Claiming on insurance for drugs from chemist

Re: Claiming on insurance for drugs from chemist

Gillian Mostyn — Tue, 21 Feb 2012 22:58:22 GMT

I am not suggesting in any way that I will not give people a prescription. I am happy to do so. I just don't see why we should be the ones making the insurance claim for it. We wouldn't claim for anything else that we didn't do or supply ourselves, so why is this any different? Why should we be taking the time to check that the drugs have been supplied correctly? The insurance companies are the ones that are benefitting from the increased popularity of pharmacies so why on earth shouldn't they be the ones to put a system in place for claiming for the cost?

[quote user="Steph Worsley"]I don't particularly agree with internet pharmacies etc but I think we have to accept that they are here and if they can potentially help us treat patients better/for longer then maybe we need to embrace them, [/quote]

Accepting they are here to stay is one thing - expecting us to take the time to do their job for them is asking a little too much methinks! I won't be embracing them just yet!

Re: Claiming on insurance for drugs from chemist

Steph Worsley — Tue, 21 Feb 2012 22:24:59 GMT

I am trying to play devils advocate here and explaining how I interpret the guidance and how we can help our clients potentially get the most out of their insurance, surely we should help that

I have already suggested a way to check if the drug has been supplied to the client and you just turned round and said how do you know it's genuine and now you're saying how do you know it's been supplied.

I agree that paper work on its own can be forged etc however thats why I suggested getting the client to bring the meds with them so that you can check that they have been supplied.

I don't particularly agree with internet pharmacies etc but I think we have to accept that they are here and if they can potentially help us treat patients better/for longer then maybe we need to embrace them,

Re: Claiming on insurance for drugs from chemist

Gillian Mostyn — Tue, 21 Feb 2012 22:12:40 GMT

But the question is to whether the drug has actually been supplied to the client. As I said, I wasn't actually referring to the quality of the product. I would assume that a veterinary surgeon would only obtain a drug from a source they trust.

Sorry if I seem argumentative - I don't mean to be. We all have to interpret the rules in our own way - I am just explaining how I see it.

Re: Claiming on insurance for drugs from chemist

Steph Worsley — Tue, 21 Feb 2012 22:06:56 GMT

have you never had to apply for an STC or SIC for drugs, Imported from abroad for example cyproheptadine, mitotine etc

Sorry that should have said re-formulated rather than reconstituted for example gabapentin oral liquid

Re: Claiming on insurance for drugs from chemist

Gillian Mostyn — Tue, 21 Feb 2012 22:03:43 GMT

sorry - I meant the paperwork may not be genuine.

As to the quality of the drugs, I am not sure what you mean. Import from where? Reconstituted outside the practice?

Re: Claiming on insurance for drugs from chemist

Steph Worsley — Tue, 21 Feb 2012 22:01:49 GMT

[quote user="Gillian Mostyn"]

I know I am being picky - but regardless of what meds and paperwork you are shown you cannot prove 100% that any of it is genuine.

[/quote]

The same can be said of any drugs that you have to import or any drugs that are reconstituted for you so are you going to stop signing claim forms for those as well?

Re: Claiming on insurance for drugs from chemist

Gillian Mostyn — Tue, 21 Feb 2012 21:59:13 GMT

I know I am being picky - but regardless of what meds and paperwork you are shown you cannot prove 100% that any of it is genuine.

We each have to interpret the letter as we feel it is written - and, to me, it is saying that we cannot certify the supply of drugs from pharmacies. There are always ways and means of reading between the lines but I do feel the overall message is pretty clear.

Re: Claiming on insurance for drugs from chemist

Steph Worsley — Tue, 21 Feb 2012 21:52:30 GMT

It then goes on to say:

‘to the best of my knowledge’ would have no meaning unless the veterinary surgeon had some involvement in the matter. In this case, the veterinary surgeon is unlikely to have any knowledge that the pharmacy had supplied the medicine.

Which is why I suggested that the client brings the meds in along with their reciept to proove that the meds have been supplied!

