Insuring Instant Karma For One Dirty Agent

, , , , , , | Legal | May 16, 2020

I work in Medicare insurance, getting people coverage through part C and part D. My job has many, many rules, and serious consequences for breaking them. One caller’s situation stands out.

She called in the middle of February, distraught, because another agent had called her and signed up for a new plan. 

This — in the first minute of the call — was my first red flag. It is illegal for a Medicare insurance agent in Wisconsin to cold call anyone, as well as to enroll them in a new insurance plan on an outbound call; agents can only ever enroll people who called them.

After sign-up, she’d run into trouble getting her prescriptions refilled, so she’d wanted to talk to her agent again. She’d spent more than a week trying to get in touch with him and had eventually found my number, thinking that my office was Medicare itself.

My office’s name does have Medicare in the title, but we always immediately clarify that we do not work for the government.

My workplace has an unusual approach to callers: no matter what they called about, spend at least ten minutes helping and continue to help for as long as they need. We are a sales office, but we’re paid hourly and our commission is negligible in order to support this behavior.

I start asking questions and track down the plan she’s been signed into. My first bit of good news is that it’s a plan that I’m contracted with; I can pull up the full contract and can figure out the answers to every one of her questions, but with every question she asks, my internal alarm bells chime a little louder.

Insurance agents are supposed to be responsible to their customers. Whoever this other agent was, he left her not knowing most of what she needed to know; he’d effectively bullied her into changing and then left her high and dry.

The medicine issue was actually coincidental; I told her what she needed to tell her pharmacist to clear things up but asked her to stay on the line and answer a few more questions, and I checked to make sure her family doctor was in the network of her new plan.

He was not, and the other agent had not even told her that changing plans would have restricted her from seeing him. This could have cost her thousands of dollars!

That medication issue that sent her to me saved her from an untold amount of hassle. The plan change could only go into effect at the beginning of the next month; the new plan wasn’t in place yet, and we could overwrite or cancel it just by submitting the paperwork.

I did one last piece of digging. Election periods are the times of year that a person is allowed the opportunity to change their coverage. If this other agent had submitted a change, what had he used? He hadn’t mentioned this to my caller at all. A quick rundown of options left only one answer. The other agent had used an election period called OEP to change her coverage.

OEP is effectively an emergency exit at the start of the year for when someone finds out that their plan is not suitable to their needs. Agents are prohibited from advertising or even mentioning OEP on calls; the customer must request a change or express distress before OEP can be brought up. Using OEP without the customer knowing or even understanding what was being done? Egregious.

So, I go through the paperwork with her and get her signed back into the plan that she had originally, and I give her the appropriate phone numbers to check up with her plan to ensure that she won’t have any trouble. But before we disconnect, I have one final errand for her.

I give her the phone number of the Commissioner of Insurance of the State of Wisconsin: the regulating body responsible for cracking down on bad insurance agents.

Let’s run it down, shall we?

Cold-calling a Medicare insurance customer, uninvited? $25,000 fine. Per person, if he’s called others.

Enrolling her on an outbound call, willfully signing her up into an unsuitable plan, and abusing OEP? Forfeiture of license, along with twice the value of any money they hoped to gain by doing this, plus a $5,000 fine and up to three years in prison. 

That’s three counts of it, mind you, so up to six times the money he tried to make, a $15,000 fine, and nine years in prison, and probably being banned from insurance work in the United States for life.

If he’s done it to one innocent old woman, he’s probably done it to others. I will never know the fallout from the case, but knowing the tools at the Commissioner’s fingertips, I’m reasonably confident I got a swindler his comeuppance.

1 Thumbs

Insuring Nemo

, , , | Right | April 4, 2020

(In some states, our claims are required to have a list of all the passengers in a vehicle that’s involved in an accident. The person I am speaking with here is from one of those states and he’s been giving me a hard time for most of the interview already.)

Me: “Okay, next question: were you the only person in your vehicle at the time?”

Caller: “Naw, it was a full car; I had my wife, kid, and gran’kids with me.”

Me: “And what are your passengers’ names, please?”

Caller: “Do I have to tell ya? I mean, why would you even need that?”

Me: “I’m sorry, sir, but in your state, it’s required for us to have a list of the names of everyone in your vehicle.”

Caller: “Well, we had some fish in the car; you wanna know about them, too?!”

Me: “You know, I guess that depends, sir. Do your fish have names?”

(He took a few seconds to recover from that but was much more cooperative for the rest of our conversation.)

1 Thumbs

This Debt Collector Had Better Hope HE Has Insurance

, , , , , | Healthy | March 29, 2020

(I’m a broke college student supporting myself with student loans, whatever hours I can get at my work-study job, and the small amount of money my parents can spare. Luckily, I’m still on my parents’ insurance. When I get into a bad bike accident and have to get stitches and x-rays at the hospital, their insurance covers the bill. It’s been a couple of months since then when I answer a call from a number I don’t recognize.)

Caller: “Am I speaking to [My Name]?”

Me: “This is her.”

Caller: “My name is [Caller], and I’m calling on behalf of [Debt Collection Agency] about an unpaid medical bill.”

Me: “What? I didn’t think I had any unpaid bills.”

Caller: “The bill is [amount] for an ambulance ride on [date of the bike accident].”

Me: “But my insurance covered that!”

Caller: “Sometimes insurance doesn’t cover certain services, like ambulances, if they are seen as unnecessary.”

(The ambulance was definitely necessary since there was a suspicion at the time that I’d seriously injured my neck and I was bleeding profusely from my head.)

Caller: “The billing department attempted to contact you multiple times, but you’ve consistently ignored them. Now the bill has been sent to us, and it will negatively affect your credit. However, if you pay it right now, we can try to remove it from your credit report. How will you be paying today, [Card #1] or [Card #2]?”

