Urgent Care Fiasco

First off, I am on mobile. Sorry. This also might be kinda long.

So, to preface, I work in a call center for a major health insurance provider in the good old US of A.

My last call today started about an hour before the end of my shift. It was a woman who was having pain in her back/shoulder for over a week and wanted to go to urgent care because her primary care doctor was out of office for a while. I find some places she can go and quote her benefits – $35 copay if it is deemed emergency use and 80% after deductible for non-emergency use. Her deductible was $750 and she had nothing met towards it. She starts bellyaching that she can barely afford $35 but she’s in pain and how I have to find her somewhere to go. I DID find you somewhere to go. I told you your benefits. Its up to you to make a decision now based on that info.

No. She pays her premiums every week and I have to find somewhere she can go. I have to tell her it will be considered urgent because she cant afford a huge bill.

I suggest that they would probably let her do a payment arrangement. No.

I suggest finding a specialist for her to see because that benefit is just a copay. No.

She keeps going round and round with me that I need to tell her what to do. I explain that I can’t. We are like 40 minutes into the call at this point. She asks me to find someone who can help her and I place her on hold.

Now, in my call center we have the most FUCKED UP system for getting a supervisor. We have to send a Skype message to our Quality Analysists and Client Advocates to try and get someone to come over to try and help de escalate. So I do that. Ten minutes later I get someone at my desk and they help me pull up a definition for emergency/non emergency. I get back on the phone and read this to her. She snaps at me for taking ten minutes just to read her a definition. She still insists I tell her what to do “I’ve said this like thirty times now” and “How dare you do this to someone who is in pain!”. I explain that I’m trying to find her the best path to care and I said to “enlighten you so as to make your decision easier”. Well somehow THAT was rude so she kept throwing that back at me. The QA (call her Sally – not her real name) is there and points at the number for our 24 hour nurse line. I suggest this to the member and she refuses, I just wanna get her off my line and how if the nurse cant help her she wants to come back directly to me. I can’t tell her that its past the end of my shift at this point, so I hit her with the “it’s an inbound call center and I dont have an extension” (true). Shes not happy about that. I told her over and over again that theres nothing else I can do, I have gone over her options and she needs to make a decision. She just wants me to tell her what to do so that she can come back and blame me for it if she gets a bill. She then asks for my supervisors name and I say I can see who is there to speak to her. No, she wants my managers name. I tell her my sup’s first name and advise her to call tomorrow (as my sup wasnt in today) and try and reach her then. So I’m going to have to corner her tomorrow and explain what happened before this lunatic gets a hold of her.

Anyway, I eventually convince her to talk to the nurse. I tell her I’m not trying to get her off my line (I was lol) but that the nurse could possibly help or maybe find a way to relieve her pain without her going to urgent care at all. That’s the end of it, so not super like dramatic but that call took me an hour past my quitting time and I was shaking and cried at the end. I didn’t have a great day before that (knocked the side mirror off my car because I was running late and had frost on my windshield lol) so I was spent.

Sorry if this was boring but I had to get it off my chest. This lady was just going back and forth with me and saying I was fighting with her and being rude, I wasnt! I was just telling her what I was able to!

I dunno I guess I’m just hoping for some validation that I’m not a horrible rep and I did what I could. I think she was just a bitch because she was in pain but that’s no excuse. Please dont act like this lady.

Thanks for reading.

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