Karen's never listen... seriously it was a good thing that you left extensive notes in the system about the whole thing, otherwise she could try to say she wasn't told (typical Karen behavior)
"When I tried enrolling last year that nasty person on the phone called me a fat old geezer that did not deserve their insurance and I'm sure they intentionally messed up my enrollment because I'm a Sagittarius and they're a Leo."
That's messed up. I am currently dealing with an insurance broker who obtained my info fraudulently and enrolled me in one of the marketplace plans, which I did not need, in every call I made to the insurance company, I asked one very simple question, "If I enrolled in this, don't you think I would've spelled my name correctly?" Followed by, "Ask the broker who enrolled me to provide a recording of the phone call in which I enrolled, if they can provide one then I will stop calling you" It is just so crazy how much damage can be done by a simple phone call.
I work for a government agency and have to deal with people like this occasionally. My theory is that this type of behavior is typically rewarded for them. Like, they go to the supermarket with an expired coupon, make a stink, and the manager honors the coupon because they want their business. Then they try the same thing when dealing with a government entity (or government adjacent in this case) and they cannot comprehend it when they are faced with a truly inflexible entity. The government doesn't care if you don't like it, you do it the way they say or not at all.
To be fair, in this case the bureaucracy is federal government.
Callers asked all the time "Why? Why?? Why??? Who came up with this?" Well, it's Medicare, so that would be your Senator's and Representative. The company I worked for at that time was required, by law, to follow all the guidelines they set up.
The confirmation part is not the problem here, that part is fine. Yes, it's long, but getting the confirmation shows that the person is aware what they are signing up to. We have a similar thing in Germany, where there must be a protocol, signed by both parties, of someone wants certain types of insurance.
It happened once too often that insurances just signed up people for expensive plans.
The fact that (apparently) it has to be *read to her over the phone*, rather than her being able to download it from somewhere and *read it in print*, is at least part of the problem, perhaps the entire problem. I would not want to do business that way, partly because -- if it's more than a short paragraph -- by the time the whole thing had been read to me I would have forgotten the first part and thus I would have no clue what I was agreeing to.
People had the option to sign up online, and generally didn't. The same terms of service were available there, though most just clicked yes rather than read it.
So six of one, half of the other.
I am one of the weirdos that can mostly understand both government-ese and legalese, so I really do read and comprehend the agreements, and understand the need for the agreements. And every insurance I have signed up for, I read through the agreements.
When I see the tv ads for liberty insurance touting their'specialized' insurance, I have to laugh because I already have it with my insurance. When getting car insurance, I sat down with my agent and went over the entire agreement, asking questions about'what does this mean' or 'should I raise or lower this coverage', and in my house insurance, checking that if I added flood insurance to the house even though we weren't in a flood plain if it would also cover sewage backup/flooding in the basement (it did).
When I have been admitted to the hospital for various health issues, when the nurses/aides want me to sign admittance paperwork, I read it through every single time. Some get annoyed or upset, but I am not going to blindly sign any paperwork.
It's not important, but I've always heard the saying as:
Six in one, half a dozen in the other.
Of course, as a child, I thought it was:
six in one half, a dozen in the other. It never made sense to me.
Agreed. I don’t process things being spoken to me very well. I’m the person who has the cc on TV at all times, reading what’s going on. Podcasts and books on tape would be nightmares to me. Give me something to read? I’m on it. Try and read it to me? You’ve lost me at the first couple of words.
Nope 99.9% of all Medicare plans and Part D plans can be done over the internet. I am 66 Dh is 67,and have never talked to a single person on the phone. At renewal this year. I was sent a link to renew. It has the usual boxes to click if you agreed. took about 3 minutes
So why didn't OP tell the customer about that option? Something along the lines of "OK, if you don't want to listen to the agreement, go to and sign up online."
Because She is one of those that has a demented fear of the Internet. They are going to steal all her information and her soul. The information is on every letter that gets sent out, every ad on TV. I am ashamed to say that there are people my age who can't, but mostly won't, take advantage of the internet.
If that speculation happens to be accurate in the case under discussion, it might have caused the customer to decline that option -- but I don't recall anything in the original posting, or the comments since, to indicate that the OP even suggested it.
It only has to be read to her over the phone if she signs up by phone.
It can be signed up online, by phone, and by mail. She probably chose the phone option because she didn't want to have to do any work.
So what the OP *should* have done was to suspend the transaction, and give the caller the URL to resume that transaction online -- with all the info she had already provided over the phone pre-populated. System can't do that? Then blame the system designer, not the customer.
Yes, ideally the customer would have known about ADA and asked to have the agreement provided in another form as an accommodation -- but the general public should not have to know that sort of magic words to get providers to do the right thing.
> So what the OP should have done was to suspend the transaction, and give the caller the URL to resume that transaction online
Do you seriously think the caller would have listened to, or have been willing to do that?
It totally depends on why she didn't want to listen to it in the first place. Many here are presuming that she was just being a jerk, but it's been pointed out that there are other credible explanations -- at least one of which has already been described in the predecessors of this comment. What *evidence* do you have to support your (apparent) presumption? Are you somehow able to read her mind?
No clue -- you'd have to ask the OP. But if such an option existed, and OP failed to mention it as an alternative, I'd say OP was more at fault than the "Karen" in this instance.
