Unfiltered Story #153714

, , | Unfiltered | June 3, 2019

(I work for a counter fraud department within a large well known insurance company, primarily my job consists of investigating new policies and looking for any signs that might link to fraud, fraud rings, ghostbrokers etc and validating the information on new policies, however sometimes we do take an occasional call from a policy holder who’s file we investigated)

Caller: Hi, my policy was cancelled by you and my new insurer is looking for proof of no claims, I should have 11 years?

Me: Alright let me have a look for you.

(I check his file and notice we confirmed with his last insurer  that he left them with 9 years and was with us for a year so he is entitled to 10)

Me: Okay sir, I can send you an email confirming 10 years no claims discount is that okay?

Caller: No I have 11! I had 9 with [Last insurers name] and have been with you for a whole year so 11!

Me: No sir that would be 10 years no claims discount…

Caller: *In an belittling tone* Please explain to me how you are coming up with this calculation because I did the maths and you owe me 11 years no claims discount!

Me: Certainly sir, well 1 + 1 is 2 yes?

Caller: Yes..

Me: And when you add 1 to another number that number becomes 1 more than it already is yes?

Caller: Yes?…

Me: Therefore 9 + 1 is 10, I’ll send out the email within the next 24hrs.

Caller: Oh, okay.. Uhm.. *Click*

They Don’t “Do” Paying

, , , , | Healthy | May 28, 2019

(I used to work for a medical insurance company. I answered phone calls and emails from customers who had questions about their insurance policy or reimbursements. In this case, the customer had a coverage of 80%, meaning that he had to pay for 20% of the amount himself. The following is an exchange over email.)

Customer: “I saw that 80% of my invoice was paid, but what do I have to do about the remaining balance?”

Me: “The coverage for this type of expense is 80%. This means that we have paid for 80% of your expenses to the hospital directly. The other 20% should be paid by you, yourself.”

Customer: “I don’t understand. What do I have to do?”

Me: “Since the coverage is not at 100%, this means that we cannot pay for 100%. We have paid our share to the hospital. The remaining balance of [amount] should be paid to the hospital by you, yourself. If you have already paid this to the hospital, everything is fine and no further action is required. If you want, you can give me a phone call or provide me with your phone number, so I can give you a call, so I can explain this to you by phone.”

Customer: “I really don’t understand. What do you want me to do?”

(He has given me no phone number and no other option than to send another email.)

Me: “The amount of [amount] has to be paid to the hospital by you, yourself. If you have already paid [amount] to the hospital, you should do nothing. If you have not yet paid [amount] to the hospital, you need to pay [amount] to the hospital. If you are unsure whether you have paid or not, please contact the hospital’s billing department.”

Customer: “I am [Customer]’s manager and I have been over these emails with him. We both do not understand what he needs to do.”

(Again, I was given no phone number. At that point, I decided to break the rules and put the email back in the general mailbox instead of my personal one to let someone else deal with it. The worst part is that these people work for the United Nations.)

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Not Changing His Methods

, , , | Right | May 24, 2019

(The insurance company through which we write typically does not allow cash payments; HOWEVER, they do make an exception for our agency, since most of our book of business does not have bank accounts. One of the stipulations is that we NEVER have more cash on hand than we are going to deposit each night. As such, we generally do not have the ability to make change. MONDAY:)

Customer: “Yeah, I want to put $70 on my policy.” *hands me a $100 bill*

Me: “I’m sorry, I don’t have change for this.”

Customer: “Well, what am I supposed to do?”

Me: “There are two banks across the street, and one two doors down. They’ll be happy to make change.”

Customer: *huffy* “Well, if I leave, I’m not coming back today!”

Me: “I understand. Your bill is due by Friday.”


Customer: “I want to put $70 on my policy.” *hands me $100 bill*

Me: “I’m sorry, I still don’t have change for this.”

Customer: “Well, when will you have change?”

Me: “I really can’t tell you. We are not allowed to have any more cash on hand than we receive throughout the day; that’s corporate policy. In fact, we are one of the few agencies in the state permitted to handle cash at all.”

Customer: “Does anyone here have change?”

Me: “I’m sorry, but we are not allowed to personally give change, either. Again, corporate really has strict rules about agencies handling cash.”

Customer: “Then how does anyone pay?”

Me: “We have several options: check, credit, debit, automatic withdrawal, money order… In fact, if you want to get a money order, the two banks across the street, the grocery store next door, or the big box store down the street are happy to help.”