Re: Claiming on insurance for drugs from chemist

Gillian Mostyn — Tue, 21 Feb 2012 21:47:38 GMT

[quote user="Steph Worsley"]Hmmm I think I can actually read that a different way as well.....if the client presents you with an invoice or reciept which accompanies the prescription you have written then surely that is enough for "to the best of my knowledge"??? the client details would have to be the same and the drugs itemised and dosages would have to be the same, even if you ask your clients to bring the meds so you can check them when they drop their claim form off. so you would know that the pharmacy had supplied the meds.[/quote]

No, I don't think so. The actual wording is:

A veterinary surgeon may be asked to certify ‘to the best of his/her knowledge’ as Mr Whitehead indicates in his letter. However, in relation to the filling of a prescription by an internet pharmacy, it would not be possible for a veterinary surgeon to certify even on the basis of ‘to the best of his/her knowledge or belief’.

Thus there is no leeway - regardless of what documentation you are provided with, you cannot certify that the prescription was filled by a pharmacy. The RCVS says that you can give a supporting letter to the claim, stating that you have every reason to think the drugs were supplied, but you can't make the claim yourself. Annoying, but it is clear.

Re: Claiming on insurance for drugs from chemist

Steph Worsley — Tue, 21 Feb 2012 21:40:49 GMT

looks like we cross posted

Hmmm I think I can actually read that a different way as well.....if the client presents you with an invoice or reciept which accompanies the prescription you have written then surely that is enough for "to the best of my knowledge"??? the client details would have to be the same and the drugs itemised and dosages would have to be the same, even if you ask your clients to bring the meds so you can check them when they drop their claim form off. so you would know that the pharmacy had supplied the meds.

I actually think the guidelines are, as per usual with the RCVS, as clear as mud and can be interpreted in a couple of ways. a bit of lateral thinking, and you're away!

Re: Claiming on insurance for drugs from chemist

Steph Worsley — Tue, 21 Feb 2012 21:26:53 GMT

[quote user="Gillian Mostyn"]

[quote user="Steph Worsley"]I can understand the RCVS not allowing a direct claim for external pharmacy drugs but if the claim is going to the owners and you have issued the prescription then surely this should be ok.[/quote]

You've always issued a prescription, whether the drug comes from the local pharmacy or the internet one. The RCVS doesn't get involved in whether it is a direct claim or not - it is simply about whether the vet can guarantee the supply of the drug, which you can't unless you have supplied it yourself. As I said, the insurance companies will be OK with us signing it (indeed, will be happy as costs to them may be reduced) but that is different to what we, as vets, are actually able to certify.

I have a copy of the guidance notes pinned to the office wall but I can't find a link at the moment...will keep looking.....

[/quote]

I am aware that a practice has always issued a prescription whether the drug has come from a local or internet pharmacy and even an inhouse pharmacy supply. If you can write a prescription for a client to obtain the drugs from elsewhere, and sign that then surely there is no problem in signing a claim form to say that these drugs have been obtained when accompanied with a reciept from the said pharmacy.

As I said I would be interested in reading the guidance notes,

Re: Claiming on insurance for drugs from chemist

Gillian Mostyn — Tue, 21 Feb 2012 21:22:07 GMT

Found it - it was a letter in the Vet Record.

http://veterinaryrecord.bmj.com/content/164/16/508.2.full

not sure if you can see it without being a member so I paste it below:

Veterinary Record 2009;164:508 doi:10.1136/vr.164.16.508-a

Letter

Insurance certification and medicines obtained via the internet

Lucy Evans1

+ Author Affiliations

¹ Professional Conduct Department, RCVS, Belgravia House, 62–64 Horseferry Road, London SW1P 2AF

Lucy Evans of the RCVS Professional Conduct Department, comments: The first principle of the 12 principles of veterinary certification is as stated in Mr Whitehead’s letter. Therefore, a veterinary surgeon should not certify that his client has had a prescription filled by an internet pharmacy, as the veterinary surgeon would not have this in his own knowledge or be able to ascertain this personally. In this situation the internet pharmacy, or the client themselves, would be able to confirm that the prescription has been filled.