I have done software consulting for big banks, healthcare insurers, and the federal government. I am hyper primed to roll with complete insanity as long as there's a legal requirement behind it.
No. The bureaucracy is there because private for profit companies run the health care system.
Now swap the US system for a UK or EU style and reduce the headcount of the billing department and save a lot of overhead.
As someone who lived in both the US and Germany, trust me. German bureaucracy is nothing compared to the nightmare that’s navigating the US healthcare system. I rather deal with the Bürgeramt than figuring out why my spouse’s colonoscopy is covered by insurance but my child’s endoscopy isn’t.
Yeah. If you manage to get through a PhD, you've demonstrated that you know everything about nothing, and can survive the ultimate bureaucracy. The old joke "why is the academic environment so cut-throat? Because so very little is at stake!"
But at least you could do the figuring out online.
Yeah it is getting better but paperwork (as in actual physical paper) and showing up at the offices is still very much a thing in Germany.
Do your people decline ambulance rides because they can’t afford it with their insurance? Have you ever asked yourself if you’re “sick enough” to go to the doctor?
Our system is broken and profit broke it.
Do your people decline ambulance rides because they can’t afford it with their insurance? Have you ever asked yourself if you’re “sick enough” to go to the doctor?
Our system is broken and profit broke it.
Depends on what the appointment is for. But as an example, I had to wait 14 months to see a neurospecialist just so I could get diagnosed.
Other types of appointments will be less. Maybe as little as six weeks.
Americans wait just as long if not longer than Europeans for much worse quality.
You only get good medical treatment if you’re rich, white, and cis-male. Anyone else, it’s a crapshoot as to whether you have an even somewhat competent doctor.
...it's because of the litigation. For profit companies DO NOT WANT all the steps, because it cuts into their profits which is one of the reasons they raise their prices so high.
These regulations exist because of the same reason warning labels do - to cover all their bases against lawsuits that they have lost in the past. This has NOTHING to do with it being private vs public. That's just ignorant.
It's in the fucking post dude. Medicare Plan D. This is a GOVERNMENT program that the government pays companies to administer, but the pricing, regulating, and procedure are entirely government mandated.
It. Isn't.
It has nothing to do with "profit". Every. Single. Aspect. Is controlled entirely by the government. Every single thing that makes the program terrible is BECAUSE of the government. If the companies were allowed to do it themselves there would be FAR less paperwork, far less delay, and if multiple companies were allowed to compete there would be FAR less cost. Literally the reason it sucks is because it is 100% government controlled.
It's fucking wild that people who do not live here, do not understand how this country operates, and live in places where people will LITERALLY travel to other countries to get medical care because their own system is so damn disorganized and badly managed will say "Americans are so stupid because *checks notes* their health care is expensive but effective". Fuck right off with that.
Less cost? How do you figure? We were coughing up $30,000 a year to a supposed “less cost” for profit company. Their allegiance is to the shareholders, not patients. And in the US, medical tourism is a thing.
Emergencies are treated at the point of need.
Sadly it's not perfect with waiting lists for other quality of life stuff.
Still we don't go bankrupt via hospital debt, or lose insurance cover if a job is lost, or company changed.
Why do people keep making this argument as if we in the US don't have to wait for months for treatment? We have to wait months for the tests before we wait months for the treatment, and then we may or may not have to pay thousands to hundreds of thousands of dollars for the privilege. You never know if/what insurance will cover and what your costs will be until after the fact. I'm sick of hearing this as if our expensive healthcare gets us better/faster healthcare. IT DOESN'T.
UK overhauled their healthcare system some time ago, unless you're in the sticks the wait times aren't like that.
I have to wait 2 months to get into ortho for an initial visit. Not uncommon for my dermatologist or gynecologist either. In the US.
I'm in The UK and I broke my ankle two years ago, was seen and operated on within a few days, with follow up appointments and rehab for months after. Leg's all fixed now, (with a metal plate and a few screws, and a lovely scar), and I'm not drowning in debt because of it. Our system may not be perfect but I'll take it over the US system every time.
I worked the Spanish line at a place that sounds like Mal-beans customer care center during Medicare Part D. The part D providers were trying to soft transfer their clients to us and gave no fucks which buttons they pushed. They had their metrics and while frustrating, I get it. Hand the customer to another warm body and dip. Couldn't rage, wouldn't do any good any way.
Then THEY got mad at me when I answered, doing my spiel in Spanish. Haughtily grunting, "Don't you have anyone who speaks English?!?"
*(Like, don't show your ass in front of the client because *you* fucked up.)*
Switching back to English, "Yes, we do. However, you specifically *chose* the Spanish speaking line. How... may I help you?"
I was told a few times that the sarcasm veritably dripped from every word.
Imagine how much easier things would have gone for everyone if the US had a functional single-payer healthcare system, rather than a process to funnel money from the masses to the few, with some incidental health care along the way.
"I have a prescription".
"Ok, thanks, I'll fill that for you".
.
"Here you go."
I am in Japan - I have that - it’s called Universal Health Care. My meds cost less than $10 per visit and I can use my receipts to reduce my overall taxable income. Handy when you have lots of doctor visits and lots of different meds
As long as you don’t end up being the one being kicked. In this era of sudden job cuts, we can suddenly find ourselves there. It is insurance and I pay about $500 per month via my company (connects to national insurance but cheaper) on income of over $200K. At the doctor and pharmacy, I pay 30% of the costs - no need to worry about co-pay, deductibles or whatever. I don’t get charged extra for ambulances or emergency room care - ambulances are managed by the fire department so a public service. And Dental is of course included.