Customer: “THIS IS BULL!” *storms out*


Customer: “I have $80. I want to put $70 on my policy.”

Me: “Again, we do not have change.”

Customer: “THIS IS BULL! JUST CANCEL MY POLICY! I’D RATHER GO TO JAIL FOR NOT HAVING INSURANCE THAN DEAL WITH THIS S***! YOU’RE A B****! GO TO H***!” *runs out the door, slamming it so hard it bounces back open again*

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I Will Not Not Do As You Say

, , , , | Right | May 13, 2019

(I take escalated calls for a national insurance agency. In insurance, any time a change is made to your policy that impacts the cost, the company must notify you. The notification can be in mailed paper form, or email/virtual if you’ve set it up that way.)

Me: “Thank you for calling. My name is [My Name]. The previous representative said you had some concerns about the paperwork you received. How can I help?”

(The customer goes on to explain that over the course of the year she has received many copies of her policy. She has made as many 12 changes due to failure to return forms and other things. She explains that she is old and her time is precious at her age — her words — as she doesn’t have much of it left, and that we shouldn’t bother her with mailings, because then she has to call us.)

Me: “I want to be respectful of your time. You received this mailing because of a discount we finalized on your policy. There’s no action required on your part. You will not receive anything further unless you make other changes, I assure you.”

Customer: “You’re just trying to harass me with all this paperwork. I don’t even know what coverage I have! Your company just wants to overcharge the elderly and harass us.”

Me: “I’m sorry for the confusion. The documents you have there outline all the details of your coverage. Again, I want to respect your time, but I’d be happy to review those coverages if you need me to. Also, we are not charging you anything more; we’ve applied a discount. How can I help?”

Customer: “You can stop sending me stuff. I’ve gotten so much stuff this last year…”

(The customer continues on a long rant, and I continue to apologise and ask how I can help, only to ultimately assure her over and over again that we are not sending any additional paperwork.)

Customer: “So, you’re not going to do anything about this?”

Me: “Ma’am, you literally just instructed me not to do anything. You said not to send you anything, and not to make any changes. So, yes, that’s right, I’m not going to ‘do anything.’ Is there anything else I can help you with?”

(This went on for thirty minutes of her “precious time.”)

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When It’s The Healthcare That Gives Us The Blood Pressure

, , , , | Healthy | April 30, 2019

For an assortment of reasons, my husband has been unemployed for a while, outside of extremely short temp work and off-the-book odd jobs. For a while he has been having random symptoms: foot and ankle pain, shortness of breath after exertion — more than normal — and lower back pain. All together, they don’t seem to add up to anything aside from random aches and pains, they never stick around long, and without insurance, he can’t afford to see a doctor properly, so he just treats with aspirin and the like.

Finally, it happens: the Affordable Care Act is passed. He signs up and gets real health insurance for the first time in a decade. He’s assigned a primary care physician and we call to set up an appointment. No answer. We try again, and again, and again, at both the number listed on the insurance site and on their individual site. We never get an answer; we never even get voicemail. After a bit more than a month of this, he’s feeling ill; the local EMO doesn’t take the medicare-based version of his insurance, so we head to the hospital ER right down the street. He apologizes for coming for such a minor thing but we don’t have any other options at the time. They say it’s fine and after a wait, they take his vitals… and they immediately wheel him into the observation room. We’re trying desperately to get some actual information from the first nurse bringing him in, or the second nurse coming to hook him up to all their monitors.

Finally, a full doctor comes in and starts asking questions, but we interrupt and ask, specifically, why they are doing all this. She shows us the blood pressure monitor: 220/120. His BP has always been high, especially at the doctor’s/hospital because of “white coat syndrome,” but never that high! Somehow he never actually had a heart attack or stroke over the past several months, but that unrestrained pressure did a lot of damage to his kidneys. My husband is in the hospital for about ten days — although he was originally going to get out in six, one batch of test results gets messed up and they can’t run it again until the following Monday. When he leaves, he is on a prescription for about eight different heart and blood pressure medications, two of which are quickly dropped and two others cut in half once he gets home and can relax!

The bad news is that, because of the level of damage his kidneys have suffered, my husband’s on the verge of needing to go on the transplant list. The good news is that his heart has made a near-complete recovery, his prescriptions have been cut down further, and his kidney functions have actually improved to a point where he’s no longer hovering on the verge of failure!

And that’s why we say to this day, with no irony: thanks, Obama!

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