I'm currently working at a call center for a health insurance company. I work in senior markets, which means I answer calls from old people all day about their Medicare Advantage and Medicare Part D plans. It's not fun. (It's also not in my field. Times are tough.)
In fact, it's quite possibly the most complicated and stressful job I've ever had. We have to know the ins and outs of health insurance and Medicare to answer the thousands of questions that come in each day, and there is a procedure and process we must follow for just about each and every one.
Also, there's this:
ME ON MY LITTLE PHONE HEADSET: [all smiles and happiness] How can I help you today?
OLD PENNSYLVANIA DUTCHMAN WHO CALLS IN: I got this bill from my doctor for $4. $4! And I want to know why you won't pay it!?
[I proceed to get the information about the bill and find the claim from the provider]
ME: That $4 is your copay for the [health care services] you received. Each one had a $2 copay.
DUTCHMAN: But it's $4! Why didn't you just pay it!?
M: I'm sorry, sir, but we can't do that. We have to process these bills from the doctor according to your health plan's benefits.
D: That's stupid! It's only four bucks! Just pay it! Why can't you just tell me you'll pay it!
M: [apologetic and compassionate] I can't do that, I'm sorry. We have to follow your benefits. We can't just pay everyone's copays, even if they are only $4.
D: Why not?! It's a lousy four bucks!
M: [trying to be helpful and find a solution] Would you like me to file a complaint for you?
D: That's not going to pay the bill!
M: [attempt plan b] I could also help you file an appeal for the bill.
D: NO! I don't WANT to file an appeal! I WANT you to pay the lousy four bucks!
M: [maybe he doesn't know what an appeal is] Well, if you filed an appeal, that's the step you would take to try to avoid paying the $4, so we would cover it.
D: Do you know how much paper work that would be for a lousy four bucks! JUST pay the four bucks!
M: [no other solutions left, apologetic] Sir, I'm very sorry, but I can't do that.
D: Well, then if you won't pay it, just say goodbye and hang up the phone.
M: [revert to plan b] Are you sure you don't want to do an appeal?
D: NO! NO APPEAL! Just pay the four bucks! I want to talk to a supervisor.
M: [it won't help] I can certainly transfer you to a supervisor, but are you sure I can't help you?
D: No, you won't pay the four bucks, I wanna talk to a supervisor.
M: [aborting mission impossible] Ok, please hold for a moment and I'll find a supervisor for you.
[call is transferred. supervisor has same conversation.]
Then there's this:
ME: [all smiles and rainbows] How can I help you today?
ANGRY OLD LADY: I was just at my pharmacy to get my drugs, and they said I'm not covered anymore! What is going on!? Why did you people cancel me?!
M: [apologetic and compassionate] I'm sorry, it looks like you haven't been a member with us since 2008...
A: [caller interrupts, very angry] WHAT?! What do you mean?!
M: Well, it looks like you joined another insurance plan as of January 1, 2008.
A: [still angry] I did? Which one? I didn't join another plan!
M: It looks like it was [another health insurance company]. But I can't be sure if that is your current insurance. [since, you know, it's now 2010]
A: [angry, frustrated] Now wait just a moment.
M: [trying to be understanding] Ok, no problem.
A: [rummaging, caller mumbles into the phone] I don't remember joining another plan...this is ridiculous...I pay a premium every month...[rummaging stops, long pause] Well, I do have this other insurance card here.
M: [relief, and trying to be helpful] There should be a customer service phone number on the back of that card. You may want to try and call them.
A: [not at all apologetic for yelling at me] Ok, I'll try calling them.
M: [still trying to be helpful] Is there anything else I can do for you today?
A: [still not apologetic] No.
M: [still smiles and rainbows] Ok, you have a good day.
And there's this:
ME: [smiles and sunshine] How can I help you today?
CRANKY OLD LADY: [livid] I got a bill from my hospital. I was there last month and they want me to pay $100! Why won't you people cover me? I NEVER had to pay that much before when I was in the hospital!
[I proceed to get the bill information and find the claim from the provider.]
M: [compassionate and calm] Well, that $100 is your copay for an inpatient hospital stay. According to your benefits, you have a $100 copay per inpatient admission up to a $200 annual out of pocket maximum, which means you pay $100 the first two times you're admitted. After that, you pay nothing, and we cover you at 100%. [member tries to interrupt, but I continue, still calm] Because this is your first admission to the hospital this year, you have to pay your $100 copay, but we covered the rest. For this particular claim, for a one night stay, we paid just over $10,000.
C: But I NEVER had to pay anything before! I was just in the hospital last year!
M: [trying to be helpful, apologetic] Last year, you had this same plan, and the copay was $100 then as well.
C: Well, then it was 2008 I was in the hospital. I didn't have to pay this.
M: [still apologetic] In 2008, I'm showing that the copay was still $100.
C: Well, then it was 2007. Because I'm sure I NEVER had to pay this before.
M: [it was the same copay in 2007, but I do not mention this; still compassionate and calm] I'm very sorry, but that is how your benefits work for hospital admissions this year.
C: This is ridiculous. I NEVER had to pay this before. You people are killing me. Why do I pay almost $60 a month for health insurance if you people won't even cover me in the hospital.
[caller hangs up before I can remind her, compassionately and apologetically, that her insurance plan paid $10,000 for her one-night stay in the hospital]
Service, and apologies, with a smile. Always.
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