Have you noticed that when you call for help with a claim, you’re told that “call volumes are heavier than normal and wait times are longer at this time”?
Last week, I received a bill for a procedure that should have been fully covered. The bill was for $517.15.
I called the doctor’s office and was transferred to billing, where I was told, “You need to call the carrier and dispute it.”The old joke about needing patience to call HP for support pales in comparison to dealing with people working from home.The problem started at the doctor’s office. They need more training—or they need to care about their work.However, I didn’t know that at the time, so I called the insurance carrier. Even Job would have lost patience with these people. After hours on hold, multiple transfers, and being ignored by one agent (whose child screamed in the background), my call was left on hold and never resumed.Automated claim systems don’t think; they check boxes. A person could have reviewed the issue and prompted the doctor to submit the EOB to the correct group from the start.After hours of listening to terrible hold music, someone finally answered the phone. I could barely hear him, but the bottom line was that I needed to call another party.
After more time on hold, I reached the next party, who told me the doctor’s office needed to fix their billing system and resubmit the claim properly.Back to the doctor’s office—press 1 for this, 2 for that, 3 for something else, but no option for billing. I was told to leave a message and “have a blessed day.”
To their credit, they called back before closing and told me to call the carrier again.We were stuck in a loop, and I spent most of the day listening to commercials and tinny music.I insisted on speaking to the office manager, who took my information and commented, “People—they’re stupid.”I replied, “No argument from me.”This billing error from the doctor’s office took hours of my time to address, and I’m still not sure it will be resolved correctly.Working from home is not working—these people are clearly not working.The representative at the carrier was belligerent and curt. I’m sure she just hung up when her child screamed, “Mom!”
When you finally reach a person, they look for any excuse to transfer you.After hours of commercials and hold music, I wondered why I would ever do business with this group again.AI does not possess critical thinking skills.In my experience, people working from home lack the work ethic of those in an office, especially when a supervisor is nearby.Corrective action is needed:
A: Every denied claim should be investigated by a person. As a health insurance company, is it wise to make people in need of medical care navigate a maze of IVR and AI systems that don’t understand them?
B: Calls that are recorded, as announced, should be reviewed. You can clearly hear kids screaming, dogs barking, and TVs in the background. Let’s return to hiring people who want to work and cut the dead weight.
C: Wait times should never exceed a few minutes. Waiting for over two hours is unacceptable.Thank you for your attention to this matter.
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