Former CSR: Was Following Federal Law To Help Someone The Right Thing To Do?

Jason writes in with an ethics question that’s been bothering him for the past seven years: should he have helped a cancer-stricken patient who lost her family in the 9/11 attacks qualify for COBRA coverage? Sure, it sounds like a no-brainer, but it gives us a chance to see the sort of conflicts that gnaw at customer service representatives. Do they follow the rules and keep their jobs, or do the right thing and help the customer? Consider his conundrum, inside…

Jason writes:

This is something that has weighed heavily on my conscience for seven years, and I have to get it off my chest.

Just after 9/11, I was working as a CSR for ProBusiness’ (now owned by ADP) COBRA division. (COBRA is the Federal program that allows the recently unemployed/divorced/widowed/born to gain or retain employer benefits at a set cost.) As CSRs, our job was supposed to be answering COBRA questions and working as customer advocates in resolving COBRA issues. In reality, our job was to stonewall customers as much as possible. Except on one customer, where I was asked to do much more than that.

This one customer wanted to know why her COBRA claim was denied. There was a specific deadline that she had to file by, and she missed that deadline by one day. As I explained this to her, she began sobbing uncontrollably, explaining that she had lost her husband and daughter in the 9/11 attacks, and now was about to lose her coverage while enduring cancer treatment.

Working as her advocate, I pestered my managers for options. Their cynicism was apparent: they thought she sounded like a scam, so I should get rid of her. After pushing for answers for nearly ten minutes and thoroughly annoying my managers, they did admit she had a legal right to challenge the denial. However, informing the customer of her rights was not part of my job description and I would be disciplined and possibly fired if I did so. They were not willing to talk to the customer and inform her themselves. So it was either violate Federal law and keep my desperately needed job or do the right thing and risk not being able to make rent next month.

Here’s what I decided to do: as per requirement, I returned to my customer and informed her, per the directions of multiple managers, there was nothing more that could be done, and ended the call. But, I wrote down her number, called her from a local gas station during my lunch break, and informed her of her rights and exactly what to do next. She cried some more, and finished with, “you saved my life. God bless you.”

Eventually she did get her appeal and her coverage was retroactively approved. I never told anyone beyond my close friends what I did. I never reported ProBusiness for this violation, either. On one hand, I’m proud that I used my own judgment and did what I thought was right.

On the other hand, I feel terrible that I short-circuited company policy. You see, the policy was there for a reason. A significant portion of COBRA claims are denied because they are pure fraud. Fraudsters have no problem gaming the system to its absolute maximum to get what they want And when they do, the company’s costs skyrocket. Giving fraudsters the same opportunities as legitimate customers equaled massive amounts of overhead and reduced the quality of service for customers, and put additional strain on our staff. Federal regulations do nearly nothing to protect providers against fraud, so companies have to figure it out for themselves.

Additionally, by using my case-by-case judgment, did I open up opportunities for lawsuits with “well I found out you did it for customer x and I have a better claim than she does, so why not me? Is it because I’m {specific minority}? I’m going to sue!”

So that’s my dilemma. Did I stand up for a consumer, or was I hoodwinked by a fraudster? Did I stand up for consumer rights or did I naively do damage to the company?

- Jason

p.s.: I do want to be clear that if I did hurt the company, I don’t feel that bad about it. ProBusiness was pure evil. Here are three examples:

1. Even if you pay your monthly premium, you coverage wouldn’t officially activate until you attempted to use it. This was because claim activation a processing in 2001 was all done by paper and fax, by Federal regulation paper trail requirements. That’s very labor intensive, so the company minimized the labor by not doing it until a customer actually needed it. Unfortunately, this meant that when Grandma went down to the pharmacy at 5:01pm on a Friday to get her diabetes medication, her claim would be denied and she would have to pay out of pocket or go without until we could fax an activation request to her provider Monday morning and wait 48-72 hours for it to turn around. When this happened (and it did – to me – twice) the official excuse to give to customers was, “hmm, I’m not quite sure why your claim wasn’t activated. But, rest assured, we here at ProBusiness are right on top of it!”

2. Limiting call handle time is nothing new, but ProBusiness was especially pernicious about it. We had a policy where any customer with a record of long handle times was to be forwarded to a specific CSR. She was a real pitbull when it came to handling customers, and she would make them go away no matter what it took, including being psychologically abusive. The worst part is, she thoroughly enjoyed tearing customers a new one. She gave herself a gold star sticker every time she made a customer cry. She had a lot of gold stars. Ironically, she had a tiara on her computer monitor that said “Princess.”

3. If QA flags you for something your supervisor told you to say, you get sacrificed. This is actually how I got fired after six months. Supervisors frequently gave CSRs shortcuts and quick answers that saved call handle time. I made the mistake of telling a customer, “let me call your provider to get an answer for you,” letting my supervisor and her floor manager give me the answer she knew the provider would give me, and then getting back on the phone with the customer to say, “the answer is x.” QA caught one of these calls, interviewed my supervisor who had no problem throwing me under the bus, and even personally fired me with the QA agent, floor manager and HR manager in the room. My customer service skills were so good, I had four times as many customer compliments as any other employee, including supervisors. And I still got the axe. Ouch.