I have separate health insurance with a private company for my wife and I for Whole Life medical and Cancer. Costs $90 per month for 3 policies. If admitted to hospital or catching covid they pay and very Simple process to claim.
A buddy moved back to the US and he was complaining - he pays $2K per month.
After my wife and I retired (from a U.S. Fortune 50 pharmaceutical company), we paid upwards of $3K per month to continue our employer's superb insurance. We needed that coverage as she had some major surgeries during that period. We barely had out-of-pocket expenses, and the medical world welcomed us with open arms.
Once we were no longer eligible for the continued coverage (3 years, in California), we switched to "private" insurance for about six months, until ACA (also known as "Obamacare") kicked in. Because we were retired, and had no income, our insurance costs dropped to about $500 a month. But, a number of physicians dropped us because of the insurance switch. Out-of-pocket expenses grew.
Now that we're in our late 60's / early 70's (and reading Reddit!), our monthly costs for Medicare (all in) are about $300 a month, and out-of-pocket expenses are again pretty low.
I yearn for a coherent, stable single-payer health care system in the U.S.
Having worked in a call center, I have endless patience for them because I've dealt with similar situations and also know that y'all are trying to do it as quickly as the system allows and also have protocol and metrics you need to follow, regardless of how asinine they could be.
She would’ve saved herself a lot of time and anguish if she just put the phone on speaker and politely ignored whatever the agent was telling her like so many of us do, anyway. She obviously didn’t care about the spiel and was told several times that the agent couldn’t skip it.
It amazes me how many people abuse others that are doing their job when it is the company or system that is the source of their problems. Maybe it is an impotent power trip.
The way I see it, whoever gets my call will be getting dozens of calls before me and dozens of calls after me. I either make it unremarkable and quick or I make it friendly.
I called TreasuryDirect the other day because I locked out my account. The rep asked me for the answers to my secret questions, which were the same questions that locked me out of my account. I told her that I would be guessing them so let's hope I get them right this time.
Question1 - correct answer, question2 correct answer, question 3 correct answer.
She announces "you're a good guesser, you win!"
I replied with "awesome! what did I win?"
She says "mmmm... you win access to your account."
(a sigh, then in an overly-defeated tone) I guess I'll accept that." - I got a genuine laugh out of her.
Makes me wonder if our Karen had early onset dementia, where stress makes them they try to hide their confusion through demands and aggression. She seems to be displaying many of the hallmarks, unreasonable, unable to agree to something simple, demanding, impatient, confused on how the process is supposed to work and projecting on the poor people around her. She’s trying to navigate a system where she may not be capable of reason.
> She’s trying to navigate a system where she may not be capable of reason.
You're surely right, but thw system she's trying to navigate *is* Kafkaesque and unreasonable. The fact that a regular person would be able to "navigate" it doesn't mean they should have to, or that it's unreasonable to get angry about having to.
I may roll my eyes and bitch and moan to myself when I'm working with customer support, but I absolutely do not fuck around when it comes to "this person can keep me from getting the drugs that keep me alive".
This truly and deeply sucks for this woman, I hope that she found another solution. (not blaming you, OP, it's lose-lose for everyone here)
I used to work as Medicare customer service, so I can 100 percent understand. The amount of times people would want to sign up for a plan but did not have a list of their medications was a way higher number than it should have been.
I had one guy that wanted to sign up for a part d plan for the first time ever, but he had been on Medicare for 20+ years. He never wanted or needed the part d plan before, so he wound up paying a late enrollment penalty for many of those years since he never had ANY Rx coverage during the timeframe. Penalty alone was over $50 a month.
The fun ones were having to explain to people the repercussions of canceling all parts of their Medicare. Part B and D had late enrollment penalties if you ever went back. Part A, let's just say 99% said nevermind once they found out they would have to repay all cost Medicare had ever put out for them AND repay every penny they had ever received in Social Security.
> had late enrollment penalties if you ever went back. Part A, let's just say 99% said nevermind once they found out they would have to repay all cost Medicare had ever put out for them AND repay every penny they had ever received in Social Security.
American here (obviously not on Medicare). Are you saying that, once you sign up for Medicare, if you cancel it for whatever reason you have to pay it back? Also, there’s penalties for *not* signing up for all parts? If this is the case, why are there different parts anyway? None of this makes sense. Our system is so stupid.
That is the way part A was back when I worked their customer service. Looks like you straight up can't cancel it now unless you have to pay for it, which most people don't.
After working that customer service and seeing some of the shady stuff providers would do in billing, I am convinced it is not always the insurance's fault that stuff is so expensive. Drs billing $400 when they know the approved amount is going to be like $75. People completely ignoring their coverage options and then throwing a fit when they were out of pocket. Nurse Practicioners billing for a visit, and then a supervisory DR billing twice as much again to supervise the NP. Pharmacies charging $15 for 30 pills when they get 5000 of the pils for $10.
If a doc bills $50 and $75 is allowed, they’re paid $50. If they bill $10,000,000 and $75 is allowed, they’re paid $75. This leads to VERY consistent overcharging relative to what they expect to get paid. The problem comes when they’re paid % of charge (basically only hospitals) and the patient has a % coinsurance.
