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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