(My insurance company is supposed to cover one physical per calendar year. However, I am surprised to receive a bill from my doctor’s office. With it is a letter from the insurance company stating that they will not cover because I’ve had two physicals in one year. Since I know this is not true, I decide to call.)
Customer Service Rep: “Hello, this is [name]; how can I help you?”
Me: “I’m calling to dispute a denied claim. My name is [name] and my birth date is [birthday].”
Customer Service Rep: “Okay, I’m looking at your information now. Looks like you were denied coverage because you had two physicals in one year, and we only cover one per year.”
Me: “Yes, I know that. But I didn’t have two in one year. I’m looking at my records and the appointments were a year and a day apart.”
Customer Service Rep: “Hmm. Let me look at that again. Okay, according to what your doctor sent us, your most recent appointment was December 6th, and last year’s was December 5th. Oh, that is over a year. I’m so sorry!”
Me: “No worries. So what happened?”
Customer Service Rep: “Looks like someone on our end entered this year’s appointment as December 4th, which caused the system to reject the claim. I will fix that and re-submit it for you. I am so sorry!”
Me: “Hey, it’s all right.”
Customer Service Rep: “I wish I knew who did that! I’m really sorry, it wasn’t me…”
Me: “I’m not blaming you. I used to work in retail, so I know how it feels to get yelled at by a customer for something that’s out of your control.”
Customer Service Rep: “Oh! You understand!”
Me: “The stories I could tell… so do I need to call my doctor or anything?”
Customer Service Rep: “Nope. I just resubmitted it with the correct dates. There shouldn’t be any more issues. Thank you for being so nice!”