Excellence in Caring: Justin Boylan
Justin Boylan works with the Home Delivery Pharmacy team where he deals specifically with claims that require additional authorizations from our clients. Whenever home delivery claims reject, Justin must contact the adjuster for approval and make a determination if the rejection is valid. He must also keep up with the latest policies and procedures when handling rejected claims. Justin always keeps the pharmacy in the communications loop during the approval process on all rejections and is relied upon heavily to get approvals and additional notifications back in a timely manner.
Recently, Justin received a rejected claim for a claimant and upon review, noticed that the claimant had been prescribed a medication that had newly undergone a significant price change. Justin called the pharmacy prior to contacting our client for approval to see if there was a valid reason for the switch. Justin often checks with the pharmacy on high dollar accounts before submitting to the adjuster to ensure the price is correct. The pharmacy reviewed the order, and upon further research, found that the doctor had changed the prescription to the more expensive medicine. Justin’s watchful eye saved the client money and provided an opportunity for a Prescription Review. Keep up the great work, Justin!
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