The Continuing Saga Of Customer Service Reps - Healthcare Style!

I phoned the boys pediatrician today to schedule their physical. Since last year it was performed in June (sports related) and I was trying to get back onto their birthday, the receptionist suggested I contact my health insurance carrier to make sure they would cover two physicals ten months apart. This seemed appropriate and dare I say, simple. Following is the timed blow-by-blow, thanks to the running clock on my office phone.


0:01: When I dialed the 800 number I was prompted that they needed to verify who I was “in two simple steps.” This should be the first sign that things are about to go drastically wrong. The first auto-prompt was to state my relationship to the member. I am on my wife’s plan and was really tempted to say “cocks-man,” but settled on the more appropriate, “spouse.” The second was to key in my ID number. I was promptly transferred to a customer service rep (CSR if you remember my previous post…though this gal was decidedly in the US). The first words out of her mouth were, “what is your relationship to the member?” And you guessed it; I then had to give my number again. So, while still pretty simple, it is actually four steps and not two.

1:45: I stated, almost verbatim, this very simple inquiry: “My two kids had their physicals last June but I’d like to get them back near their birthday and have them this month. Will these appointments be covered since they are less than a year apart?” Stunned silence, then, “please hold.”

9:38: “Can you continue to hold I am checking with a supervisor.” Cue a chamber music rendition of Penny Lane. I was now rubbing my hand briskly over my face and felt trapped. It was like being halfway through a forty-five minute wait at a restaurant. I wanted so bad to leave but was so invested at this point.

20:32: This is where I am reconnected but am having a hell of a time relaying succinctly what was said since the explanation was extremely contorted…nonetheless, it went something like this: “I checked with a few supervisors and they said that if their birthday was in, like, November of 2010, then they could still be covered for their physical the next year.” Wha, wha, what? I asked my question again and kid you not, received the same, twisted anecdote about some phantom November birthday. Was there a staff meeting involved…perhaps a pharmaceutical drug trial going on in the office? I rephrased my question, “Is their physical covered this month?” “Yes,” was the answer.

I envision the “Explanation Of Benefits” statement now. “These physicals are not covered, if only they were born in November!”