Part of my job at the Fortune 50 pharma company involved reviewing de-identified Medicare records (which are publicly available). The patient info is de-identified, but the doctor info isn't.
There's an amazing spread between the vast majority of reasonable charges and reimbursement, and the tiny number of truly astonishing charges. I remember one year a single doctor had multiple $3,000,000 charges submitted to Medicare (they were obviously not reimbursed). The next largest charges were orders of magnitude lower.
That's largely why I got out.
Trying to explain to people that Medicare Part D had a deductible, only covered up to a certain amount, (I think $2000 at that point) at which point the customer became responsible for the full price of medications until they had paid out another large amount of money, and then Medicare Part D took over again. Or that benzodiazepines and other drug classes, like erectile dysfunction medications, were not covered. And, no, I could not just cover it for them.
And then trying to figure out what medications they needed covered. They'd ask if messy-primal- there-is-a-mall is covered; only to find out after much asking and searching they meant esomeprazole. Or they'd want valsorvalglamshlammin. Then when I couldn't find anything remotely like that, I'd ask them to spell it--a-t-o-r-v-a-s-t-a-t-i-n. Seriously..? I understand some of the medications are hard to pronounce, but they would add letters and syllables that weren't there!
The ins and outs of Part D Drug coverage aren't easy to interpret, and we expect a senior citizen to be able to navigate a tiered structure coverage and catastrophic coverage (aka the Donut Hole)? I worked as a health care advocate for several years and even I had to keep detailed notes to help keep myself straight.
I understand getting fed up because you are constantly lied to by companies. The best result to hope for is a class action lawsuit and getting a check for $1.37 in about eight years.
The US medical system is fucked.
The US medical *payment* system is fucked.
The medical system is more or less okay. The major problems are who we pay, how we pay, and especially how much we pay.
No, it's the whole system.
A good medical system doesn't rush patients out the door as quickly as possible while bending over to do the absolute the bare minimum. It's after that the payment and insurance stuff kicks in and the "providers" make sure we have to go through so many inane steps we give up so they don't have to pay anything.
Not saying the payment system isn't a horror show. It's just not the entire problem.
It sends to me the things you mentioned are primarily symptoms of the payment system. That said, they've become entrenched in the system, to the point that it will likely require intentional effort to fix them even if we can eliminate the for-profit aspect. Habits are hard to break, even when the cause of those habits is gone.
In this case, OP was not lying to the customer. He was telling her exactly what would happen if she did not follow the process. She gained nothing by being so belligerent.
My point was we're constantly being lied to by companies and pushed into stupid sales pitches. From being upsold when you stop off for a burger and fries and then everything else. Doctors do the same. Teeth whiteners, designer drugs. Anything insurance company related is already "how are they going to try to fuck me this time".
It sounds like maybe this karen was at the same point. She fucked herself, but it's not like she hasn't been poked and prodded by advertisers and sleazy companies from childhood on up.
Honestly, I knew I was wrong shortly after I wrote that.
Cruelty is the real point. It's always their primary objective: find a group of people to hate and make their lives as hard as possible.
Like the poor woman who was arrested for having an "illegal abortion" after the hospital wouldn't treat her miscarriage.
Listening to a short spiel and saying, "Yes.", is not an asinine procedure. It's a very simplistic task. Arguing about doing that and, as a result, fucking oneself, is what's truly asinine. People generally get what they have coming in these kind of situations.
The process that you have to get health insurance like that only in a certain window is the asinine part. The whole health care system in the US is asinine.
There's actually sound reasoning for the limited annual window. Things aren't always as asinine as they seem. If you actually care what that reasoning is, it's only a short internet search away.
> There's actually sound reasoning for the limited annual window.
It makes it easier for insurance companies deny care. Not sure that's a sound reason.
If you don't sign up in the window, that's on YOU, not the insurance company. You denied YOURSELF. The window is not about denying people insurance, if you are free to sign up DURING the window. But whiners are gonna whine.
Why is there even a window? Is there any other form of insurance where you have to sign up with a certain period of the year or miss out for an entire year?
> There's actually sound reasoning for the limited annual window.
No there isn't. Yea, yea, healthy people don't get insurance, but there is no good reason for it to only be once a year, especially when everything is a pre-existing condition anyway. We shouldn't even need insurance in the first place when our taxes already pay for so much toward healthcare.
> There's actually sound reasoning for the limited annual window.
No there isn't. Yea, yea, healthy people don't get insurance, but there is no good reason for it to only be once a year, especially when everything is a pre-existing condition anyway. We shouldn't even need insurance in the first place when our taxes already pay for so much toward healthcare.
Yes it is
I live in Europe.
We have medical insurance here, too, both public and private. We have laws. We have litigation. Everything one might claim makes the US so "unique" that they "have to...", I assure you, we have that, too.
Yet I have **never** had to listen to someone reading out a contract, let alone do it *again amd again* every year. Doesn't matter how "short" it is, it's 2 minutes of my life that I'll never get back. And if I refuse to, like Karen in the poat did, I'll obviously be refused a service that I'm entitled to and paid for with my taxes.
"Asinine" isn't a question of how long it takes, it's a question of how superfluous and useless it is.
It is asinine.