(Photo: nyghtowl)

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  1. Blinky987 says:

    A good friend of mine was doing insurance claims while applying to graduate school for psychology. He encountered a similar problem with weight-loss medication. It’s a very popular for abuse, so when a woman filled out her form improperly, he was told to deny her claim.

    The woman wept uncontrollably, and she talked to him about how hard it is being overweight. Incredibly bright and someone who will likely be a leader in his field, he analyzed the caller and made the call that she legitimately needed the medication. He pushed through her claim.

    I think I’d do a similar thing as you did. All you did was inform this person of their rights. While you cost the company money, you upheld the essence of the contract that woman had with the company within the law. The company has an obligation to follow all laws (as they certainly hide behind laws themselves to dodge payment) and honor the contract. Kudos to you.

  2. N.RobertMoses says:

    To paraphrase the Dalai Lama – If you can help, help. If you can’t do no harm. Free Tibet!

  3. B says:

    Denying the claim in the chance it might be fraudulent doesn’t seem like a valid reason.

    • fleebailey33 says:

      @B: And your solution is to approve everyone?

      • coren says:

        @fleebailey33: How about investigating it so the answer is clear?

        • Stephmo says:

          @coren: The unfortunate truth is that investigating takes time – and sometimes it’s not so cut and dry. Her claim – relatives died in 9/11 – could have been substantiated through death certificates. Easy enough to prove.

          But the fraudsters will come up with all sorts of inability to prove a negative junk to get through things. Or want to know why they have to be “further traumatized” by providing proof of deaths, layoffs, witness protection programs, limb dismemberment and whatever else they think will tug at heartstrings.

          It’s heartbreaking. It really is. In my CSR days, I was suckered more than once trying to go above and beyond only to find out that a customer was all to willing to take advantage of a hurricane, tornado or even a killing spree in the news and make it connected to them and why they needed special treatment. Everyone that’s ever spent time on the phones has experienced this – and it makes those with real problems suffer.

          Shitty people ruin it for everyone.

          I’m glad the story submitter let his gut speak for him and he figured out a creative way around the problem. He found his win-win. It’s a shame the shitty people still have him hoping she wasn’t a scammer (scammers are great criers, by the by – and they LOVE telling you how much God loves you).

          • B says:

            @Stephmo: The fact that the insurance company was scammed is no excuse for them breaking the law, which is what the CSR was instructed to do.

            • floraposte says:

              @B: That’s the crappy thing–he wasn’t breaking the law. She had the legal right to appeal; since he didn’t have the legal obligation to tell her that, his company was allowed to forbid him to do so. And, of course, she would then have had a tough time finding out she had that right. Hooray for the company!

              Maybe there needs to be an insurance equivalent of Miranda rights. Trim ‘em down, require everybody in the business to recite them to their customers. Let them enter popular culture enough that even people not in insurance battles have an idea of the guidelines.

              At any rate, Jason, I think what you did was fine, and I don’t agree that “the policy was there for a reason.” If you didn’t have the tools to distinguish legitimate claimants from fraudsters, which it sounds like you didn’t, it’s up to people actually examining the claims to determine. The policy wasn’t weeding out fraudsters, it was blocking denial appeals, with the additional characteristic of penalizing the most physically debilitated, since they’re the least likely to have access to other information.

    • bohemian says:

      @B: That is the pat excuse insurance companies use to routinely deny claims in order to save money. Instead of figuring out if it is fraud or not they reject because “it might”. Since just about anything might be fraud it is an all purpose answer for any question.

  4. locakitty says:

    I had to leave a company because I got tired of lying to customers about their “warranty” coverage for their furniture. They paid however much to Levitz or Macy’s (any Federated company, actually) or whatever furniture store for this “coverage” (please not, it was NOT insurance, at least that’s what they told the Florida Insurance Commission) in case something happened to their furniture. Stains, pieces falling off, etc.

    These people got jerked around so much, and I had to bald face LIE to them about the whereabouts of their shipments (no tracking numbers ever given out, I didn’t even have access to that information). And this was just furniture! Not even something important like health coverage.

    So, Jason, I for one am glad that you were able to do the right thing. Even if this person was a fraudster, you helped out someone that you felt really needed it. Of course, after they fired me, I probably would have given a report to whatever federal department they had to answer to.

  5. DrWebster says:

    If it’s that easy for fraudsters to game the system, then obviously there hasn’t been enough fraud to justify fixing the way the system works. I’d say you did the right thing; I’d rather see a fraudster get away with their scheme than a legitimate request get denied because a company is greedy.

  6. catastrophegirl chooses not to fly says:

    i know a place that’s hiring people like jason- we’re adamant about ethical treatment of our customers.

    one time that i felt i had to step over the line i went right to my supervisor’s office after the call and said “hey, i just broke all the rules. in case you pull the call for quality”
    then i explained that the customer wanted to know if our [medical] product could cause her lungs to burn. a little investigational conversation helped me determine that she had started feeling that sensation when she was cleaning the bathroom…..

    anyone? bueller? bueller?

    yeah, she read me the back of the cleaning products and i just flat out googled poison control for her area, told her to hang up with me, call that number and tell them just what she said to me. so she could be treated for inhaling chlorine gas.

    we’re not allowed to look up phone numbers for people. or give advice.

    my boss said ‘let me make a note of the time of the call and just won’t pull that one’

    if i were jason – i’d rather get scammed than live with knowing i might have contributed to needless death and suffering

  7. k6richar says:

    He told her she had a legal right to challenge the denial. He followed the law. He did nothing wrong, i would have reported the company and sued for wrongful dismissal if i was fired.

