I work claims for a health insurance company, mainly dealing with payments and adjustments. Our department closes at 6pm Friday for weekends, and there’s an “after hours” line for hospitals to call if something is urgent (like if the online system is down).
I had a customer phone through to me at 5:55pm on a Friday saying he hadn’t received a payment of $500 for his wife’s dental treatment which he was told had been paid that morning. Apparently this guy had sent his claim in that Wednesday and called twice a day to check the progress of said claim. I checked his history and sure enough we had paid the funds into his account that morning. I explained to him that interfund bank transfers usually take overnight to appear in the receivers account but can take up to 3 business days. Apparently he REALLY needed to have the money before the weekend – well asshole, generally claims take 5 business days be verified with the provider so we have done you a favour by having it done in 2.
I pulled up the claim to confirm the bank account details said claim had been paid into just to assure him the payment was on it’s way. Read out the number, low and behold it was the wrong account, which was not his. Cue this guy going off and swearing at me about incompetence, saying he had put the details on his claim form and called to confirm it.
I checked the audit log and saw that his account details had been changed, per the details on his signed claim form. This guy had filled out a claim form and signed it with the wrong account number, called us again with the wrong account number, and now it’s our fault he doesn’t have his money. I can hear him yelling at his wife “they fucked up the claim and we won’t be getting it tonight”.
Told him I’d have to log a trace with the bank it was paid to, so the funds could be recovered and we can make a new payment but that could take a week. Guy doesn’t seem to understand that even if I could make another payment now to his correct account, it’s now after 6pm on a Friday so there’s no way the funds will be in his account before Monday.
Told him to have a great weekend and we will be in touch once the trace has come back. Cue bogan wifey in the background “well we fucking won’t be having a great weekend now will we!!!”.
Came in on Monday to see he had called early that morning to tell us the money had gone into his wife’s bank account – they forgot they had recently opened a second account – which was on the claim form, and the money had gone in by Friday night. I really wish the trace had gone through before he realised and the bank had stopped the payment, just so it would have taken even longer for the guy to get his money.