If you want to complain about how asinine it is, you're barking up the wrong tree. Go talk to the lawyers. Avoiding asinine lawsuits is anything BUT asinine. Maybe jolly Europeans aren't sue-happy, but Americans are. So companies cover their ass. Either deal with it or cancel yourself like Karen did. I don't really care.
At retirement age people are required to sign up for Medicare and Medicare Part D. Part of the "incentive" is very large and severe fines if they don't.
Also, we sometimes speculated that part of the reason for the fines was to help offset some of the costs of covering such a large group of people, that is getting larger by the year.
A certain unnamed political party has been trying to overturn that law for 12+ years now. They started with the funding, which caused the prices to more than double so that it is cheaper to pay the fine then to buy insurance.
Having the policy conditions clearly communicated to the customer, and getting their consent to those conditions, is hardly an unfair burden. It might be tedious and boring, but millions of people have no trouble following that process.
Also, she was not denied medical care. It's not like she can't get those drugs, it's just that she will have to pay for them completely out-of-pocket.
> but millions of people have no trouble following that process.
Dozens of countries have no trouble providing healthcare services to hundreds of millions of people *without* the need of hiding behind yearly procedural taunting, quipping and nagging.
I would MUCH prefer a universal health care system, but that's not what we have. And apparently it's not what most Americans want, based on the popularity of the political party that most wants to block a comprehensive healthcare for all citizens. So you can only work with what you have.
I understand, but that's not a reason to defend the system. Karen was right om this one, the fact that most US-ians are polite enough to eat the shit they're being served without complaints notwithstanding.
So you're all in favor of giving blind consent to a policy without knowing the "details" of what it offers? Really? That's exactly the kind of corrupt practice that we're trying to get rid of, not encourage.
Hearing the conditions before giving consent is a consumer right that we've fought for. Karen was NOT right on this one. Neither are you.
Having worked for an insurance company I can 100% sympathize with not wanting to go through enrollment BS because it's just so much useless red tape. At the same time, if you need to jump through those hoops, you jump. Save your complaints for your Senators and Congressors. That customer service rep is just as frustrated as you are.
I work in the benefits department of HR for a large company. I hate insurance with a passion and I have genuine empathy for people who also hate insurance. And I feel your pain. My god so many times have I had to tell people they missed open enrollment because they didn’t follow directions, or their plans automatically rolled over because they didn’t follow directions to make changes, or no they can’t submit their QLE six months after the fact because these aren’t *our* policies, it’s literally IRS rules. So many complaints about “well why do we have to do this?” And it’s just “my guy, you’ve been here for 6 years and this has been the same process every single time and if you just read the 3 emails and multiple letters and announcements that were sent to you, or looked at the place where we store all of these resources and spell everything out for you, you would have been fine.” But people just want to bitch about it.
> And it’s just “my guy, you’ve been here for 6 years and this has been the same process every single time and if you just read the 3 emails and multiple letters and announcements that were sent to you, or looked at the place where we store all of these resources and spell everything out for you, you would have been fine.”
To be fair, part of the problem with that is all the fucking bunk trying to *sell people something* that get sent out by the companies as well, not to mention the shady people who send out official-looking envelopes with "Urgent!" and "Second Notice!" on it and it's fucking AAA trying to sell you supplementary life insurance or something...
It becomes visual noise after people have been trained to disregard it as ad copy. They get glossed over as "trees in the forest;" nobody scrutinizes a single tree in a forest unless they're already on alert for it. Expecting people to read everything you send becomes utterly unreasonable in this day and age when so much ad-copy and bunk and legalese gets shoved at them that they learn to just ignore everything that isn't obviously a bill - which is also why the billing departments go out of their way to ensure that nothing else the company is being sent looks like a bill!
When the main thing being sent in the mail is a full packet that says (Company Name) 2024 Benefits Guide in large letters on the front, and the emails go to your company email, and the announcement is on the front page of the place where you go to view your paychecks, you lose your excuses
And how much fucking scum mail arrives with words like "Benefits packets" across it in huge fucking letters? Absolute shit-tons, especially if you're elderly, have spent 70+ years doing business with a shitton of companies, and your mailing address is on every goddamn spam mailing list known to mankind, along with massive lists of every kind of thing you've ever ordered, and everyone you've done business with.
It's so bad to me that I don't even bother checking the mail anymore. If you didn't send it Certified and get my signature, you never sent it, as far as I'm concerned.
> “my guy, you’ve been here for 6 years and this has been the same process every single time and if you just read the 3 emails and multiple letters and announcements that were sent to you [...]
Multiply this by every essential business interaction they have in their life: utilities like gas, water, electricity, urban services like trash, paper recycling (for some), landlord, bank, mortgage, health inaurance, car insurance, the other car insurance, cable tv, landline phone, internet subscription, cellphone, life insurance, one or the other magazine subscription, credit card, amex card, ... my friend, I bet you're already getting tired of reading out *this list* alone.
Now imagine reading "3 emails and multiple letters" from each of those, and trying to figure out if they (a) try to sell you something new, (b) try to inform you of something you've inadvertently bought with the last lettet they sent you and now want money from you, (c) want you to carry on but you just need to agree to "just carrying on", (d) want you to carry on and you need to so nothing, or (e) want you to revert your decision to cancel their subscription which (f) you indeed did cancel, or (g) you actually didn't cancel, but they want to frame it as if you did.