    • Papa Midnight says:

      @k6richar: It’s actually much more difficult to “whistle blow” after being fired. Then the accused party can claim that the accuser is actually being spiteful for being fired… and without other employees ready to do the right thing and possibly be fired or never promoted for being willing to come to the aid of the accuser, it’s pretty much his word against the word of the monolith.

  8. mythago says:

    Insurance companies have an affirmative obligation to help their insureds – yes, even to the point of telling customers they can appeal decisions, or that they have claims that they didn’t already know about (but the insurance company does).

    I don’t know how this extends to COBRA, but I have a hard time believing it doesn’t.

    If there is a problem with fraudsters, the solution is to fix the system – NOT to refuse to tell anybody about the system they’re entitled to use.

    You did good, Jason.

  9. Anonymous says:

    From what I read, even if the 9/11 lady was a fraud, all you did was give her the information that the denial could be challenged. Thats simply information that would allow someone the ability to prove their situation through an appeal process rather than rubber stamping what may be fraud.

  10. acwatts says:

    Nicely done – when my wife got sick our insurance company tried to stick it to us big time. It was 90% luck and 10% smarts that they didn’t succeed. It strikes me as pretty crappy that hard working people who pay for insurance have to put up with crap like this, AND pay the huge portions of bills that the insurance company worms out of covering, AND pay for a bunch of freeloaders on welfare to get the same treatment for free with no BS from insurance companies. Now our nation is on the way to Socialism. In the short run atleast the medical system should improve. Long run – I’m glad I dont have any kids because the future is gonna suck!

    • Shaggy says:

      @acwatts: Um…how exactly is our country “on the way to Socialism”? Don’t believe all the crap the pundits on T.V. are spewing.

      Yes, we are heading towards socialized medicine. That isn’t Socialism, and it isn’t a bad thing. We’ve already got LOADS of social services in our society, like police and firemen. Are THOSE Socialist?

  11. KyleOrton says:

    @fleebailey33 – Nice use of logic there. I’d hate to live in your world with only two options for anything.

  12. bohemian says:

    Insurance companies technically are supposed to help those they insure but there is just too much conflict in the industry these days because they are obsessed with short term profit.

    I had to laugh. Our previous health insurer had these people who were supposed to be health advocates for the patients. Now coming from the clinic I used I could understand this, that would make sense. Coming from an insurance company that had a track record of screwing me at every possible opportunity not so likely. This advocate from the insurance company called me like a stalker multiple times a week, sent me post cards etc. The supposed guise was to help you handle your medical condition. Sure an insurance company has a vested interest in you not ending up in the ER or with some major medical problem if it can be prevented but I certainly didn’t trust them to give me advice about what was medically best, only what was in their best interest financially.

  13. puka_pai says:

    As CSRs, our job was supposed to be answering COBRA questions and working as customer advocates in resolving COBRA issues.

    Jason, I see no conflict whatsoever between what your job description called for and what you did. Regardless of what happened “in reality”, you did just what your company told you to do. In reality, your managers were heartless SOBs (or their managers were, more likely) who routinely violated, at the very least, the spirit of the law.

    What you did was both factually AND morally right. Sleep peacefully, Jason.

  14. Sri Ramanujam says:

    Look, if the CSRs don’t help people, who will? Certainly not the company. Rock on, dude.

  15. quizmasterchris says:

    @NRobertMoses: Isn’t that the Hippocratic Oath? Like most religious leaders, I imagine that the Dalai Lama gets his chestnuts from bumper stickers, Reader’s Digest and fortune cookies. And I worry that “Free Tibet” actually means “restore the theocratic serfdom.” Yay.

    @Jason: Good job, buddy! We should all be working undercover at work for our fellow human beings as far as we can push it. You did the right thing.

    @ everyone: Once again, we need to END the private health insurance system in this country, they prove time and time again that they weasel out of the ONLY reason we pay them. Single payer now!

  16. HogwartsAlum says:

    Jason, do not feel bad about trying to help. If she was a scammer, YOU’RE not out anything, and since you obviously think she wasn’t, helping her was the right thing to do. Your bosses sound like giant assholes.

  17. psm321 says:

    @acwatts:

    Wait, so you admit that people on government-run welfare right now are better off. And that you get jerked around by the privately-run insurance company (because their only motiviation is pure profit). And end with the conclusion that socialized medicine is a bad thing in the long run? I know people have different viewpoints and all, but I can’t for the life of me see the argument you’re trying to make.

  18. ceejeemcbeegee is not here says:

    I did the same thing when I was teacher. A student of mine had a legal document (an IEP) that stated the school must make certain academic accommodations, but our principal ignored it and told me to do the same. The parent came to me for help, and my principal warned me that if told her of their rights or otherwise I advised her in a way that would cost the district money, I could be fired. So, I called the parent from a pay phone and told her of her rights, who to call, etc. The eventually child got their proper education.

