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Helping patients with third-party billing

June 11, 2024
Regulated members have the opportunity to demonstrate person-centred care by working with each patient to support their care and advocate on their behalf.

From time to time, pharmacy teams are presented with complex scenarios involving third-party billing and multiple insurers. Helping patients with these third-party billing claims can be a time-intensive process. However, it is an important way in which regulated members can support patient care and potentially prevent disruptions in their medication therapy.

Recently, ACP has received reports from members of the public about how some pharmacy teams manage third-party billing. According to these reports, these pharmacy teams seemed unwilling to coordinate patients’ benefit plans.

For example, some members of the public have drug coverage through both provincial and national health benefits programs. In these instances, there has been confusion about the submission process and the coverage available. This has resulted in patients being told they have to pay out of pocket for their prescriptions when the medication could have been eligible for online coverage.

In their reports to ACP, patients have indicated that these experiences left them feeling dismissed and disrespected. There have also been reports of patients feeling that they have been discriminated against and stigmatized when their coverage is not applied.

While there are limitations in how pharmacy teams can assist patients with third-party billing claims, regulated members are encouraged to be mindful of the patient perspective in these interactions. Not being able to use benefits coverage is a frustrating and possibly financially burdensome experience for patients.

When insurance issues or questions arise, it is an opportunity for regulated members to demonstrate person-centred care by meaningfully engaging and communicating with the patient. Developing positive and trusting relationships through open, respectful, and clear communication can help to prevent or resolve concerns.

Licensees can also support their pharmacy teams by developing procedures to outline processes for addressing common third-party billing issues. This will help to ensure regulated members have steps to follow to better support patients.

From a patient’s perspective, not receiving their benefits coverage can be perceived as a lack of person centredness from their pharmacy team. As partners in patient care, regulated members collaborate with patients when providing professional services. Regulated members work and communicate with each patient to support their care and meet each patient’s unique health needs and goals.