Helping Patients Understand Insurance Information At The Pharmacy

Getting medical insurance is one of the best investments that anyone can make for the future. With increasing life expectancies and continually upward-spiraling medical costs, more and more people are requiring medical coverage as the years go by. As the elderly population – and population in general – increases, the number of people that will require medical insurance is likely to rise as well.

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Pharmacy technicians actually have an important role to play in all this. Although the two fields – pharmaceutical medicine and medical insurance – seem as disparate as any two areas of medical specialization could be, there are actually quite a few areas in which they converge.

In a typical pharmacy setting, pharmacy technicians could expect to deal with medical insurance issues at some point in their professional lives. In fact, handling issues and concerns related to medical insurance is becoming more and more commonplace in the retail pharmaceutical industry. Furthermore, this upswing trend will likely continue well into the foreseeable future.

Roles Of A Pharmacy Technician

Pharmacy technicians already have a number of duties and responsibilities assigned to them as part of their job descriptions. They are usually the first point of contact for patients obtaining medications prescribed by their doctors. When patients walk into a pharmacy, the pharmacy technician is the person they count on to provide to address their medication and information needs. And if this is not available, they will expect the pharmacist on call to provide a feasible alternative.

A large part of the pharmacy technician’s role has to do with interacting and communicating with customers. These customers may be patients, family members, or caregivers of patients. In any case, customers rely on pharmacy technicians not just to fill their prescriptions, but also to assist them with any pharmaceutically-related issues or concerns, as well.

One of the major issues that patients routinely face is the inability to understand the various terms and conditions of their medical insurance plans. This is quite understandable, as most of the documentation that comes with the plan is usually filled with legalese and confusing technical terms. They can be challenging enough for many medical professionals to understand, so you could imagine just how difficult they are for the typical patient.

Addressing Medical Insurance Literacy

Many other factors come to play with regard to the subject of helping patients understand the various aspects of medical insurance in a pharmaceutical setting. It should come as no surprise that communication issues are prevalent in health care settings. Such cases often go undetected, and they can have tangible–and serious–consequences on patient health.

Several studies have indicated that there is a connection between insufficient literacy skills and poor health. Patients with low reading fluency are less likely to have accurate and up-to-date information about chronic diseases. They are also less likely to implement preventive treatment and healthcare action, and they generally leave a lot to be desired in terms of managing their own health care.

That being said, it is important to note that limited literacy skills are among the many factors that influence low health literacy. As defined by the Institute of Medicine, health literacy is the degree to which people are able to obtain, process, and understand information and services related to their health. All factors being equal, people that are health literate are in a much better position to make informed decisions that will be beneficial to their overall health than those with low health literacy.

Pharmacy Technicians: Bridging The Divide

Given these factors, one could easily imagine the important role that pharmacy technicians play with regard to informing and educating patients on their medical insurance and healthcare options. Because of the high likelihood of encountering patients with low literacy skills, it falls upon the pharmacy technician to bridge the divide.

In real terms, pharmacy technicians can help inform and educate patients with any number of medical insurance specific concerns. Informing them about the extent and scope of their medical insurance coverage is only one aspect. Far too many patients know only that they have insurance and that they are entitled to free or reduced rate medications. In some cases, they may not even be aware of whether or not they actually have insurance.

For patients that do have insurance, a common problem is a lack of understanding as to what is covered under the terms of the plan. Even if the medication in question is prescribed by a doctor, it may or may not qualify for medical insurance.

Doctors will usually inform patients as to what medications are covered by the plan, and what alternatives are available, if any. But not all patients will remember all these details, particularly when dealing with a stressful illness or financial pressure. Patients may, therefore, turn to pharmacy technicians to clarify this particular aspect of their plan,

Matters are further complicated when the medication in question is unavailable. For patients that have serious or chronic illnesses, having to wait until the specific medication prescribed to them becomes available is simply out of the question. In such cases, pharmacy technicians may then suggest a medically-approved substitute, or consult with a care provider or primary physician on the spot.

It is important to keep in mind that pharmacy technicians are not qualified to dispense medical advice or to prescribe medication, no matter how much education and training they have had. That is strictly the domain of medical doctors, and doing any of those will be overstepping their bounds, not to mention illegal.

Pharmacy technicians are also not qualified to give advice with regard to medical insurance claims and programs. That being said, they may recommend a course of action that is approved by the insurance company, especially in cases wherein specific medications are unavailable, or when a patient’s claim is denied.