    • Randelyn Trapp says:

      @ceejeemcbeegee: Bachelor at Large: As a parent on the other side of that IEP, thank you. I have had aides for my child pull me aside and tell me what’s really going on in the class and what was supposed to be going on according to my child’s IEP. It thanks to them that I could fight for my child’s rights. It was another friend who taught me the right phrase…”due process”. That one gets things done.

  19. frodolives35 says:

    He is saying our current mix of half private half goverment helth care sucks and will be better under a total goverment system. However the rest of the goverment intervention that comes with it will be worse then the current overall picture.

  20. Tony Collett says:

    It’s incidents like this that I’m in a different line of work now. That, and the nepotism at the job. It went well when the supervisors liked me, not so much if they didn’t.

    • chatterboxwriting says:

      @Tony Collett: Wow, my reply button worked! First time in over a week.

      Anyway, I left the HR field for similar reasons. I want people to have all the tools they need to do their jobs and to get the benefits they need. The company I worked for wanted me to slash their benefits and not give them any tools or training. I couldn’t do it anymore.

  21. kbrook says:

    The CSR did the right thing. I’ve called police five states away to report that a caller told me someone was trying to kill her – she sounded like a nutbar, but I could not have looked at myself in the mirror if I didn’t say something.

  22. badhatharry says:

    @Mr. Duck Sauce:

    It’s “you’re” and “grammar.” If you’re going to rip on someone else’s writing skills (who simply forgot a comma), try not to make your correction more rife with errors.

    I’m not trying to nag, but what is going on with the reply button?

  23. Trai_Dep says:

    Great to see the private market providing individualized, appropriate, consumer-oriented yet cost-effective health care. I’m sure that the patient’s husband and daughter, looking down from Heaven after being struck down by 9/11, brush away a grateful tear with their wings that they left their ailing mother in the more-than-capable hands of The Best Medical System on the Face of the Planet!

    (Mad props to the rule-breaking employee who proved he retained his immortal soul, in spite of working for the insurance companies)

  24. BuddyGuyMontag says:

    I swear to GOD I am not blaming the poster, but I have not heard of a Saving Private Ryan-esque loss of both a father and a daughter during 9/11.

    • floraposte says:

      @BuddyGuyMontag: I was wondering about the confluence of events myself. However, I think that everybody’s entitled to exercise their right to appeal an insurance denial, so I can’t consider the result undeserved whether her story is true or not.

      • BuddyGuyMontag says:

        @floraposte: The problem is, she lied about losing people on 9/11. (see below post) How do we know she wasn’t lying about cancer and just scheming to get COBRA coverage?

        I hate to sound heartless, but there are a LOT of scammers out there, and there are a ton of them who used 9/11 to prey on people, especially in the months after the attack.

        The thing is, 7 years later, we know exactly who died so some fact checking that the CSR may not have had access to at the time says that she may have been fradulent.

        • floraposte says:

          @BuddyGuyMontag: What I’m saying is that we don’t have to know. Jason didn’t have to know. If she was denied coverage, she had the right to appeal–to the people whose job was to assess the validity. Those are the people who mattered.

          I get that the story particularly moved Jason because of this claim, and it’s definitely ironic if it turns out that that very story is what marks her as a scammer. And my skeptical heart is warmed that you did actual and successful research on this; you’re definitely my kind of BuddyGuy. And sure, it would be nice if Jason had made his moral stand for somebody less questionable.

          But I still think that the basic policy of essentially blocking appeals because the company didn’t want to pay, not because somebody’s assessed the case as not appeal-worthy, is somewhere between bullshit and evil. And I don’t think that right of appeal gets taken away from somebody because they’re rude, or manipulative, or bonkers. She was denied something it was agreed she was otherwise entitled to because she missed the date by one day. I think that’s a legitimate cause for appeal whether you’re Tania Head [en.wikipedia.org] or not.

          • BuddyGuyMontag says:

            @floraposte: I’m apologizing throughout the thread. I was directed to a father/daughter combo that did in fact die on 9/11, so I’m summarily saying I’m an idiot and not to listen to me.

    • formergr says:

      @BuddyGuyMontag: Had the samr exact thought when I first read the post.

  25. Applekid ┬──┬ ノ( ゜-゜ノ) says:

    Which is better: that the innocent get justice or the scamsters get a free ride?

    If you don’t know which side of that coin you’re on, I suggest you figure it out soon before one of these moral dilemma smacks you in the face.

  26. kreatre2009 says:

    What’s really bad about COBRA is that fewer than 10% of eligible customers actually use it. Why? It’s often more expensive than just getting a new policy from another insurance carrier. My mom was recently quoted an outrageously high premium through COBRA. We shopped around, and found a premium that was half what it would have been under COBRA for roughly the same coverage.

  27. pwillow1 says:

    The above is one of the best arguments I’ve ever read on Why Americans Need Single-Payer Universal Healthcare.

  28. redkamel says:

    how would you NOT be doing the right thing by helping a cancer patient get coverage, especially one whose whole family died, and who was ONE day late? this is gnawing at you, really?

    You didnt even break the law, you broke some policy at work for someone you believed in. If it was a scammer so be it. Thats what investigations are for. This should be on your resume.

    Its like the old interview question: you find a bottle of alcohol in your workmates locker, a violation of policy. What do you do?

    Wrong answer: Report them to my boss.

