So to preface this, I work for a health insurance company in Australia, and part of my role is to deal with escalations.
This woman had called previously and asked about benefits payable for a certain type of dental procedure (a crown). She was told, correctly, that she could claim x amount of dollars and she was happy.
She called back today as she had attempted to claim with her card (which is swiped at the point of sale at the dentist) and it was rejected, so she didn’t get any money back.
She blew up at the original officer who took her call so, enter me. It’s not word for word because I try to block out escalated calls as soon as they’re over, but you get the gist.
Customer: I was told yesterday I’d be able to claim for this crown but I didn’t get anything today! What happened? You need to pay me what you told me you would.
Me: absolutely, if we have provided you with the wrong information we will definitely honour our word (as is company policy)
checks her claim history
M: okay so it looks like you haven’t tried to claim for a crown. The claim that came through today is for a scan of your teeth
C: yes, you need to get the scan of your teeth before you get the crown
(Important to note that we are not trained on anything to do with dental. We use item numbers to check what benefit is paid – if I knew how to be a dentist I would NOT be answering phone calls, lol)
M: oh okay. Was the item number you discussed with my colleague “xxx”?
C: I didn’t ask him about the scan, he told me I was covered for a crown and I’m not, he lied to me!
M: the scan is a completely different procedure from the crown, my colleague had no way of knowing you would be getting this scan during your call. If he had known he would have been able to tell you that no benefit is payable due to “x”.
C: well he should have guessed, my claims are right there, I always claim for this scan right before a crown
checks claim history again, going back three years
M: you haven’t claimed for one of these scans since (date) and you’ve had a crown this year without the scan preceding it
C: it doesn’t matter, I don’t know anything about dental stuff! You’re supposed to know, I want you to listen to the call and then pay me the money I was promised!
by this point my eyes have rolled back so far I can pretty much see my brain, but once a member requests a formal review we can’t refuse
M: okay, I will raise this as a complaint and your call will be reviewed. A member of the complaints team will be in touch in the next day or two to discuss the outcome. If we have misled you in any way causing a financial loss we will definitely adjust your claim to pay what was promised. Is there anything else I can help you with right now? (I say this knowing the complaint will absolutely not be resolved in her favour)
C: okay thanks for that. Have a nice afternoon.
To her credit, she was perfectly pleasant to me – the illusion of speaking to a “senior” staff member I suppose. But still one that warranted a few of my colleagues to message me after I launched the complaint to laugh about how ridiculous it was.
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