I worked at “Scam Home Warranty” in the authorizations department a few years ago. I determine if a repair is or isn’t covered and have 16 pages of contract to pull denials. One of which is “SHW will not reimburse customers for work done without authorization, you cannot make a repair without an authorization number.”
So one day a customer’s own technician calls in demanding an authorization number. After some time he finally tells me the claim number and I pull it up.
Tech: “what’s my authorization number for the job, I finished it yesterday and you need to get that check out to the customer ASAP.”
Me: (notates work done without auth in huge numbers on the claim) “Ok lets go over the facts of the case, model, serial type of failure, repairs needed ect.”
I fill out the form like normal, since I already marked it for denial.
Tech: “so what’s my auth number?”
Me: (if it was our tech I’d tell him its denied but when its a customers own tech we flag someone L2 to call them with the denial) “its currently review, customer will be informed of our determination in a day or two.”
Tech: “bullshit, works done you pay up now.”
Me: “unfortunately we have to review the claim before determining any -” (caller hung up)
Next day get an email from my bosses boss: “we have to talk about claim #”
Me: “work done without auth, open and shut claim.
Bosses boss: “technician blew up our email saying you lied to him to deny the claim, that you said it was covered and that he was fine to complete the repairs – since he didn’t touch the unit until you told him he could oh and you gave him a fake authorization number.”
Me: “pull the call.”
Bosses boss: “yeah, we will pull that call but as a professional courtesy I’m letting you come clean if you handled it to force a denial.”
Me: “pull the call.”
Next day, bosses boss grabs me at my desk: “I’m going in the VPs office to pull the call right now, this is your last chance to be honest about the call.”
Me: “pull the call.”
About an hour goes back and he’s back at my desk: “thank you for being so cool about all this themadkingnqueen, but he swore up and down that he said nothing about doing the claim and the customer backed him up….”
*********
I’m not proud of what I did at that job working for those thieves but at the very least I covered my ass when it came to denials like this – a lesson I learned over years at UPS. when I found myself thrown under the bus as fast as humanly possible by everyone on top of me.
If you or someone you know has a home warranty and you wanna talk about it or something, let me know I’m happy to help you in any way I can. We denied 70% of claims, they can afford to cover one claim once in a while.
submitted by /u/themadkingnqueen
[link] [comments]