    Right answer: is it open? is it a nice bottle of wine, or a bottle of cheap liquor? Is it in a bag or just sitting out? Is there a special occasion coming up? What else is in the locker? Half empty bottle Jack; tell co-worker to turn himself in or be reported. Bottle of nice wine, wrapped; tell co-worker to put it in his car.

    the spirit of the law should always triumph over the letter of the law.

    • TheThirstMutilator says:

      @redkamel:

      You made me laugh when you said he should mention this on his resume.

      *Can type 150 wpm
      *Degree in computer sciences
      *I will go behind your back to do things against your interest when you explicitly ask me not to.

  29. BuddyGuyMontag says:

    Here’s the problem though…

    I just spent a few minutes doing a few searches on CNN’s 9/11 tribute. One of the things on CNN’s tribute is family relations who died on 9/11.

    Several husbands and wives died together on 9/11. Several families died on 9/11. Several fathers and sons died on 9/11.

    Unfortunately, I can’t seem to find a daughter/father combination dying on 9/11.

    • floraposte says:

      @BuddyGuyMontag: I gotta say, this makes the story considerably more interesting.

    • MmeSosostris says:

      @BuddyGuyMontag: “Unfortunately”? Dude I’m sorry to say this–I know you are probably (justifably) proud of your great prowess at harnessing the powers of the internet–but that is warped.

    • Paladin_11 says:

      @BuddyGuyMontag: 9/11 was a day like any other day. Lots of people died in unrelated events. The daughter could have died by getting trampled in the rush out of Manhattan or she could have died in a traffic accident in Des Moines. The important thing for the caller is that those two people died on the same day, which then became conflated in her mind as the two of them dying on 9/11. Either way the daughter’s death wouldn’t show up on the lists you checked.
      Just scouring the official lists of 9/11 victims isn’t good enough to know for sure.

      It wouldn’t be the first time a distressed person was imprecise about their use of language.

      I’d say you did a good job of beginning the investigation but there’s no way we’re ever going to know if this person was a scammer or not without knowing their personal information.

      • BuddyGuyMontag says:

        @Paladin_11: Incidentally, there were no “trample to get out of Manhattan”. It was pretty calm in the hours following the attacks outside of the obvious. Everyone was scared, but everyone was working together.

        However, some further fact checking, I found out that I was in fact wrong, and there was a father/daughter combo that died on 9/11. To protect the OP’s information, I will not reveal who it was or where they died.

        • Techguy1138 says:

          @BuddyGuyMontag:

          “everyone was working together.”

          Not quite true. I heard from some emergency responders that people were uncooperative. There was an intense state of shock.

          People were just standing and staring. It got to the point that my relatives that were trying to help people just left.

          After the buildings fell it was just as you said.

        • Paladin_11 says:

          @BuddyGuyMontag: Thank you for the correction. I was referring to the film where you see people running to escape the debris cloud that was caused by the collapsed buildings. I’m glad I was wrong.

          And especially thanks for continuing to look into this and posting about your mistake. Very good of you. It’s also nice to know that this story has the possibility of not being based on a scam.

  30. JiminyChristmas says:

    Can someone explain to me what the potential fraud is here? I’m just not seeing it.

  31. cametall says:

    I didn’t vote in the poll, but you should be following the law, no matter if it helps the customer or the company.

    If the customer doesn’t agree with the law, they need to hire a lawyer or appeal with the governing body.

    Is it a very cold way of looking at the issue? Yes, but in most circumstances I feel the law will help the customer.

  32. NikkiSweet says:

    @BuddyGuyMontag – there are not enough details in the story to make that assumption or not. Nothing was said about this woman’s age, the age of her daughter… typically a woman changes her last name when she’s married, and there is no information given about family relations on the cnn tribute site.

  33. twophrasebark says:

    Most people live by excuses and rationalization for doing the wrong thing.

    You did the right thing, Jason. And you did in a prudent way. There’s always a way to do the right thing.

  34. Zenatrul says:

    I’m a CSR and I’m happy I work for the company that I do, they actually have competent supervisors that didn’t just brown nose their way up, I saw one try to get a supervisor position and was denied.
    I have never seen them let a person go for any stupid things like that, its usually a valid reason and they give us verbal warnings, written warnings, and suspenses before a termination.

    Luckly if they did fire me for something stupid or without a real reason I would bring it up with the Labour Relations board here in Canada.

  35. dorastandpipe says:

    I had cobra insurance this past spring and my claim at a pharmacy DID get declined just as listed above! Yep, called the company, they gave me the song and dance…you we’re declined? Oh no! You are covered let me get this fixed right away. Thinking back on it, it was the first claim sent through once we started using the cobra insurance. I had been paying on it for two months at that point. That is total crap! That seems these insurance companies are pocketing the money if you don’t use your cobra…that is WRONG!

  36. Thunderdome says:

    I would of done the same thing in Jason’s shoes. Better to risk letting a fraudster get the better of you than to let a poor woman die. A big company can better absorb the cost of fraud better than a woman can absord the cost of her own life…or something like that. You get my meaning. People are lying, cheating, stealing bastards, but if you start treating everyone as if they’re a lying, cheating, stealing bastard, you’re no better.

  37. Skaperen says:

    The fraudster here was the company.

  38. MBEmom says:

    I have a COBRA story:

    My husband left his job for a new one and there was the corresponding gap in medical coverage for our family of one month. We enrolled for COBRA coverage.

