Computer gremlins are whispering lies to Utah pharmacists: "Psssst. Her insurance coverage expired. Make her pay full price for that medicine."
Many of an estimated 2,000 Utahns who belong to small group insurance plans offered through Intermountain Health Care have been victimized by the gremlins, and many more may get the same shocking treatment before the error is straightened out.But everything should be back to normal by Friday, promises Daron Cowley, IHC public relations manager.
One Salt Lake woman whose daughter is seriously ill went to a local pharmacy Monday to have a prescription filled. As usual, the pharmacist checked her coverage through a computer hookup, she said.
But instead of approving payment through IHC's Care Plus Insurance plan, the computer notified the pharmacist the family's benefits had been terminated as of Feb. 28. The information was false.
"I gave them my (insurance coverage) cards, including the one that I'd just received in the mail, and said, `That's not possible,' " she said. But a second computerized check had the same result: coverage terminated.
She talked with the administrator of the insurance plan, who called IHC officials and learned that a computer problem was to blame. IHC told the administrator that the customers should pay the full amount for now, with IHC promising to reimburse them.
Her normal co-payment for the prescriptions would have totaled $15. Instead, paying the full amount, she had to come up with $82.
Did IHC warn the family of the error? "Nope, nope, nope," she said. "They hadn't notified the pharmacy either, and that's a little bothersome to me because I wouldn't want my pharmacy to think I hadn't paid my insurance."
Joanne Weber, administrator of one of the small IHC insurance plans for a local law firm, began hearing from plan members who had run into the same road-block.
"There were three attorneys' wives who went to get prescriptions yesterday," she said. "The pharmacist would go to the computer to try to bring up their accounts by their Social Security number, and (the computer information) said coverage had been terminated as of Feb. 28."
Cowley said the mixup actually happened in January. He did not know why mistakes were happening in March.
"We've had a computer glitch or problem . . . just pertaining to around 2,000 of our members," he said.
They are members of small group insurance plans, each of which covers between two and 25 employees. Altogether, 200 plans were affected.
Only prescription reimbursement was involved. Other coverage items such as doctor visits and hospital stays were unchanged.
IHC's small group plan benefits were changed recently with the addition of another option for pharmacological services. The change required that data about participants be re-entered into a computer. Then the information was used to print out new insurance cards for members, including the new card flourished in vain by the woman who couldn't get coverage for her daughter's medicine.
But through some goof, when the computer printed the cards, "that caused it to delete all the information" from its hard drive.
When pharmacists tapped into the computers' empty memory banks, they found benefits were no longer authorized for those members.
Cowley emphasized that if patrons have to pay full price to have their prescriptions filled, they can be reimbursed by IHC. Asked how long that will take, he said, "We know it's an issue with some individuals, and we're going to try to respond as rapidly as possible to get that reimbursement back."