of shift to ensure a parent could get a one-time fill of a drug that kept their child alive. That evening, they had been met with bad news by a couple of reps who didn't know how to make sense of their coverage. A lot of insurance groups can allow for a one-time coverage at a discounted rate for customers who have either changed plans or have had a new medication. The hard part about processing these claims is that it can be a troublesome task of finding the right channels to fix the issue. I set them up with the next steps to get their coverage for this medication, and they got processed at the end of the night.
I would definitely do this line of work again, but it would have to be for better pay and for a better title. I know it is easy for people to get in a loop when it comes to call center work, but I hope that anyone in this profession can see how justified their work is and how much easier they are making people's lives. Thank you for reading a chapter in my life and I wish you all the best in life and business.