    Generally, I am a healthy person but of course, I ended up having to go to the hospital for emergency surgery during this period of time (for the curious, ruptured ectopic pregnancy). Bummer.

    Yes, my COBRA claim was denied and I got 12000 dollars worth of bills but with a twist…it all happened nine months after the fact. They actually paid the hospital but then randomly, for no reason that I was ever given, reversed it nine months later.

    I spent many, many hours of my life on the phone in attempts to fix it. I honestly don’t remember how many phone calls I made but it was more than 20. The CSR’s were routinely polite but had no information as to why it happened. I was always promised that some apparently mythical manager would know and would call me. We all know that never happened.

    After about a month of frustrating calls, I finally had my husband email the HR person at his old job to help. After about 2 more weeks and a couple more emails to the HR gal, everything was resolved. Apparently, these people thought that I was a fraud and only the actual HR person could convince them I was not.

    So on behalf of people who are not scamming the insurance companies, I thank you for doing the right thing. Maybe she was scamming you but at least you did what you thought was right. That’s what really matters. Imagine if you hadn’t called her back. How often might you regret it? How bad would you feel? I’m guessing it would be worse than any worrying you might be doing now about the evil company you used to work for.

  39. Anonymous says:

    Jason

    You KNOW you did the right thing. You did it because you knew it was the right thing to do. Nobody here knows the circumstances as well as you did, or is in the spot and has to make a decision, as you had.

    It is human, I guess, to seek validation, confirmation, when we must make a judgement call.

    But it’s a bit like the habeau corpus: I would rather see you do what is right, and be wrong, than not.

    I congratulate you in having – and using – both spine and brains. WWII showed us that “simply following orders” may not always be the best policy. If more folks were a bit closer to you in action, we would not be in this mess we’re in.

  40. seamer says:

    Unauthorised use of personal data. If you were willing to do that you should have done the right thing in the first place.

    • Rectilinear Propagation says:

      @seamer: So he shouldn’t have done the right thing unless he did it in a way that got him fired?

      He wrote down her phone number, not her SSN.

      • seamer says:

        @Rectilinear Propagation:

        A phone number isn’t considered private information anymore? The article doesn’t specify if her number was public or unlisted, we would have to assume it’s unlisted since he had to write it down instead of looking it up in any public phone directory.

        As for being fired, I’m sure that in this day and age anyone fired for doing the proper thing does get looked after – the media makes sure of that. How many stories have there been where someone is fired for stopping a robbery or whatever, a huge public outcry ensues and the person gets a new job/reinstated, 15 minutes of fame and a nice fat check?

  41. ospreyguy says:

    WTF is this about “sorry investigation takes time?!?” I work in a mortgage underwriting department (that is in the top 3 for FEWEST defaults BTW) and we never assume the customer is lying, you make think it but you always get supporting docs. Just to make the assumption and say we don’t have time is stupid. If you don’t have time to do it right, learn how. If you can’t, go out of business because you suck and shady practices hurt everyone.

  42. jfischer says:

    Lots of slimeballs rationalize their borderline illegal and customer-hostile actions with “we are preventing fraud”. Yeah, right.

    So, lets see… someone “defrauds” by getting COBRA coverage, which applies to people who just lost their job, and pays several times what they paid for health care when employed so that they do not go without coverage. OH YEAH, that sounds like a real fraud problem, where people line up to PAY MORE for something that they can barely afford, now that they are UNEMPLOYED.

  43. pastabatman says:

    I’m with JiminyChristmas.

    What fraud does everyone THINK there is here? Maybe she lied about her husband and kid. so what? That’s a lie.

    But either she was denied or not. Nobody is arguing whether she had COBRA or not. of course she had COBRA. She blew it on the filing. what fraud?

    What is she gonna do now that she gets her chemo covered? laugh all the way to the bank?

    or is it that she DOESN’T have cancer and the last laugh will be on the ins. company as they pay huge sums of money so she can be irradiated for no reason?

    • kbrook says:

      @pastabatman: Having seen how much Medicare and Priority Health paid for my dad to be in the hospital for a week while they figured out why he was so sick (turned out to be metastatic lung cancer…), I cannot even tell you how grateful I am for Medicare. The thought of how much they’re going to shell out (my parents haven’t been billed a penny so far) for the chemo and radiation makes me shudder. And he’ll probably need a couple more rounds.

  44. savdavid says:

    You say ProBusiness is Pure evil. Problem solved.

  45. Brady Cox says:

    Trying to reply to a different person, but whatever.

    When you get COBRA, you’re still paying for insurance… the same insurance that was being paid for previously.

    Yeah, I can see how this could be used in fraudulent ways, but no different than regular insurance.

    So that lady was covered before under the same insurance, the insurance company knows she has cancer and is happy they don’t have to cover her anymore if they make it hard for her to continue the insurance she already had.

    Reminds me of the guy in the Incredibles movie.

  46. tworld says:

    How pathetic has this country become, that a guy with ethics has to become Deep Throat to do the right thing? This story totally disgusts me.

  47. Quilt says:

    You’re like Mr.Incredible, except you didn’t beat up your boss.

  48. akuma_x says:

    This kind of thing will continue to happen until we Americans wise up and figure out that putting our health into the hands of a company whose soul purpose is to turn a profit is the worst idea in the history of the world. In other words, this will always happen.

