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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