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The Magic Words - or how i learned to stop being pushed around, and pissed off the insurance...

post #1 of 6
2/4/10 at 7:49pm
Thread Starter 
It's a funny thing just how hard insurance companies try to find ways to weasel out of coverage. Here's my story from today:

As a grad student, I have access to cheaper health care through my school. As it turns out, adding my wife to my plan was cheaper for her than getting health insurance through work.


Fast forward to today, when the doctor's office says my wife is not covered - the pharmacy said the same! Furious, I called up the insurance company, who spewed out a bunch of mumbo jumbo about how since this was not my first semester, and since she had not just experienced a life changing event, my wife was ineligible for coverage - ironic, since they had no trouble accepting our cheque for payment 2 months ago.

After a prolonged lecture about how it was my fault for not reading the brochure, I asked her where this ineligibility was mentioned in the pamphlet. 10 minutes on hold later, she could not find it, but assured me the words were there.


I'd had more than enough by this point, so I dropped the MAGIC WORDS: "You know, this is beginning to sound like bad faith."


The 3 second of silence on the other end of the line was golden "Hold on, let me get my supervisor," she said. Not 5 minutes later, the system showed my wife fully covered, as was verified by the pharmacist who promptly filled her prescription.


I guess 2 semesters of business law are finally showing some utility in my everyday life I like to think I scared the crap out of them... something along the lines of "oh no, he called a lawyer."
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post #2 of 6
2/4/10 at 8:27pm
Owned. Good work, mate.
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post #3 of 6
2/4/10 at 8:35pm
2 words every insurance company tells every CS rep to look for they hear it and quiver
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post #4 of 6
2/4/10 at 8:44pm
I used to work as an insurance adjuster (for auto insurance). My guess is that she was simply mistaken about the facts or her computer system had a glitch. When you threw out "bad faith", she realized you were really upset and called a supervisor. I doubt she had any idea about the legal principles involved. I knew absolutely nothing about tort law as an adjuster even though I was routinely asked to make liability judgment calls. No supervisor ever told me about "bad faith" as magic words.

If I could have, I would have written every single person who called me a check for $1,000,000. Denying coverage actually works against the natural incentives. You think anybody likes getting yelled at? In fact, I LOVED it when people asked to speak to my supervisor. It meant that I didn't have to listen to them rant anymore.

With the exception of a few bad applies, insurance companies are pretty rational. They won't take positions that would end up costing them more money in the long run (through court battles) or through a DOI (department of insurance) investigation. Trust me, Insurance companies live in mortal fear of the DOI (at least mine did). However, they really aren't afraid of lawyers or litigation. I was just an adjuster, it was no skin of my back if someone sued the insurance company. In fact I loved it, it meant I could just refer the case to the litigation department and get it off my docket. The only thing I worried about was the DOI (which could subject me to a really annoying audit) or getting in trouble with my supervisor (which wouldn't happen as long as I acted reasonably).

Oh, as a general aside for dealing with call centers: If you don't like an answer, always try to get someone else on the phone. Training is never uniform, and you get people in different moods and of different intelligence levels. Finally, be polite (sometimes being firm is OK, but only when you need to be). I went out of my way to help people who were nice, and would do nothing not required of me for people who were jerks.
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post #5 of 6
2/5/10 at 1:35pm
Dude, you are my hero. I will remember those words until the day I die.

(I wonder if they'll work on my supervisor?)
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post #6 of 6
2/5/10 at 3:44pm
Quote:
Originally Posted by nealric View Post
I used to work as an insurance adjuster (for auto insurance). My guess is that she was simply mistaken about the facts or her computer system had a glitch. When you threw out "bad faith", she realized you were really upset and called a supervisor. I doubt she had any idea about the legal principles involved. I knew absolutely nothing about tort law as an adjuster even though I was routinely asked to make liability judgment calls. No supervisor ever told me about "bad faith" as magic words.

If I could have, I would have written every single person who called me a check for $1,000,000. Denying coverage actually works against the natural incentives. You think anybody likes getting yelled at? In fact, I LOVED it when people asked to speak to my supervisor. It meant that I didn't have to listen to them rant anymore.

With the exception of a few bad applies, insurance companies are pretty rational. They won't take positions that would end up costing them more money in the long run (through court battles) or through a DOI (department of insurance) investigation. Trust me, Insurance companies live in mortal fear of the DOI (at least mine did). However, they really aren't afraid of lawyers or litigation. I was just an adjuster, it was no skin of my back if someone sued the insurance company. In fact I loved it, it meant I could just refer the case to the litigation department and get it off my docket. The only thing I worried about was the DOI (which could subject me to a really annoying audit) or getting in trouble with my supervisor (which wouldn't happen as long as I acted reasonably).

Oh, as a general aside for dealing with call centers: If you don't like an answer, always try to get someone else on the phone. Training is never uniform, and you get people in different moods and of different intelligence levels. Finally, be polite (sometimes being firm is OK, but only when you need to be). I went out of my way to help people who were nice, and would do nothing not required of me for people who were jerks.
good to know. getting frustrated with my health insurance provider. I have not pulled the legal crap on them yet. DOI seems like a sensible path.

do the insurance company fear "you are dealing with me fairly" as much as "you are acting in bad faith"? I wonder about the combined effect
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