Me: “Um, I won’t be paying today. I need to contact my insurance company to see what’s going on. This should have been covered, and I’ve never heard of it before today.”

Caller: “If you don’t pay today, your credit will be negatively affected. You will never be able to get a loan, a mortgage, or a credit card.”

Me: “I need to talk to my insurance company before I do anything.”

(He keeps trying to convince me, so I eventually just hang up. I contact my insurance company and find that no claim was ever submitted for the ambulance trip and that they would have covered it if it was. Then, I call the hospital billing department to figure this out. It takes a very long time to reach the right person, but I finally find out what happened.

In an amazing display of incompetence, someone had billed it to the wrong insurance company in the wrong state using the wrong contact details. Obviously, that claim was denied, so they sent the bill to whatever address they’d written on the claim. With this level of screwing up, I’m guessing they mixed up my file with someone else’s.

Luckily, the person I talk to is more helpful, and she gets all the information she needs to submit the claim to my real insurance. She also promises to take the whole incident off my credit report once everything’s done. However, it will take several weeks at the very least for the claim to go through. In the meantime, I get another call several days later from the same bill collector.)

Caller: *after making sure he’s speaking to me* “Our records indicate that you still haven’t paid your bill. What payment method–”

Me: *cutting him off before he can get too far into this* “I’ve contacted my insurance and the hospital’s billing department and gotten the whole thing sorted out. There was a billing mistake. Many, in fact. But the claim has been properly submitted to my insurance now. It just takes a while to go through.”

Caller: “Well, you still haven’t paid. It’s on your credit report. I can’t take it off at this point since you’ve refused to pay it once already, but paying today will make sure your credit doesn’t get even worse. How will you be paying today, [Card #1] or [Card #2]?”

Me: “As I said, my insurance is paying it. We just have to wait for the claim to go through.”

Caller: “But your credit–”

Me: “The billing department said they’d take it off my credit report completely, as they’re the ones who made the mistake.”

Caller: “I’m looking at your credit report right now, and it’s not looking good.”

Me: “The claim was only submitted a few days ago. It hasn’t gone through yet.”

Caller: “If you pay in full right now, this will go away immediately. No need to wait for the claim to go through.”

Me: “Hold on. You want me to pay for something that I never needed to pay for in the first place, just to speed things up? That’s ridiculous! And even if I was going to pay, it’s not like I have that kind of money just lying around.”

Caller: “Surely you have some jewelry or electronics you could sell. I can give you the address of a pawn shop nearby.”

Me: “What? No! I didn’t mean I intended to pay you. My insurance is paying it directly to the hospital. We all just have to be patient.”

(This went back and forth for a while. It became clear that he was working on commission and wouldn’t get any money if the bill was paid through the insurance company. Eventually, I just had to hang up on him again, since it was obvious he was not giving up. He continued to call me multiple times a day for weeks, sometimes during class. Finally, the claim went through, and the debt collector stopped calling.)

1 Thumbs

You Can’t Insure Those Who Cannot Help Themselves

, , , , , | Right | March 26, 2020

(I am a licensed insurance agent. I have a client who was involved in a car accident in which he was not at fault. The other driver’s insurance company is responsible for repairing his vehicle. He calls me over a year after the accident and tells me that he is not having any luck with the other company. My agency prides itself on going above and beyond in order to provide excellent customer service. I spend over an hour tracking down a supervisor at the other company, who explains that their claim had been closed by mistake. She reopens her claim and promises that she will have someone call my client. I call him back and let him know to expect a call from the other company. Two days later, he calls me and tells me that no one has called him. I get the other company’s supervisor back on the line. She tells me that her employee called my client the previous day at a particular time and left a voicemail, and also sent him an email. I call him again.)

Me: “The other company called you yesterday at [time] and left you a voicemail. Did you receive it?”

Customer: “I have voicemail set up, but I don’t know how to check it. Can you tell them to call me again?”

Me: “Did you get a call yesterday at [time]?”

Customer: “Yes, I did, but I don’t answer the phone if I don’t recognize the number. Too many telemarketers.”

Me: “They also sent you an email. Check that, and it will give you the number to call them back.”

Customer: “I have email set up, but I know how to check it. Just tell them to call me again.”

(This scenario repeats again two days later, with him unable to check voicemail or email, and not answering a phone number he doesn’t recognize.)

Me: “[Customer], you are going to have to answer the phone in order to talk to them and get your vehicle repaired.”

Customer: “I’ll try, but I really hate telemarketers, so I don’t like to answer numbers I don’t recognize.”

Me: *facepalm*

1 Thumbs

Unfiltered Story #187801

, , , | Unfiltered | March 6, 2020

I work in an insurance office where we handle mostly commercial lines, but occasionally offer personal lines for high net worth clients. We have just sent a marketing email to a large number of business.

Caller: Hi, I wanted to know if you could quote on my home insurance.
Me: Certainly. I’ll need to take a few details so I can take them over the phone or send out a form for you to complete. Which would you prefer?
Caller: I don’t want to fill in any forms.
Me: Okay. That’s fine. I can take some details now. Can I start by taking your name.
Caller: *gives name*
Me: And your email address
Caller: You should have that. You already sent me an email.
Me: Okay. I’ll have a look through our mailing list later to get that.
*I go through other setails, like phone number and address*
Me: Great, thanks. Do you know the rebuild value of the property?
Caller: Why do you need that?
Me: Well, so the underwriter knows the level of risk they’re taking on.
Caller: I don’t want to give that to you.
Me: well, I can’t quote without all the info.
Caller: Okay. I’ll call back if I want a quote.

I don’t understand how he thought I could quote without knowing anything about his property.