Just to be clear, these courses of action should have already been approved by the medical insurance company beforehand. Pharmacy technicians are not qualified to recommend an alternative insurance provider. This would go beyond ethical constraints, and will likely be illegal as well.

In general, pharmacy technicians can only give advice, information, or recommendations that have been pre-approved by the insurance company. Their role essentially involves letting patients know what their options are, and it ends there. If the patient is unable or unwilling to accept the limitations or deal with the outright denial of his or her plan, the pharmacy technician will have to direct the patient to the medical insurance provider.

Handling Claim Denials

What happens when a medical insurance claim is denied? Pharmacy technicians actually have a role to play in this as well, and it is an important one. Depending on the circumstances of the patient, and relying on their own professional expertise, pharmacy technicians may actually be called upon to support the outcome of the claim. This could be the case whether the claim is subject to denial or eventual approval.

A pharmacy technician may be called on by the medical insurance provider to divulge information pertaining to the medical history of the patient, how long he or she has been taking certain medications, and so on. A pharmacy technician’s records and professional opinion carry considerable weight in such cases, and their word could play a big part in overturning the insurance claim denial or upholding it.

A More Compassionate Approach

Even without having to handle claims denials, pharmacy technicians typically have their hands full with the insurance-related concerns of their customers. It is somewhat unfortunate that much of the medical insurance industry assumes a certain degree of literacy–and even fluency–on the part of the beneficiary. It often seems as if patients are required to understand every bit of jargon and every technical term with the same facility as medical professionals.

But this is hardly ever the case. As shown in quite a few studies, a sizable number of people that need medical insurance the most are not in a position to understand the various terms, conditions, and implications of the plan which they have optimistically signed up for. When they enter a pharmacy and face the possibility of being denied the medication that they so desperately need, they will understandably turn to the person that they feel is most qualified to help them: the pharmacy technician.

Details Of The Job

Along with the technical skills and capabilities required for their profession, pharmacy technicians will also have to develop specific skills that will enable them to provide valuable services to customers. They should be able to fill prescriptions according to the terms of the medical insurance plan, they should ensure that the patient is getting the right medication, and they should ensure that all personal and insurance-related information is in order.

This last concern is actually quite important–perhaps one of the most important that the pharmacy technician will have to fulfill in their role as it relates to medical insurance. The name of the patient and the name on the prescription should match perfectly, and all other information–address, phone number, date of birth–should tally as well.

Pharmacy technicians should also be aware of the most important details of a patient’s medical history and of the existence of any allergies or health conditions that may affect the safety and effectiveness of the medication prescribed.

Again, we have to emphasize that all of these will have to be done within the professional scope of the pharmacy technician. As is the case with medical insurance advice, pharmacy technicians are not qualified to provide medical or health advice to patients. This is not only beyond their professional capabilities but is illegal as well.

Even without dispensing medical advice, pharmacy technicians provide valuable services to customers. They often serve as the medium between the patient or caregiver and the medical profession, interfacing with customers on one end, and with doctors and medical insurance company representatives on the other.

Facilitating The Medical Insurance Claims Process

Part of the role of the pharmacy technician also involves making it easier for patients to get the medical insurance assistance they need. In order to do so, they will themselves have to have a certain degree of familiarity with medical insurance terms and conditions, as well as the policies of specific insurance companies. More importantly, they should be able to educate and communicate these in a way that patients will understand.

A good deal of guidance is often required of a pharmacy technician, preferably tempered with patience, care, and genuine compassion. The last thing that patients need is to be confronted by a hostile and impersonal pharmacy technician, particularly when they are already dealing with a worrying health condition.

Pharmacy technicians should make every effort to ensure that patients are thoroughly at ease and comfortable when dealing with medical insurance concerns. They should speak to patients in clear and easy to understand terms, without showing outward signs of exasperation, annoyance, or resentment. No patient should ever be shamed for seeking clarification for any aspect of their medication, coverage, or the terms of their insurance plan.

The Bottom Line

Ultimately, the goal of the pharmacy technician with regard to helping patients with medical insurance concerns is to ensure that patients leave the pharmacy with exactly the right medication that their doctor prescribed. If that isn’t possible, the job of the pharmacy technician is to find out what obstacles are getting in the way of the patients receiving proper medication. Finally, they should be able to inform the patient of the status of the claim, what available options there are, and who to consult with if there is a need for further guidance or resolution. If the pharmacy technician is able to do this, he or she will have played a big part in helping ease some of the difficulties associated with understanding medical insurance claims.

Search Pharmacy Technician Programs

Get information on Pharmacy Technician programs by entering your zip code and request enrollment information.

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