The phrase ‘to the best of my knowledge’ would have no meaning unless the veterinary surgeon had some involvement in the matter. In this case, the veterinary surgeon is unlikely to have any knowledge that the pharmacy had supplied the medicine. In the circumstances described, it would appear that only the pharmacist or the client could confirm this. The veterinary surgeon’s knowledge is limited to confirming provision of a prescription.

The issues therefore lie with the insurance company insisting that claims are only paid if the veterinary surgeon signs the forms, but the veterinary surgeon not being able to do so for the reasons stated above. The problems would need to be sorted between the animal owner and the insurer and not the veterinary surgeon. The veterinary surgeon’s helpful statements might ensure that the insurance claims are dealt with smoothly. A solution would be for the insurers to change their rules and adapt to the re-introduction of the prescription charge.

Whether veterinary surgeons charge for their professional time when completing insurance claim forms is not a matter on which the College gives specific advice. It is for a practice to decide if it wishes to make these charges. These administrative charges should be made clear to the client. The Guide to Professional Conduct states, in part 2B, that, regarding invoices, ‘All invoices should be itemised showing the amounts relating to goods and services provided by the practice. Fees for outside services and any charge for additional administration or other costs to the practice in arranging such services should also be shown separately.’

Veterinary surgeons can be helpful or less helpful depending on the circumstances. For example, a veterinary surgeon might add that he/she has provided a prescription and has no reason to doubt his client had the prescription filled. The real issue lies with the insurer changing its rules.

A vet asked what he should do if asked to claim for a drug obtained elsewhere, and the RCVS made it clear in this letter than the claim should be made by the client or the pharmacy.

It is clear that there is sometimes a conflict over what the insurance company wants vs what we are supposed to give them, but nonetheless our guidelines are clear.

Re: Claiming on insurance for drugs from chemist

Gillian Mostyn — Tue, 21 Feb 2012 21:12:18 GMT

I have a copy of the guidance notes pinned to the office wall but I can't find a link at the moment...will keep looking.....

Re: Claiming on insurance for drugs from chemist

Steph Worsley — Tue, 21 Feb 2012 20:57:23 GMT

I have just asked for further clarification on this from PP.

I can understand the RCVS not allowing a direct claim for external pharmacy drugs but if the claim is going to the owners and you have issued the prescription then surely this should be ok.

Would you be able to either post a link or copy and paste the guidance notes please as I would be interested in seeing them?

As far as I am aware most insurance companies ask for a veterinary surgery representative to sign the claim...not a pharmacist or the owner so would then not be able to claim for these drugs. TBH it's not something I even thought about until I heard how much my parents were being charged for the concoction that their cat is on, and looked into it. When I have recieved further clarification from PP I will post it on here

Re: Claiming on insurance for drugs from chemist

Gillian Mostyn — Tue, 21 Feb 2012 20:36:01 GMT

Sorry but that advice is incorrect. Vets can only claim for drugs which they have dispensed. You will need to either fill in the claim yourself or your chemist will need to fill it in for you. The RCVS sent out guidance notes a while ago, mainly relating to internet pharmacies, and they made it very clear that we are only allowed to claim on insurance for drugs we have supplied.

Sorry if that makes your life more complicated! If the people at PP said differently then I guess they will actually accept the vets making the claim - but the RCVS has said we shouldn't do it...!!!

Re: Claiming on insurance for drugs from chemist

Kim Buckley — Tue, 21 Feb 2012 19:01:24 GMT

Cool cool thanks Steph!

Re: Claiming on insurance for drugs from chemist

Steph Worsley — Tue, 21 Feb 2012 18:46:35 GMT

I asked my lovely friend at PP about this not long ago, what you need to do is get an itemised reciept and give to your vet to add to the claim and that should be it!