My concern when I arrived home from touring Express Scripts is that I wouldn’t be able to express how innovative the research facility is. I was hoping that I could instill some confidence that Insurance Companies are listening to their clients. Can the usage change overnight? Probably not, but when Insurance Companies make the decision to change it amazes me how quickly they are able to move.
We walked over to what looked to me like any other desk, we were very surprised at how amazing this desk is. There was a glass top in the desk and it was a computer. This computer is used by the fraud department. It wasn’t so much that there was a computer in a desk, it was how they could manipulate the data. They can pull up a claimant and look at the geographical area of the Doctors they have seen and the pharmacies they have gone to. Researching the Doctors are just as important, they are able to look up a particular Doctor and see their top prescriptions. It is important to see what the specialty of the Doctor is as well, since there are Doctors that deal strictly in pain management.
Express Scripts in the US have 800 people in their fraud department.
So far I have had one fraudulent situation. The money was paid back to the insurance company and they are required to send in paper claims from now on.
For more information on how you can manage your claims, contact Glendinning Insurance Services, your Resource Specialist.