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

[BeenThereDoneThat]

Oh, the humanity...(said in the same tone of voice as the Hindenburg disaster reporter...)

[Ironclad Alibi]

Oh, the humanity...(said in the same tone of voice as the Hindenburg disaster reporter...)

For those who haven't heard it, the Hindenburg disaster.

[BeenThereDoneThat]

For those who haven't heard it, the Hindenburg disaster.

Thanks, I was much too lazy to look that up myself

[tilly101]

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? [/QUOTE]

Yes, yes I did
My first few years working here I would have never dared
But being in this job forever and having tested the waters, so to speak, with that I can and cannot get away with...I say this kind of thing on an almost daily basis now
Just so over people being stupid and/or rude

[tilly101]

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

She had notes alllll over her policy letting us know that she did this kind of thing every time she would call in. Like she had nothing better to do with her time, and she thought she was smart and clever making it 'difficult' for the call centre staff
Notes on her file that 'customer is rude/patronising'...'customer will talk/laugh over you during call'...'customer made comment that I 'work for her' and that I need to 'work for my dollars'"

That kind of cr*p
Soon as I read her file notes I gathered she was taking pleasure in acting like a d*ckhead, like she wanted me to say in the end 'FINE well I cant help you' and hang up on her, only for her to cal back and lodge a complaint that she was hung up on and not assisted, and demand a discount premium the next month. She's done it a few times before, f*ck that if she thinks it's going to happen with me

[Pixilated]

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.

*is speechless*

Your insurance goes up if you just call to get information??? Okay, I have never heard of that before. I can understand why somebody would be hesitant to give any specifics under those circumstances.

However, in this case it sounds as if she already had the surgery lined up, so sooner or later her insurance company was going to find out about it ...

[wolfie]

*is speechless*

Your insurance goes up if you just call to get information??? Okay, I have never heard of that before. I can understand why somebody would be hesitant to give any specifics under those circumstances.

In the case given as an example (hail damage), I can understand - someone calling about whether they have coverage probably has hail damage, and therefore represents a higher risk even if they take care of the damage themselves rather than putting in a claim.

[earl colby pottinger]

Insurance company

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?

Yes, yes I did
My first few years working here I would have never dared
But being in this job forever and having tested the waters, so to speak, with that I can and cannot get away with...I say this kind of thing on an almost daily basis now
Just so over people being stupid and/or rude

Insurance companies are known for working hard to *NOT* pay out money on claims. Sure part of the reason is company greed, but they also have to deal with insurance fraud *ALL* the time. If anything I am betting his bosses love it when he catches any hint that the claim does not have to be paid out.

[BrenDAnn]

Just a thought here but are we sure she didn't make up knee replacement to cover for whatever it may have actually been? If not then the only thing i can think of is she was just that embarrassed about having to have a joint replaced "at her age" or whatever. Odd, and I'm sure frustrating, either way. Way to get the SC to spill though! Kudos!