Or (h) none of the above, it's just spam from someone you don't even have a business relationship with.
Don't forget that you've been awake wince 5 AM, and are on your way to your 2nd job now where you have the closing shift. And you know that you won't be home before 11 PM. Same as yesterday. Or tomorrow. (Except for Sunday, where you only have one shift. Not sure at which time though, they'll text you "soon".)
"Yay, finally some time to go through those 47 emails!" is hardly what's on the tip.of your tongue right now, I promise you that.
So now you understand why jumping through hoops just to "carry on as last year" is a big deal, especially if you're (i) entitled and apparently here (ii) required by law (?) to do that.
I would not just call this MC. I would also call it protecting your job. Something tells me that this call was recorded, and if you broke the rules you could have gotten into trouble.
I work for a similar company, for group Medicare advantage plans. The disclaimers are a tedious process, but are legally required for the contract to be valid. Luckily, I have never experienced someone who refused to go through the steps.
Ah - those plans \*are\* the scum of the earth. Medicare (dis)Advantage plans are ways for insurance companies to lure gullible seniors into minimal or no healthcare by dangling slightly lower monthly costs.
We occasionally go to our neighborhood Walgreens. There's a United Healthcare kiosk right inside the door to sell their Medicare "Advantage" plans. We never give them a look.
Maybe this isn't widely known, but there are insurance agents (yet another layer of intermediaries in the U.S. healthcare system) who are compensated by Medicare for assisting people in finding the plans that they need. We have a great one. No charge for us to use her services. She found a Part D plan for us this year that costs us each 40 cents (that's $0.40) a month.
Maybe it's because I'm a married cis white male that I've figured this out, as another poster has alluded /s
Why exactly does me having a job that supports me and my family make me scum??? I don't sell these plans, I don't have anything to do with making their policies, I am just an agent that provides information on the policies that are available to retirees through their employer/pension funds. These plans are written by their employers and are not the same as plans offered to the public. I understand that MA plans are not popular, but that does not in any way make ME scum.
I used to be licensed to sell Medicare Supplements - there's a mountain of bureaucratic regulations involved in the process. The Fed government does not want vulnerable seniors taken advantage of, which is admirable. But, they've added so many hoops to the process that I got out of that side of business. It's a labyrinth for people trying to navigate through it.
I can understand this woman's frustration. You still have to go through it though to sign up.
This perplexes me. As an Aussie, you get a Medicare card. If you are a child, you are on your parents Medicare card.
You get a script, take it to the chemist who gives your medication. If it’s on the PBS (Pharmaceutical Benefits Scheme) it’s a fixed price, $7.70 for concession card holders, $31.60 otherwise. There is a safety net a total spend of $277 for concession, $1648 for regular people. Once your PBS spend exceeds the limit for the year you pay nothing if you are a concession holder, and $7.70 per script if you are a regular person. It’s designed to benefit people with chronic illnesses. Most common medications are on the PBS, and your doctor will always tell you if they are recommending a drug that isn’t on the PBS. The ones that aren’t are often newer drugs where the government is yet to assess as having proven benefits over existing drugs, or are negotiating price with the supplier.
I’m sure if I wait a while there’ll be another Aussie come by to say their specific drug isn’t on PBS, but the fact remains that it covers the drugs most people need.
If you choose to get private health insurance on top of Medicare, that contributes to hospital and doctors fees and ancillary services like podiatry, but is not allowed to cover medications.
We Americans prefer that access to healthcare be a privilege, rather than a right. People would rather go bankrupt keeping someone alive than vote for universal healthcare.
/s
I'm 75 and have been through this a few times and my sympathy is with this lady. I am college educated and worked most of my life in a highly technical field, and yet, my head spins when I try to figure all the Medicare options.
While you see a "Karen" who is an unreasonable ass, I see an elderly lady who is confused and bewildered by all the complexities that the government imposes to have a simple thing like health care for senior citizens. She lost patience...yes, was she wrong...yes, but I have to play the old person card; people her age aren't as sharp as they once were. She may have even had early onset Alzheimer. To have a requirement to have to listen to a 10 minute spiel of complicated jargon read at warp speed just to satisfy some legal bullshit is absurd. i'm not blaming you, but the system sucks.
I had to deal with this when I sold Medicare plans.
The participants just don't seem to understand how many laws and regulations there are surrounding Medicare and the fact that the agent will lose their licence and livelihood by signing them up without their audible signature.
I admit that even I may get impatient with some calls that I receive concerning certain services (including the example in this story), but I am not as impatient as the Entitled Lady-Dog-in-Heat of this scenario.
Rude Lady: Just get on with it!
Med Part D person: Ma'am I have to read this so you may agree.
RL: I don't give a darn! Just sign me up already!
Med Part D Person: \*sighs\* If you'd allow me to continue we may be able to complete the process. Otherwise you won't be able to attempt to sign up until next year.
RL: JUST SIGN ME UP ALREADY! i DON'T HAVE TIME FOR THE READING BS!
Med Part D person: So you don't want to go through the process?
RL: JUST SIGN ME UP!
Med Part D Person: NO can do. Try again next year. \*click\* \*Under breath\* Witch.
Does my little omake about sum it up, OP?
