When Copay Saved The Day

, , , , , , , | Legal | November 6, 2019

(This takes place after I receive a statement from my medical insurance company, who is also my provider.)

Agent #1: “Thank you for calling [Company]. My name is [Agent #1]. May I please have your name and insurance number?”

Me: “Hello, my name is [My Name], and my number is [number].”

Agent #1: “How may I help you, Mr. [My Name]?”

Me: “I am calling about the statement that I received in the mail recently. There are several charges against my insurance that I don’t recognize. Those are the charges from [dates], for [amounts].”

Agent #1: “So, you are claiming that you did not make these charges?”

Me: “Yes, those are not my charges, and no one else has my insurance information.” 

Agent #1: *suddenly defensive* “So, are you saying that someone here at [Company] ran charges against your insurance? Could it be more likely that you gave your insurance card to someone else, and now you are trying to rip us off? I don’t know what you did, but we are not responsible for what you do, and we aren’t going to help you defraud us!”

(My insurance is very good; my copay is never more than $20 for Schedule 2 drugs and surgical procedures. Regardless, the accusation infuriates me more than the insurance fraud.)

Me: *furious, but keeping my temper in check* “Now you can transfer me to your manager.” 

Agent #1: “Why? So you can lie to her, as well? I’m not going to let you try to rip off [Company] anymore. Don’t call back or I’ll give your number to the federal government for insurance fraud!” *hangs up*

(By this point, I am absolutely furious and am about ready to call National Insurance Crime Bureau myself, but I decide to try one more time.)

Agent #2: “Hello, thank you for calling [Company]. May I have your name and insurance information?”

Me: “My name is [My Name] and my number is [number].”

Agent #2: “How may I help you today?”

Me: “Does the word HIPAA mean anything to you?”

Agent #2: *slightly confused* “Yes, of course. Every medical company follows HIPAA rules.”

Me: “Apparently not.” *explains situation* “Now, the first agent accused me outright of giving my insurance to someone else. I, however, have to wonder how your company gave my private medical information to some random person. That is a major HIPAA violation.”

Agent #2: “If you’ll hold for a moment, my manager wants to speak with you about this.”

Manager: *taking the line* “Hello, my name is [Manager], and I understand you have some issues with some charges against your insurance?”

Me: “No, I have issues with what your company has done, by the admission of your own agent and the charges I see here. There are charges on my account that I didn’t make. Now, one of two things happened here. One, someone else was allowed to use my insurance information to schedule an appointment, see a doctor, and get several high-class prescriptions, all without checking to see if they were me. That would be so many HIPAA violations I can’t even count them all. Or two, someone in your company is scamming insurance for money or drugs. That would be insurance fraud, in which case I would be within my rights to sue.”

(The manager is suddenly quiet, followed by the sounds of typing. When she comes back on the line, she sounds a little shaky and nervous.)

Manager: “If you’ll just bear with me for a little bit longer, I think I might know exactly what happened. Can you please confirm the dates, doctor’s name, and pharmacist name listed on your account?” 

Me: “The dates are [dates], all of them are listed as being with [Doctor], and the prescriptions are all listed as filled by [Pharmacist].”

Manager: *eerily calm now* “I think I have found the problem. Please give me a phone number, and I will call you back as soon as I get what I need.” *gives my number* “Again, my name is [Manager] and my direct extension is [number].” *call disconnects*

(She called me back about three hours later and explained everything. It seems that it was, in fact, insurance fraud: hundreds of thousands of dollars worth of it. From what the manager told me, the doctor, the pharmacist, and [Agent #1] were all family. It seems that they had been running a MASSIVE insurance scam, one where the doctor ran up fake appointments against insurance, usually avoiding triggering patient copay by billing it as a copay-free appointment. He would then write prescriptions, also against insurance, which would then be filled by the pharmacist, also his sister. They would then take those prescriptions and sell them for a much lower price and pocket the money. [Agent #1]’s job, it seems, was to direct patients away from any suspicion. Usually, he succeeded by claiming it was some type of hidden fee, but that insurance would handle it and there would be no charges for the patient. They messed up this time, though; my insurance is through the state, and one of the prescriptions that the doctor wrote automatically triggered the copay on the state insurance plan, thus my problem. This manager just happened to notice the family connection, and, when she opened the records, she put it all together from the appointment records. Things drug on for a while, and the doctor tried to run once the feds started investigating, but in the end, all three were arrested. Last I heard, they are all facing very, very long sentences. As for the charges? They were reversed with no difficulty by the manager who took my call the first time.)

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Meet Mrs. Fraud’s Son

, , , | Right | October 21, 2019

(I ring up a purchase for three teenage boys. One of the boys swipes a credit card at the card reader.)

Teenager: “Um, this is my mom’s card. Can I sign for it?”

Me: *shocked* “No.”

