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    Throwing Trash Is Pay Dirt

    | Seattle, WA, USA | Bad Behavior

    (I work in a customer service call center for a health plan that is also a cooperative; it’s the kind where it’s both your insurance and your doctors. On this particular call, a woman is upset because one of her claims was denied, after the referral she’d requested for the service had also been denied.)

    Customer: “I don’t understand why my claims are denying.”

    Me: “Ma’am, did you receive the referral letter we sent you that said that this service was denied?”

    Customer: “Well, yes, but it seemed like there was a mistake, so I just threw it out!”

    Me: “You threw it out?! Ma’am do you understand that that denial letter is a legal document that states we are in no way going to cover these services? Why didn’t you call us if you thought it was mistake?”

    Customer: “Well I figured if it was a mistake, you guys would just find it and then I could go have this done and it would be covered!”

    Me: “Do you realize that we process thousands of referrals to authorize a day? How are we supposed to know that what you requested is wrong, if you don’t tell us?”

    Customer: “Don’t put this on me! You denied the referral! It was a mistake! I don’t have to pay! You have to pay!”

    Me: “Ma’am, it’s not our fault you threw it away and did nothing about it. We are not going to pay for these services.”

    Customer: “You are going to pay! You should have known I would throw it in the trash! You will pay! You will pay!” *click*