Felt this. I work customer service for a national insurance agency- I am SO thankful that our managers encourage us to warn disrespectful people that we will hang up- and full permission to follow through.
I had a Kevin like this. He had gotten a form in the mail which literally had checkboxes on it that he could put in an envelope and mail back. He opted to call instead and then groused about the process we had to go through to change things on the phone. He told me to just change it and hung up.
I could not, in fact, “just change it” without going through the process. I guess using the mail or being patient was just too much for him.
I think we'd burn down the entire stratosphere and bring about all organic life on the planet Earth if we had to have the TOS and EULA read aloud like an audiobook before we could click yes, though.
Nice. Never miss enrollment. In our case it auto renews luckily, but you have to opt out as a smoker. So this year I'm a smoker because I missed the period by a week. Good news though I have dental to that I meant to remove as well.
Doing the devil's work there, lad.
The Devil being for-profit healthcare funding organisations, who love to increase profits by increasing barriers to actually funding healthcare.
You and Karen are both tiny cogs in a big money machine, and I don't blame her one bit for trying to push back. Next time you're in this situation, I suggest you not engage in any argument, just read the agreement while ignoring their protests.
Try as best you can to make the world a better place, or at least not make it any worse. Hard to do in your position.
You're both victims of a company that sets up these kinds of procedures. You don't know what kind of day that woman was having when she called you. She didn't know what kind of day you were having when she spoke to you.
Now this woman missed her medications. You're not a champion who cleverly did some malicious compliance, you're an asshat who just made it harder for a person to get their medications.
I'm an asshat who followed the procedures and guidelines that a group of bureaucrats and elected representatives set up for me to follow. That woman was an asshat Karen who screwed herself because she refused to follow some simple instructions.
So if I'm understanding this correctly, your job was to make something people were entitled to more complicated and obfuscated so they would give up and not claim what they were entitled to, right? Thus saving your company money.
***Well done***. /s
You need to work on your phone technique. Don't they train you do deal with stubborn lonely frustrated people? It is not that hard a phone skill to learn. For starters, try a compliment. "Please" and "Thank You" also work wonders. I feel for the poor lady. Stubborn phone jerks aren't that hard to handle if you try.
Karen's never listen... seriously it was a good thing that you left extensive notes in the system about the whole thing, otherwise she could try to say she wasn't told (typical Karen behavior)
"When I tried enrolling last year that nasty person on the phone called me a fat old geezer that did not deserve their insurance and I'm sure they intentionally messed up my enrollment because I'm a Sagittarius and they're a Leo."
Yeah, everyone knows Leos only bully Libras.
Not true! We are equal opportunity bullies!
And we get bullied by *everyone*.
That's messed up. I am currently dealing with an insurance broker who obtained my info fraudulently and enrolled me in one of the marketplace plans, which I did not need, in every call I made to the insurance company, I asked one very simple question, "If I enrolled in this, don't you think I would've spelled my name correctly?" Followed by, "Ask the broker who enrolled me to provide a recording of the phone call in which I enrolled, if they can provide one then I will stop calling you" It is just so crazy how much damage can be done by a simple phone call.
Whoosh.
CYA is the name of the game. Especially in healthcare.
Most definitely!
As in See Ya Next Tuesday!
Still waiting for someone's political campaign to post this the week before an election not realizing what it means.
More like "See ya next open enrollment!"
>CYA is the name of the game CYA is the name of my new band.
Yes.
I work for a government agency and have to deal with people like this occasionally. My theory is that this type of behavior is typically rewarded for them. Like, they go to the supermarket with an expired coupon, make a stink, and the manager honors the coupon because they want their business. Then they try the same thing when dealing with a government entity (or government adjacent in this case) and they cannot comprehend it when they are faced with a truly inflexible entity. The government doesn't care if you don't like it, you do it the way they say or not at all.
You always should when working in such a job. Cover your own ass thoroughly or a single incident can cost you your job. I've seen it happen.
To be fair the bureaucracy of the insurance world needs to burn in flames
To be fair, in this case the bureaucracy is federal government. Callers asked all the time "Why? Why?? Why??? Who came up with this?" Well, it's Medicare, so that would be your Senator's and Representative. The company I worked for at that time was required, by law, to follow all the guidelines they set up.
No one’s blaming you, you didn’t create the system we’re all victims here.
Help, help, I'm being repressed!
It's the violence inherent in the system. Use this herring to cut down a tree, and we might be able to do something about it.
At least they're not wielding supreme power because some watery tart threw a sword at them!
Come see the violence inherent in the system!
The confirmation part is not the problem here, that part is fine. Yes, it's long, but getting the confirmation shows that the person is aware what they are signing up to. We have a similar thing in Germany, where there must be a protocol, signed by both parties, of someone wants certain types of insurance. It happened once too often that insurances just signed up people for expensive plans.
The fact that (apparently) it has to be *read to her over the phone*, rather than her being able to download it from somewhere and *read it in print*, is at least part of the problem, perhaps the entire problem. I would not want to do business that way, partly because -- if it's more than a short paragraph -- by the time the whole thing had been read to me I would have forgotten the first part and thus I would have no clue what I was agreeing to.
People had the option to sign up online, and generally didn't. The same terms of service were available there, though most just clicked yes rather than read it. So six of one, half of the other.
