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We’re Just Glad She Isn’t Driving

, , , , , , , | Healthy | November 23, 2022

I work in customer service for a health insurance company that mainly administers benefits for Medicare and Medicaid populations. In my state, members who receive benefits through state Medicaid have access to medical transportation to and from medical appointments. Unless you have a certified disability or other specialized need, that medical transportation normally goes through regular cab companies.

A notable percentage of our Medicaid membership suffers from psychiatric illnesses and other behavioral health challenges, and because of this, getting cursed out and/or threatened is not uncommon. It’s the nature of the beast, and we’re all trained to understand that and not get frazzled or mirror their energies.

My specific job is to take escalated phone calls. This one happened recently.

Me: “Hello there, thank you for holding. How can I help you?”

Insert unhinged screaming, with no discernable words.

Me: “I can hear that you are clearly upset and that something is wrong, but I can’t understand what the exact issue is. Could you repeat yourself?”

There’s more unhinged screaming about seemingly nothing in particular, followed by:

Caller: “You dumb c***, I am former FBI, so GET AWAY FROM ME OR I’LL HAVE YOU ARRESTED!”

Me: “Ma’am, I work from home and can assure you that I am nowhere near you. Could you please fill me in on what the issue is?”

Caller: “I made a hurricane that destroyed the whole world! Do you really want me to do that again?!”

Me: “I certainly don’t, ma’am. I can help you, but I need to know what’s going on.”

Caller: “You’re parked outside my house!”

Me: “Again, ma’am, I am talking to you from home, and I am definitely not parked outside your house.”

Caller: “There’s a [Cab Company] car outside my house!”

Me: “Did you request a medical ride for today?”

There’s a pause before the caller responds in a surprised, chipper voice.

Caller: “Yes! I have to go to the pharmacy today!” *Click*

Yes, ma’am, you go get those meds.

When They Act Tough, You Call Their Bluff, Part 2

, , , , , , , | Working | November 22, 2022

When my baby was six months old, the pediatrician’s billing service sent a notice saying the insurance company refused to pay for one of his well-visits. Since it should have been covered, I called the insurance company first.

Insurance: “It’s a network thing. You needed to get a referral from the primary care doctor first.”

Me: “But we saw the primary care doctor.”

Insurance: “The claim says you visited an anesthesiologist in [Town #1].”

Me: “Uh, no. We went to the pediatrician’s office in [Town #2].”

Insurance: “Oh, I see the problem. The healthcare network’s billing agent reversed two of the numbers in the billing code. They put in 123456, but they should have input 123465. Have them resubmit the bill, and we’ll pay it.”

I called the billing center and explained the problem and that if they resubmitted the bill, they’d get paid.

Agent: “No.”

Me: “No?”

Agent: “I already submitted it, and they rejected it.”

Me: “You submitted an incorrect claim, and that’s why they rejected it.”

Agent: “It’s been submitted and rejected, and now you need to pay for the visit.”

Lather, rinse, and repeat for about two minutes.

Me: “Okay, well, have a nice day.”

I hung up, brewed myself a nice cup of tea, and played with the baby for a while. Feeling refreshed, I called the billing center back. I got the same agent.

Me: “Hi! I called before about an incorrect bill you submitted to insurance.”

Agent: *Huge sigh* “There is nothing I can do about it.”

Me: “Well, I’ve turned you in to the state insurance commission for insurance fraud.”

Agent:What?!

Me: “They said they’ll call in the next couple of days.”

Agent: “Why would you do that?”

Me: “Because you billed my insurance company for a visit to an anesthesiologist in [Town #1] that my son never went to.”

Agent: “But you—”

Me: “My son never had any surgery or any medical condition that would require an anesthesiologist. I can prove quite thoroughly that I had nothing to do with this doctor.”

Agent: “Are you serious?”

Me: “Finally, I can prove I wasn’t there because at exactly the same time you claim I was receiving services in [Town #1]… I was in my son’s pediatrician’s office twenty miles away.”

Agent: “Why are you doing this?”

Me: “By insisting my insurance should pay for that visit, when you know I was never there, that’s insurance fraud.”

Agent: “…”

Me: “…”

Agent:Fine. I’ll fix the claim!”

Me: *All sunshine* “Thank you!”

