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