Am I covered...for...something...

[tilly101]

Scarily...this happens all too often. I just had this 3 times within the last hour alone. Yes, I'm keeping track

Me -
SC - sh*t for brains!

SC - "Yeah hi, so I have a question about my policy"

Me - "Sure, how can I help?"

SC - "I just need ot check if I'm, like, if I'm covered?"

Me - "Ok, sure, I can have a look for you. And what service is it that you are wanting to check if you are covered for?"

SC - "Ummmmmmmmm...."

It is at this point that I start weeping. Why oh why do people insist on calling when they have no fu*king clue what they are actually calling for?!

Me - "Do you know the type of service you are wanting to check ma'am"

SC - "Um...its, like...you know..."

Me - "No, I'm sorry, I don't know. Your policy has a long list of services that are both covered and not covered. I need to know specifically what it is you are wanting me to check to be able to assist you, ma'am"

SC - "Ohhh, oh okay, so you can't tell em if I'm covered or not?"

Me - "Not without knowing what service it is that you are wanting to check ma'am, no, sorry"

SC - "Ohh okaaaay, okay, well, it's....like...surgery"

Me - "Surgery, ok, and what type of surgery? Again, your policy has types of surgeries that are covered, some are partially covered, others are not covered at all, so just need the type fo surgery you're getting please"

SC - "Surgery"

Me - "Okay...I just need to know the TYPE of surgery"

SC - "Why do you need to know the type?"

Me - "As mentioned some types of surgeries are only partically covered and others were not covered at all on your policy"

SC - "Ok, well it's surgery, just look it up on your little computer"

Oh...oh no, no she didnt just say little computer... tilly doesnt like that

Me - "Sorry MA'AM but I've already advised I doneed to know the type of surgery. Without knowing that I wont be able to assist you. Sorry. What kind of surgery is it?"

SC - *snotty tone* "I don't know. Surgery. Look it up on your little computer"

Me - "You...don't know what kindof surgery you are going in for? Even a general description will suffice"

SC - "I don't know, it's just surgery! God! you're not too good at your job are you, pft !"

Me - "Okaaaaay... I can try and narrow it down by region. What body part is being operated on?"

SC - *snotty again* "Dunno"

Me - "Do you recall anything from your consultation with the surgeon? Did he give you any paperwork that you can fax us so we can try and work out what you are going in for?"

SC - "Yeah I got papers, he didn't tell me anything though"

Me - "The...surgeon didn't tell you anything? What was discussed during your consultation? normally you would go in, advise of the problem, and he would talk you through options and ultimately the surgery that will be done"

SC - "He didn't say anything" *giggling*

Me - "Okay. So he was silent the whole time?

SC - "Yeah" *giggling again*

Me - "So essentially, no consultation took place? You went in, and you both sat there in silence for over an hour?"

SC - "Yep"

Me - "Okay. Well I can see here we paid for that consultation. The health fund does not pay towards services that were not properly conducted. I'll need to refer this to one of our assessors, they'll need to revoke that claim and get the money back from the surgeon. I would contact him today if you can as he will now need to bill that consult to you, since the fund wont be paying for it any longer. thank you though for bringing this to our attention, we really do need to crack down on dodgy DRs like this!"

SC - "Um...no, it's...um...*mumbling* knee replacement"

Me - "So you're getting a knee replacement then ma'am? Sure, I'll check the coverage for that right now"



Me? Passive-agressive? Never hehe

[lineswine]

A KNEE REPLACEMENT?
Damn, I thought "boob job", or "Liposuction".

There's no shame in having a joint replaced...hell, I might get round to that one day.

Not today though, eh?

[Pixilated]

Yeah, I was thinking something a lot more giggle-worthy myself! Why on earth was SC being so coy about a bloody knee replacement??

And passive-aggressive? Nah. Actually I love the way you backed SC into a corner. Amazing how fast she became cooperative when she realized that (a) her surgeon was about to get an inquiry he was not going to like, and (b) she was going to have to fork out some cash.

[Sapphire Silk]

With some kinds of insurance, your premium can be jacked up if you even call to inquire if a certain kind of damage is covered. For example, you can see a rise in homeowners insurance rates if you call to see if hail damage to the roof is covered after a recent hail storm.