The minute the corrected claim arrived, insurance paid up.

Related:
When They Act Tough, You Call Their Bluff

Even A Toddler Can Understand Why You Need Insurance

, , , , , | Right | September 18, 2022

A lady calls our cell phone help center. 

Caller: “I need a replacement phone. I gave my toddler my new Galaxy Note while we were out by the pool, he dropped the phone, and it shattered and bounced into the water.”

I get the account up, expecting to start an insurance claim, but there is no insurance. I look at the proof of purchase, and she initialed “no insurance.”

Me: “Ma’am, are you aware you don’t have insurance.”

Caller: “I never get insurance! It’s a scam.”

Me: “I’m sorry, ma’am, but as you just upgraded two days ago, you have twenty-four months before you’re eligible for another subsidized phone. You’d have to buy another at full retail.”

Caller: “No! I fully expect you to replace the phone for free.”

Me: “For what reason?”

Caller: “Because he’s a two-year-old! You should understand that they will break phones!”

Me: “We do. That’s why we offer insurance.”

Caller: *Click*

Trouble Between Junctions And Insurance Barely Functions

, , , , , | Working | September 14, 2022

I was driving along a motorway and noticed there were some kids on the overhead bridge ahead of me, kind of leaning over the rails. As I went under the bridge, something tiny hit my windscreen. It scared me half to death because the impact was really loud, and when I looked in my mirror I could see the kids running to look over the rail on this side.

I pulled over at the next emergency phone and reported what had happened and that I thought the kids had thrown a stone. The operator said they could see the kids on the cameras and would notify the police. Because the only damage was a small crack, I carried on my journey.

The fun started when I put in an insurance claim for the repair; because of the size and location of the crack, I needed a new windscreen. I got a call from the insurance agent.

Agent: “You’ve missed a few details from your claim form. I need the exact location of the bridge.”

Me: “I already stated in the claim that it was between [Junction #1] and [Junction #2].”

Agent: “There are several bridges on that stretch of road. Which bridge was it?”

Me: “I have absolutely no idea! I stopped at the next phone, but I drove under a couple more bridges, so honestly, it could be any of them. All I can say is that it was a narrow bridge, so probably a minor road, definitely between those junctions.”

Agent: “Okay. Then I will need the details of the other vehicle.”

Me: “What other vehicle?”

Agent: “You claimed a stone was thrown from the bridge at your windscreen. Did you get the registration of the vehicle it was thrown from?”

Me: “It wasn’t thrown from a vehicle. I said it was thrown from a bridge by some kids.”

Agent: “Right. Could I have their names, please?”

Me: “I have no idea. They ran away and I was driving. They were long gone by the time I called for help.”

Agent: “So, you called the police?”

Me: “I used the emergency phone. The operator said they would report it to the police.”

Agent: “I need a copy of the police report. Could you send it?”

Me: “I don’t have one. I have no idea how to get it or even whether an official report was made. I just spoke to the operator.”

Agent: “Without the names of the other people involved, I won’t be able to process this claim.”

Me: “Seriously? I have zero idea how to even start looking for a police report!”

Agent: “Then I will be unable to process this claim.”

Me: “Can I change the claim?”

Agent: “Yes. What did you need to change?”

Me: “The description of what happened.”

Agent: “Okay, what is the new description?”

Me: “As I was driving under the first bridge between [Junction #1] and [Junction #2], a stone fell from the bridge and hit my windscreen.”

Agent: “What about the people who threw it?”

Me: “What people? It fell.”

Agent: “…”

Me: “So, can you process my claim?”

Agent: “Uh… yes. Yes, I can process this claim.”

I got my windscreen replaced and the claim was paid. I have no idea if that agent was right or wrong, but that’s the first time I ever knowingly falsified an insurance claim.

Well, Ain’t She Just A Pill?

, , , , | Right | September 7, 2022

Customer: “Why are you charging me a $30 copay for this medication? My sister takes the same and has a $7 copay!”

Me: “You must have different insurance than your sister. Her plan decides the copays.”

Customer: “You are discriminating against me for being old!”

Me: “Well, the non-brand generic version of this medication is only a $5 copay.”

Customer: “No! You are not going to get away with giving me fake pills!” *Storms out*