  49. Anonymous says:

    Well first of all, COBRA continuation coverage is a right that is guaranteed by law, but ALL it is is the ability to continue to be enrolled in your insurance plan by paying the premiums. There is no “fraud” involved in that situation (except maybe on the COBRA company’s end) – the lady just wanted to keep her insurance plan that she had already been enrolled in so she could continue to use it. Why I say that the fraud may be on the COBRA company’s end – they are being paid to be an administrator, so they are required to actually enroll these people and to actually give them correct and legal advice. They are employed to do this by the business that formerly employed the person looking to continue coverage. That means they are failing to do what they’re being paid to do. They’re trying to collect premiums and hold them without activating the insurance policy.

    So to the OP – you did the right thing. Your company was engaged in immoral and potentially illegal practices. I would thank your lucky stars you got out of there.

  50. Shrew2u says:

    Wouldn’t the original COBRA packet and/or the denial letter contain information about the appeal process for a denial of coverage? That seems incredibly odd. Having never separated from a job where COBRA was an issue, I don’t know how a soon-to-be-former employee is notified about COBRA, nor whether a specific set of information must be issued (although I’d assume so).

    In OP’s case, I wouldn’t lose a wink of sleep over providing accurate information to someone. This CSR was not going to render the decision on the appeal – and the woman’s coverage could have just as easily been denied on appeal as approved.

    That said, I understand his company wanting to limit the information provided verbally by a CSR. However, the company could have addressed that issue in a completely ethical manner by creating a standard “Your right to appeal after denial” notice and including the notice with the denial letter.

    Since the company had a track record of failing to act in an ethical (or legal, in some respects) manner anyway, I wouldn’t have a problem doing the same as the CSR. In the meantime, I’d document the company’s shading practices and start looking for another job. Once a new job was secured, I’d blow the whistle on the company. If the CSR didn’t do THAT (blow the whistle on the company)…then that’s the thing over which what I’d be losing sleep.

  51. u1itn0w2day says:

    The CSR mentioned it wasn’t in his job description to inform the customer of their rights to appeal . But is purposely with holding relevant information which is a a deceptive business practice IN their job description .

    Detecting or actually investigating fraud should be for the investigators and not the CSRs . If a CSR thinks there is fraud fine , turn your suspicions over to investigators/supervisor . Same for management .

    And I have had dealings with ADP Cobra Services and can you say ORDEAL . And part of the problem is what the CSR is saying : they wouldn’t say squat and they wouldn’t tell you squat . It was like a yes-no Q & A in court hearing on what should be normal routine business . I had one CSR you could tell was being coached in the background as to what to say . They were useless to me . I also found out that my ex company changed the COBRA including cheaper plans and no more ADP .

    And in many states your ex-employer is held accountable with COBRA so if you have problems don’t be afraid to file a complaint with the local BBB and/or the insurance regulators – my problems were solved after I did .

  52. P_Smith says:

    The only rule or law that is “one size fits all” is “kill ‘em all”.

    Civilized people don’t do that. Jason chose to be civilized and realized that not everyone’ circumstances are the same.

  53. P_Smith says:

    @Applekid:

    Which is better: that the innocent get justice or the scamsters get a free ride?

    If you don’t know which side of that coin you’re on, I suggest you figure it out soon before one of these moral dilemma smacks you in the face.

    As the “Blackstone ratio” goes, “Better that ten guilty persons escape than that one innocent suffer.”

    [www.law.ucla.edu]

    But this is the land of the free-from-thinking we’re talking about, the US, where businesses are allowed to presume customers are guilty until proven innocent (vis-a-vis, receipts at the door). Businesses are protected, not people, and part of what they’re protected from is responsibility.

  54. verdantpine says:

    You did the right thing.

    And your description of your evil “princess” coworker, who loved to make people cry chilled my blood. Not that I should be wishing harm on anyone, but I’d hope someday she has an experience that forces her to gain empathy for other people.

    Thanks for being one of the good ones. The fact that you would even consider you might’ve done a little wrong to this shitty company shows that you’re far more ethical than the majority of folks in this world.

  55. Erin Cummins says:

    @ acwatts

    where are the welfare people getting free health care? I haven’t had health care in over a year (I work part time, to keep costs down my company eliminated most of the full time jobs). I could seriously use a doctor visit.

    Last time I went to the hospital it cost me over 3 grand. I’m on a payment plan and should be debt free in about 3 years. I’d really like to know where this free healthcare stuff is. Unless of course you just made it up.

  56. BuddyGuyMontag says:

    Well, I’m an asshole.

    Upon further review, I did find a father/daughter combination that died on 9/11. The CNN site didn’t list their relation plus there was a spelling error.

    So this myth turns from busted to plausible. Also, since she got her COBRA approved, one would think that fact checking was done in the process.

    So I apologize. I fucked up, plain and simple.

    Also, to protect all parties, I will not mention the names of the people involved nor where they died on 9/11.

  57. BuddyGuyMontag says:

    Well, I’m an asshole.

    Upon further review, I did find a father/daughter combination that died on 9/11. The CNN site didn’t list their relation plus there was a spelling error.

    So this myth turns from busted to plausible. Also, since she got her COBRA approved, one would think that fact checking was done in the process.