I'll bet the caller feared an increase in her insurance rate if she simply inquired about coverage for surgery.

[vang]

Why on earth was SC being so coy about a bloody knee replacement??

If she's overweight, she might feel it's embarrassing because it's "proof" she's been bad. Or she might think that no one *her* age should have a knee replacement and so people will think something is wrong with her. Or she was brought up to think you only have surgery for something life-threatening and so knee replacement is a sign of weakness. Or she once hurt her knee doing something she doesn't want to talk about and is paranoid about further questions.

None of which changes the fact that she's bloody annoying and wasting peoples' time trying to give the runaround there. And that the poster did a great job of getting the info out of her in the end!

[Sparky]

Me - "You...don't know what kindof surgery you are going in for? Even a general description will suffice"

SC - "I don't know, it's just surgery! God! you're not too good at your job are you, pft !"

Okay ma'am. If it's cardiac bypass you're covered. If it's breast augmentation you're not covered. If it's appendectomy you're covered. If it's a facelift you're not covered.

Me - "Okay. Well I can see here we paid for that consultation. The health fund does not pay towards services that were not properly conducted. I'll need to refer this to one of our assessors, they'll need to revoke that claim and get the money back from the surgeon. I would contact him today if you can as he will now need to bill that consult to you, since the fund wont be paying for it any longer. thank you though for bringing this to our attention, we really do need to crack down on dodgy DRs like this!"

Did you really say this?

[Geek King]

All that over a damned knee replacement? They do thousands of those a year! Hell, they've become so routine the doc can probably finish one up while boinking that cute intern that's kept around for just that reason. Crimmeny, at least make it a titanium replacement vulva before you get embarassed about it. Half the people my dad's age talk about knee replacements during their bible study, so I doubt it's all that embarrassing, unless it's an old porn industry injury.

Get over it! :angry:

[taxguykarl]

A KNEE REPLACEMENT?
Damn, I thought "boob job", or "Liposuction".

Or a face-lift or butt job.

The stupid is strong with this one.

[Kaibutsu]

I was thinking something really personal like labioplasty.

[Marmalady]

I was thinking they needed a rectal craniectomy.

[Cai1987]

With some kinds of insurance, your premium can be jacked up if you even call to inquire if a certain kind of damage is covered. For example, you can see a rise in homeowners insurance rates if you call to see if hail damage to the roof is covered after a recent hail storm.

I'll bet the caller feared an increase in her insurance rate if she simply inquired about coverage for surgery.

Yeah, I know a number of people that are afraid to call in to inquire if various transgender surgeries are covered under their insurance, because if that goes on your record you can then have to pay out of pocket for other potentially related conditions (hysterectomies especially can fall under this).

However, a knee replacement? That's unlikely to be connected to anything that would raise her rates.

[Moirae]

Why was she so weird about admitting a knee replacement? This is just..... dumb.

[thatcrazyredhead]

I was thinking they needed a rectal craniectomy.

Would that be covered, tilly?

[EricKei]

For example, you can see a rise in homeowners insurance rates if you call to see if hail damage to the roof is covered after a recent hail storm.

The fact that it scares me that such a thing might even be legal suggests to me that it probably IS legal. I can certainly understand raising the rate for filing a CLAIM, but not for just asking about it >_>

On the other hand, I can see the call in my head right now...

Insurance agent: Hi this is Boof with T.Wolf Insurance Agency, how can we help you?
Caller: Yeah, I'd like to see if *ow* my homeowner's policy covers hail damage?
IA: OK, Let's look that up for you *hears loud noise in background*. Er, what was that noise?
C: Oh, nothing, nothing. *half covers phone "HEY! They can hear that! Get that branch outta there and cover up the hole in the roof!" * Sorry about that. We're getting some furniture delivered and the guys are having trouble maneuvering.
IA: Oh, okaaay, Ma'am...Er, isn't your area getting hit by a really bad hailstorm right now?
C: Oh, you're thinking of <town nearby>, we're clear and cool here- *thud* OW DAMMIT I told you to cover that hole! A big hailstone just hit me in the head!
IA: Are you OK Ma'am? I thought you said you were inside, and that the storm hadn't reached you yet...
C: ... *click*

[MoonCat]

Does her insurance cover lobotomies? Sounds like she already had one.