For background, I work in insurance as customer service. I give out benefit information to providers and members, handle claims, update eligibility info, and a host of other things. We are not allowed to give out the full details of a policy over the phone due to high call volume, but rather can send a fax with the details and provide additional info after that.
Entitled provider will be EP, I will be Me.
Me: generic greeting
EP: I’m calling for a full breakdown of benefits.
Me, after getting all my hipaa info: ok I see that you requested a fax already, what additional information can I help you with.
EP: well no I need a full breakdown
Me: I’m sorry, we aren’t allowed to give a full verbal breakdown, but I can help you with additional codes.
EP: I always get a full breakdown
Me: we are not allowed to do that ma’am
EP: since when?
Me: that’s been the policy for several years now
EP: ok well can you give me the coverage for -random benefit that I don’t get asked often-
Me: sure, what’s the procedure code for that?
EP: I don’t know!
Me: ok, I can look it up.
EP, while I’m looking it up: what about -other procedure that is definitely on the fax-?
Me: that one is going to be on page X of your fax.
EP: well this conversation isn’t going anywhere, I’m just going to review the fax and call back!
Me, internally: well, that’s literally what you were supposed to do in the first place, so thanks!
submitted by /u/sbd2010