Fraud-ee-dar-dar

[tilly101]

Folks, how are we all

As we speak I am at work. It is Friday. I am literally counting down the minutes, as I am on the verge of my head exploding. I am also in the process of trying to invent a way to slap dumb-ass custoemrs through the phone. I will work out how to do this, and then patent it, dammit.

CAST:
Me -
SC - Those who have caused my head to want to implode in on itself
-------------------------------------------------------------------------------------------
Me - "As per the letter ma'am, the reason we haven't yet paid on your claim is because your name was not on the receipt...."

*interrupting me*

SC - "WHY THE HELL WOULD MY NAME HAVE TO BE ON THE RECEIPT?!"

Me - "We need your name written on there so we need who the patient was. It basically lets us know that the claim was for you, that you were the one who got the dental treatment"

SC - "Yeah, I'm telling you right now that I was the patient"

Me - "Ok, but as advised...and I can see you have called a few times today already and we have told you the same thing each time...the dentist himself must print your name on the receipt so we have official confirmation you were the patient."

SC - *SIGH* "You're f*king kidding me!! So you're saying I have to go BACK to the dentist, waste MY time, and make him put MY name on MY receipt?!"

Me - "Yes. That is correct. And to be honest I am not sure why a dentist woudl not print the patient's name on the receipt in the 1st place. I have never seen that before"

SC - "Well you just write my name on there, then pay it"

Me - "I'm sorry ma'am, we can not hand write something on an offical receipt. Please get a proper receipt from the dentist and resubmit the claim"

SC - "No. I'm telling you over the phone it was me. Write it on there and pay my f*king claim"

Me - "No, sorry, we don't committ fraud here. If it is really difficult for you to go and get a new receipt yourself, I am happy to call the dentist myself and get him to fax one over...."

*Interrupting me again*

SC - "NO! No, this is a joke! Calling dentists, making me run around, JUST PAY THE MONEY, you people are f*king useless, you make claiming so difficult, you're a joke!"

Me - "Ok, but again we won't pay a claim unless we have evidence the claim was for that person. Again, I am happy to call the dentist and have the receipt faxed to us, if he does this today the money can be in your account within a day or two. it's really no trouble"

SC - "Yes, it is! Just pay the money! You're a joke, you're useless! I want to talk to a manager"

Me - "I'm sorry, manager's don't talk calls that don't require escalation. You need to obtain a receipt with your name there as the patient - typed by the dentist. if you cannot submit this, then your claim will not be paid"

SC - "You people are useless, f*king useless. You just take our money and then pay nothing back. You rip people off"

Me - "Ok. So I've offered you the solutions, it is up to you if you want to take them or not. I've also left notes on your policy, one of our assessors will likely contact the dentist anyway to try and help you out"

NOTE - our assessors wont do this unless we request them to. And right now I had no intention of wasting their time asking them to do this. Right now, my fraud-dar is going riiight off....and sure enough...

SC - "No, no no no NO, no I don't want you to contact the dentist..."

Me - "Why is that?"

SC - "Look you people are a joke..."

Me - "Ok, but that has nothing to do with the dental claim. I do need to advise that we report fraudulent claims, they get investigated..."

Me - *CLICK*


Ah-huh.
Another scammer bites the dust.

[vikingchyk]

Excellent pwnage

[AtDIelement]

Love it!

[barainga]

It was pretty common in the cell phone call center too. People would lose thier phone and then say they thought they had insurance the whole time and want us to back date it.

Bonus stupid for about 7 people who removed the insurance to lose thier phone a within a month.

[Tama]

So are they just trying to get money to a fake dentist, or what?

[thansal]

So are they just trying to get money to a fake dentist, or what?

IIRC, some insurance types have you pay out of pocket and then reimburse you for the procedure.

Or it could be that they were attempting to use their insurance to cover some one else?

[taxguykarl]

I am also in the process of trying to invent a way to slap dumb-ass custoemrs through the phone. I will work out how to do this, and then patent it, dammit.

Put me down for one, when you succeed.

Bonus stupid for about 7 people who removed the insurance to lose thier phone a within a month.

That rarely fails!!

Or it could be that they were attempting to use their insurance to cover some one else?

It sounds like that was Tilly's suspicion.

[HappyFun Ball]

Tilly-1
Scammer-0

Excellent pwnage.

[MoonCat]

If I understand this correctly, the scammer had no work done by the dentist at all. She submitted the claim hoping to get some money out of the insurance company.

[auntiem]

I know your pain. I worked a similar job for a year and a half. We got laid off in groups and if one of the gals hadn't looked like she was about to cry I would have hugged the person giving me the news.
I did get to talk to a lady that was 100 yrs old once though, the only reason she needed to give her permission for me to speak to someone else about a claim was that she didn't hear that well on the phone. I had to ask, and yes she had bacon every morning and her son added that she didn't shy away from the whiskey either.
If I never have to explain HIPAA ever again I will be a happy girl.

[BeenThereDoneThat]

Very nice job, indeed Kudos and cookies for you!

[tilly101]

If I understand this correctly, the scammer had no work done by the dentist at all. She submitted the claim hoping to get some money out of the insurance company.

Spot on