    So I apologize. I fouled up, plain and simple.

    Also, to protect all parties, I will not mention the names of the people involved nor where they died on 9/11.

  58. DeeKey says:

    I’ve dealt with COBRA…my premium went from $300 a month to $700 after my family grew by one member. They are in the business of getting rid of you, especially if you have an expensive medical condition. When I tried to go and get “regular” insurance that was cheaper on my own, I was denied for medical reasons and am now on “state” insurance as uninsurable.
    If you think people are getting good care from state insurance I can assure you that is not the case and the treatment they tried not to give me nearly cost me my life.
    Imagine being sent home from the hospital, because you have state insurance, and having to call an ambulance a week later because you are bleeding internally so they can rush you to surgery that could have been avoided had they not dismissed you a week ago for not being insured by one of their providers. This is after you told them exactly what your condition was, their tests confirmed it, but you weren’t in dire enough need for the procedure to stop it from getting worse.

    State insurance only insures that you get the worst and cheapest care. In my case it cost the hospital alot more than if they had taken care of me the first time I walked into the emergency room.
    Also, try getting a specialist with it, I consistently am told that none of “their” doctors are taking new patients. What they mean is, no doctor wants a patient with state insurance and the only way to get one is the emergency room.

    Having gone from the best insurance available to state insurance was quite the eye-opener about how the system isnt working. Its like putting on a fat-suit and entering the Miss America Pageant.

    I hope Obama can find a better solution than state insurance.

  59. RStui says:

    It’s not about the customer vs the company. It’s Federal Law, that’s it. End Game.

    You only covered your own ass by following the law.

  60. Boberto says:

    So let me understand this correctly;
    You’re working as a CSR for about eight years. You follow the unspoken and unwritten code whereby you routinely deny people their crucial medical coverage, with exception to this one incident.

    Then, after all those years, you get axed for whatever reason so you write in to Consumerist exposing the company’s wrong doing.

    I commend you for doing what you did, however if you had any REAL balls, you would have done much more by doing much less during those eight years.

    Right now, your doing the right thing for yourself. You could have done the right thing early on, exposed them, found another job and moved on, which is what you’re doing right now anyway.

    You’re shining example of integrity is only one instance and only because it involved the collective consciousness of 911 as a backdrop to the story.

    I don’t think you’re really asking us in your post, if you did the right thing here. In fact I don’t think you’re asking anything at all.

    I think you’re just telling us your story while at the same time exposing a company’s illegal activity. This illegal activity that you were largely a part of for eight years.

    You whored yourself that whole time and sold your soul to do it. And now that it’s over, you’ve gone the way that all old whores go when they’ve dried up and have nothing left or nowhere to go.

    Your actions now however will not bring you back your soul.

  61. rawsteak says:

    If you don’t care if you hurt the company, then what’s the problem? just feel like you made a difference and move on. the longer you think about it, the more you’ll doubt yourself. either you helped someone get by, or you helped someone stick it to the man. if you’re feeling conflicted, it’s because you wish you were sticking it to the man, so just feel like you helped someone and let go of that guilt already.

  62. Shadowman615 says:

    The only issue I take with this article is that you say you feel terrible that you short-circuited company policy. Are you serious?

  63. Mary says:

    I’m contemplating leaving a job in this economy with no other options or possibilities out there, one that pays me hefty benefits, because of this very reason.

    Every day I’m faced with situations where as a person, I know that I should help the customer. I believe them, I trust them, and if I saw them on the street I would help them in any way I could.

    But management insists on treating all of our customers as criminals. They assume that they’re all trying to scam us and our job is to figure out how and nip it in the bud before they steal all of our precious moneys.

    I can’t live like that, I can’t be like that. I’ve spend a decade in customer service jobs, and I fully believe that part of my job is not just to represent the policy to the customer, but to represent the customer and advocate for them to my employer. But I consistently get punished for doing it and taken to task over it.

    I believe he did the right thing. If he hadn’t, he would be haunted even worse. It’s a hard decision, but I think he came out on the right side of it.

  64. trujunglist says:

    It’s not very clear in the article, but by not telling her that she could file a legal challenge, then the OP would be breaking the law? And the company told the OP that he essentially had to break the law or be fired? If that is the case, then fuck that company to hell. What a bunch of dick faces. Your $10/hr job is not worth going to court over or fucking anyone else over. I just ran into a situation similar to this, even though my boss actually supports me (hard to explain, wont even bother). It’s not worth compromising your belief system anyway because then it will end up eating away at you for the next 7 years! You’ve already let it bother you for this long when it should be a moment to be proud of, imo.
    If it it was your legal obligation to tell the woman what her options were, it’s not up to you to decide whether or not the woman is a fraud. You give her the information that you’re supposed to be giving her and let her break the law if she is so inclined to do so. The same thing is true for guns, liquor, paperclips etc…

  65. xcharliemx says:

    YOU DON’T GIVE CUSTOMERS PERSONAL ADVICE!! Giving personal/legal advice you put your company up for liability if it doesn’t work out. The proper thing to suggest is “You might want to seek an attorney if you have legal questions” and leave it at that. If someone defrauded them and you tell them who did it when they find out and kill the person you/your company are responsible. Do what the person in the OP did and call from somewhere else, not as a representative of the company but as a human being.