They’re In Denial About Getting A Denial

I work in a home warranty company, in the authorizations department. I determine if a home repair is or isn’t covered. Our call center is in New Jersey and our after-hours call center is in a South American Country, so even though we have customers on the West Coast, in reality, we “close” around 5 pm local for Texas.

 I’m finishing up my shift but am not allowed to leave until the queue is empty, I’ll spare you the office politics but it’s not supposed to be able to receive incoming calls after 9 pm but in reality, it’s about 9:30 pm and the very last call of the night comes in from Texas.

 The caller is actually the customer’s own technician that they have called in to do a repair on a refrigerator, with the customer on speaker. The authorizations department usually only speaks to technicians, and not customers, so this call is already unorthodox.

Customer: “Hurry up and give us the authorization number! This tech has been on hold for way too long and doesn’t have time for questions.”

Me: “Okay, let’s start with the make model and serial of the unit.”

We use “unit” as a catch-all word for whatever needs to be repaired, washing machine, refrigerator, etc.

Tech: “No, it needs a condensing fan motor, and are you gonna cover it or not?”

Me: “So you are refusing to provide the information on the unit?”

Customer: “I said he doesn’t have time for this, are you gonna cover it or not?”

 Frankly, I don’t have time for this either as I got in the office at 7 am that morning.

Me: “Unfortunately, we cannot make a determination of the claim without the basic information on the unit as part of a diagnostic—”

Tech: “It’s a ten-year-old unit and it needs a condensing fan motor; you gonna cover this or not?”

Fine, I’ll humor him.

Me: “Do you have a part number on the fan that you claim this unit requires to have replaced?”

Tech: “No, I have it in my hand, and are you gonna cover this or not?”

Me: “How many horsepower is it?”

Tech: “1/2hp and it needs a new cap, too.”

Me: “And what’s your price on this motor and the cap?”

Tech: “$650 for the part, $200 labor, and I need another $100 for the hour I was on hold.”

Me: “I cannot authorize a repair without a part number or any details on the unit it is needed for. Furthermore, this typical repair costs no more than $375 parts and labor and we do not reimburse for time on hold. I will need to get all the documentation on the unit before we—”

Customer: “Get your boss on the line right now while you still have a job.”

I go over and get my boss, who looks at the diagnosis that is missing 99% of the needed information – at least I put the prices in and the horsepower! My boss enters the call.

Boss: “Hi, I’m the authorizations manager and I’m looking at this diagnosis and I have a few questions about the unit—”

Tech: “I ain’t answering no more questions; are you gonna cover this or not?”

Customer: “We need to know if it’s covered or not right now!”

Boss: “Without the needed information on the un—”

Customer: “Get your boss on the line now while both of you have a job!”

My boss and I exchange looks, and then he goes to find the VP of Operations, who of course left for the day so we get the next best thing and bring in someone who is technically my boss’s boss, but absolutely does not have time for this.

Boss’s Boss: “Hello, I am the head of operations. If you are unwilling to provide the needed information on the unit we will instead require a picture of the failed component to move forward with the claim and determine coverage.”

We get the picture shortly thereafter and wouldn’t you know it, the old motor was dirty. Not THAT dirty but certainly we were not going to pay this tech close to a thousand dollars for so small a job nor were we interested in accommodating or rewarding this customer/tech hybrid which was doing something shady.

I write up the denial and flag it for a level-two tier worker to deliver in the morning. My boss flags the claim with his own task explaining to anyone who looks at it what is really going on and for any over-night call center reps to inform them to call back during normal business hours.

But it is up to me to end the current call. I am giddy and excited to tell them that the gig is up but my boss puts his hand on my shoulder and says I have to play it by the book.

Me: “Hello. We have received the needed information and will be making a determination shortly. The claim is currently under review and the office is now closed for the evening.”

Customer: “NO, NO, NO! That’s not how this works! We got in before the office closed, this line will continue to remain active until we get the determination and I don’t care how long that takes but you will not leave this call!”

Me: “Unfortunately the office is closed. The system is no longer allowing me to input any new information. Our company is not an emergency service and we are contractually obligated to render a decision within 24-48 hours after the diagnosis is received from the technician.”

Customer: “If you hang up this phone I will get you fired and sue you for everything you’re worth you hear me!”

Me: “Thank you for calling [Home Warranty Company], I advise you to have a good day.”

Click.

As my boss and I walk out to the parking lot (boss’s boss left once we got the picture in) I ask him if they could actually do that or if it was one of the many empty threats we got all day long.

Boss: “What are they gonna sue you for? Hanging up a phone? Let legal handle that. We did it by the book and wrote it up the way we’re supposed to.”

I looked at the claim the next day and they didn’t even dispute the denial when they got it.