Prescription and Medical Insurance Are Different

When customers bring their prescriptions to the pharmacy, I ask if they have insurance. Too many times the customer produces an insurance card, but it is their medical insurance card and that company does not cover the customer's prescription costs. Here is the scenario that too frequently plays out:


Me: "Do you have insurance?"
Customer: "Yes."
Me: "May I see your insurance card?"
*Customer hands me his insurance card that I proceed to look over*
Me: "Did they provide you with another card for your prescription coverage? This only covers your medical costs."
Customer: "No. That's the only card they sent me."


At this point I can do nothing for the customer other than to suggest calling their health benefits manager and find out which insurance company covers their prescriptions. The customer never enjoys hearing this and often it leads to yelling or statements such as, "<Different pharmacy> has always been able use this card!" No, the other pharmacy had no use of that medical card and they must have found the customer's prescription information through some other means.

The Solution
The best way to avoid this situation is through basic insurance card education. Insured individuals should always carry their insurance cards with them, but before cramming it into the wallet take a minute to read the information on the card. Generally the information will be presented in one of three ways.

Cigna Insurance Card

If the insurance company covers prescription costs along with the medical coverage the letters Rx will be printed somewhere on the card.

United Healthcare Insurance Card

 






Sometimes the insurance company does not cover prescriptions but prints the information of the company that does on the same card.

Caremark Insurance Card

Other times a different company handles the prescription coverage and in turn provides their own prescription card.






 


 Regardless of the insurance company, the pharmacy is looking for four pieces of information.

• RxBin - the Bank Identification Number routes a claim towards the right insurance
• RxPCN - the Processor Control Number further narrows the claim to the specific insurance
• ID - the member's designated identification number
• RxGrp - the prescription group number denotes which group plan the member ID falls under

With those four numbers the pharmacy can properly submit a claim to the right insurance. If the insurance card does not have Rx or RxBin somewhere on the card then the card most likely is not their prescription card and the customer needs to hunt that information down.