Teenager: “Why not? I do it all the time.”

Me: “That’s illegal.”

(They reluctantly left. A few minutes later, the boys returned with an older woman. She wordlessly ran the credit card and signed the screen herself. They did the legal thing in the end, but it’s so nice to know that a parent in my community is actively encouraging her son to commit credit card fraud!)

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It’s Mrs. Fraud!

, , , , , | Right | October 18, 2019

(This is back in the days before chip and PIN. A customer comes up to pay for her purchase with a card. I check the signature and it’s completely different, but not just different writing, a different name. I turn the card over to check the name, and it’s distinctly a man’s name, and she is an unremarkable middle-aged woman.)

Me: “This isn’t your card.”

Customer: “No, it’s my husband’s.”

Me: “Well, you can’t use it.”

(She holds up bags from half a dozen other stores and says:)

Customer: “No one else said anything.” 

(Yup, she’d spent hundreds of dollars on a card she wasn’t even pretending was hers, and no one else had noticed.)

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Peaky Binders

, , , , , | Right | October 10, 2019

Customer: “I have to return these binders my kids didn’t need for school. I don’t have the receipt.”

Me: “Did you maybe get the receipt emailed to you?”

Customer: “No.”

Me: “Hmm. Normally, we could look up the receipt with the SKU of the item and verify it with your card number, but we have sold so many of these binders in the last few weeks it would take us forever to find it. Without a receipt, the register will only let me give you a store credit for the lowest price it’s been sold at in the last 90 days, and these were buy-one-get-one-free recently, so I know they’re going to come up at a penny. Do you want to try looking for your receipt and coming back?”

Customer: “Well, can’t you just scan them and see?”

Me: “Okay.” *scans them and they all come up at a penny* “No, it won’t let me give you anything for them, unfortunately.”

Customer: “Well, what if I just buy new ones and use that receipt to return them?”

Me: *hesitantly* “That’s… fraud…”

Customer: “How is that fraud?”

Me: “Because you’re using a new receipt to return something old. And they’re not on sale anymore, so if you originally bought them on sale, you would be getting more money back than what you paid for them. Plus, you would still be stuck with binders you don’t want, anyway.”

Customer: “Why?”

Me: “Because you would have twice as many binders as you have on your receipt.”

Customer: “Well, I would just go to another store to return the other ones.”

Me: “You can’t do that.”

Customer: “Why not?”

Me: “You can’t return something twice with the same receipt.”

Customer: “It’s not fraud just because I can’t find my receipt!”

Me: “No, but trying to buy new ones and return them all at the new price is fraud. Are you sure you can’t just find your receipt?”

(She leaves and calls the store to talk to a manager — I’m pretty sure she is just calling from the parking lot — and the manager says we can try looking her receipt up. She comes back in immediately and my manager can’t find her receipt.)

Manager: “I can’t find the receipt. And these binders have had different sale prices during the back to school time, and they’re expensive, so I can’t just return them without a receipt.”

Customer: “Can’t you just scan ones from the shelf, then? So they don’t ring up as a penny?”

Manager: “They’re the same binders.”

Customer: “But the ones I’ve brought in ring up as a penny. Can’t you just scan new ones so they scan at full price?”

Manager: “No, they’re the same binders; they will still ring up at a penny. The register does it automatically when there isn’t a receipt.”

Customer: “I don’t understand why can’t just give me what I paid for them!”

Manager: “Because you don’t have a receipt… which tells us what you paid for them…”

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Friends With Money (Problems)

, , , , , , , | Friendly | July 10, 2019

(I am at the mall with a friend, who is also my roommate. We head into a cell phone provider, as I’m going to change my plan and buy a new phone. We get to talking about how expensive it all is. Side note: he’s notoriously bad with money.)

Friend: “I can barely pay my phone bill as it is. I can’t imagine paying [price] for a [brand-new model phone].”

Me: “I can’t afford it, either; that’s why I’m getting the older model. It’s on sale now, essentially free if you extend your contract.”

Friend: “Make sure you ask about cancellation fees. [Other Phone Company] was the worst when I couldn’t pay and tried to cancel my plan.”

Me: “Yeah, I’ll ask.”

Friend: “Or you can do what I did and just disappear.” *laughs*

Me: “What?” 

Friend: “Yeah, instead of giving [Other Phone Company] like 200 bucks to get out of the contract, I just stopped paying.”

Me: “But you still owe them that money, right? They can come after you for it.”

Friend: “Let’s see them find me.” 

Me: *silence*

Friend: *proudly* “I’ve moved twice since then. They’ll never get a penny from me.” *laughs*

Me: “That would kill your credit rating.” 

Friend: “What does that matter? I already have a credit card.” 

(It still boggles my mind. He was a good person, and smart in general, just absolutely clueless about money.)

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