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. Our call center is in NJ and our after-hours call center is in [South American Country] so even though we have customers on the West Coast, in reality we “close” around 5pm local for Texas.
One night (here) I’m finishing up my shift but am not allowed to leave until the Queue is empty, I’ll spare you the office politics but its not supposed to be able to receive incoming calls after 9pm but in reality….
So its about 9:30 and the very last call of the night comes in and its a customers own tech in Texas with the customers on speaker.
Cust: “hurry up and give us the auth number this tech has been on hold for way too long and doesn’t have time for questions.”
Me: “ok lets start with the make model and serial of the unit”
Tech: “no, it needs a condensing fan motor and are you gonna cover it or not?”
Me: “So you are refusing to provide the information on the unit?”
Cust: “I said he doesn’t have time for this, are you gonna cover it or not?”
Me: (frankly I don’t have time for this either as I got in the office at 7am that morning) “Unfortunately we cannot make a determination of the claim without the basic information on the unit as part of a diagnostic-”
Tech: “its a 10 year old unit and it needs a condensing fan motor you gonna cover this or not?”
Me: (fine I’ll humor him) “do you have a part number on the fan that you claim this unit requires to have replaced?”
Tech: “no, I have it in my hand and are you gonna cover this or not?”
Me: “how many horsepower is it”
Tech: “1/2hp and it needs a new cap too”
Me: “and what’s your price on this motor and the cap?”
Tech: “$650 for the part $200 labor and I need another $100 for the hour I was on hold”
Me: “I cannot authorize a repair without a part number or any details on the unit it is needed for. Furthermore this typical repair costs no more than $375 parts and labor and we do not reimburse for time on hold. I will need to get all the documentation on the unit before we-“
Cust: “get your boss on the line right now while you still have a job”
So I went over and got my boss who looks at the diagnosis that is missing 99% of the needed information but I did at least put the prices in and the horsepower.
Boss: “Hi I’m the authorizations manager and I’m looking at this diagnosis and I have a few questions about the unit-“
Tech: “I aint answering no more questions are you gonna cover this or not?”
Cust: “We need to know if its covered or not right now!”
Boss: “Without the needed information on the un-“
Cust: “Get your boss on the line now while both of you have a job!”
So me and him exchange looks, and go find the VP of Operations who of course left for the day so we get the next-best thing and bring in someone who is technically my bosses boss but absolutely does not have time for this.
Bosses boss: “hello I am the head of operations [right now but that doesn’t matter] if you are unwilling to provide the needed information on the unit we will instead require a picture of the failed component to move forward with the claim and determine coverage.”
We got the picture shortly thereafter and wouldn’t you know it the old motor was dirty. Not THAT dirty but certainly we were not going to pay this tech close to a thousand dollars for so small a job nor were we interested in accommodating or rewarding this customer/tech hybrid which was doing something shady (yes I know the irony of that statement).
So I wrote up the denial, flagged it for an L2 to deliver in the morning, my boss flagged the claim with his own task explaining to anyone who looked at it what was really going on and for any over-night call center reps to inform them to call back during normal business hours.
But it was up to me to end the call.
I was giddy, excited I wanted to tell them the gig was up but my boss put his hand on my shoulder and said I had to play it by the book.
Me: “hello. Scam Home Warranty has received the needed information and will be making a determination shortly. The claim is currently under review and the office is now closed for the evening.”
Cust: “NO NO NO That’s not how this works! We got in before the office closed, this line will continue to remain active until we get the determination and I don’t care how long that takes but you will not leave this call!”
Me: “Unfortunately the office is closed. The system is no longer allowing me to input any new information. SHW is not an emergency service and we are contractually obligated to render a decision within 24-48 hours after the diagnosis is received from the technician.”
Cust: “If you hang up this phone I will get you fired and sue you for everything you’re worth you hear me!”
Me: “Thank you for calling SHW, I advise you to have a good day.”
click
As me and my boss walked out to the parking lot (bosses boss left once we got the picture in) I asked him if they could actually do that or if it was one of the many empty threats we got all day long.
Boss: “What are they gonna sue you for? Hanging up a phone? Let legal handle that. We did it by the book and wrote it up the way we’re supposed to.”
Looked at the claim the next day and they didn’t even dispute the denial when they got it.
Moral of the story: condensing fan motors aren’t that expensive and SHW can and will deny a claim just on price alone (even if it says we wont on every website and legal document)
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
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