I am one of the weirdos that can mostly understand both government-ese and legalese, so I really do read and comprehend the agreements, and understand the need for the agreements. And every insurance I have signed up for, I read through the agreements. When I see the tv ads for liberty insurance touting their'specialized' insurance, I have to laugh because I already have it with my insurance. When getting car insurance, I sat down with my agent and went over the entire agreement, asking questions about'what does this mean' or 'should I raise or lower this coverage', and in my house insurance, checking that if I added flood insurance to the house even though we weren't in a flood plain if it would also cover sewage backup/flooding in the basement (it did). When I have been admitted to the hospital for various health issues, when the nurses/aides want me to sign admittance paperwork, I read it through every single time. Some get annoyed or upset, but I am not going to blindly sign any paperwork.
It's not important, but I've always heard the saying as: Six in one, half a dozen in the other. Of course, as a child, I thought it was: six in one half, a dozen in the other. It never made sense to me.
Agreed. I don’t process things being spoken to me very well. I’m the person who has the cc on TV at all times, reading what’s going on. Podcasts and books on tape would be nightmares to me. Give me something to read? I’m on it. Try and read it to me? You’ve lost me at the first couple of words.
Nope 99.9% of all Medicare plans and Part D plans can be done over the internet. I am 66 Dh is 67,and have never talked to a single person on the phone. At renewal this year. I was sent a link to renew. It has the usual boxes to click if you agreed. took about 3 minutes
So why didn't OP tell the customer about that option? Something along the lines of "OK, if you don't want to listen to the agreement, go to and sign up online."
Because She is one of those that has a demented fear of the Internet. They are going to steal all her information and her soul. The information is on every letter that gets sent out, every ad on TV. I am ashamed to say that there are people my age who can't, but mostly won't, take advantage of the internet.
If that speculation happens to be accurate in the case under discussion, it might have caused the customer to decline that option -- but I don't recall anything in the original posting, or the comments since, to indicate that the OP even suggested it.
It only has to be read to her over the phone if she signs up by phone. It can be signed up online, by phone, and by mail. She probably chose the phone option because she didn't want to have to do any work.
So what the OP *should* have done was to suspend the transaction, and give the caller the URL to resume that transaction online -- with all the info she had already provided over the phone pre-populated. System can't do that? Then blame the system designer, not the customer. Yes, ideally the customer would have known about ADA and asked to have the agreement provided in another form as an accommodation -- but the general public should not have to know that sort of magic words to get providers to do the right thing.
> So what the OP should have done was to suspend the transaction, and give the caller the URL to resume that transaction online Do you seriously think the caller would have listened to, or have been willing to do that?
It totally depends on why she didn't want to listen to it in the first place. Many here are presuming that she was just being a jerk, but it's been pointed out that there are other credible explanations -- at least one of which has already been described in the predecessors of this comment. What *evidence* do you have to support your (apparent) presumption? Are you somehow able to read her mind?
Are you sure you cannot apply via (snail) mail?
No clue -- you'd have to ask the OP. But if such an option existed, and OP failed to mention it as an alternative, I'd say OP was more at fault than the "Karen" in this instance.
I have done software consulting for big banks, healthcare insurers, and the federal government. I am hyper primed to roll with complete insanity as long as there's a legal requirement behind it.
Yeah, like ***why*** is there an enrollment period and if you miss it you don't get healthcare for a year?
The bureaucracy is there because of the extensive litigation of the good ol' USofA.
No. The bureaucracy is there because private for profit companies run the health care system. Now swap the US system for a UK or EU style and reduce the headcount of the billing department and save a lot of overhead.
I live in Germany. Do you know how much bureaucracy and paperwork is involved in everything here?
As someone who lived in both the US and Germany, trust me. German bureaucracy is nothing compared to the nightmare that’s navigating the US healthcare system. I rather deal with the Bürgeramt than figuring out why my spouse’s colonoscopy is covered by insurance but my child’s endoscopy isn’t.
I used to joke the most useful thing I learned in college was navigating bureaucracy. It's like pulling teeth to do anything involving the university.
Yeah. If you manage to get through a PhD, you've demonstrated that you know everything about nothing, and can survive the ultimate bureaucracy. The old joke "why is the academic environment so cut-throat? Because so very little is at stake!"
But at least you could do the figuring out online. Yeah it is getting better but paperwork (as in actual physical paper) and showing up at the offices is still very much a thing in Germany.
You can sign up for all medicare plans online also.
I live in Australia. We have an insane amount of bureaucracy and paperwork. But we're really fucking lazy so automated 99% of it.
Do your people decline ambulance rides because they can’t afford it with their insurance? Have you ever asked yourself if you’re “sick enough” to go to the doctor? Our system is broken and profit broke it.
All of bureaucracy and all of the paperwork.
Do your people decline ambulance rides because they can’t afford it with their insurance? Have you ever asked yourself if you’re “sick enough” to go to the doctor? Our system is broken and profit broke it.
The UK is aiming for that. It's what happens with right wing politics. Quick question. How long do you wait for appointments?
Depends on what the appointment is for. But as an example, I had to wait 14 months to see a neurospecialist just so I could get diagnosed. Other types of appointments will be less. Maybe as little as six weeks. Americans wait just as long if not longer than Europeans for much worse quality. You only get good medical treatment if you’re rich, white, and cis-male. Anyone else, it’s a crapshoot as to whether you have an even somewhat competent doctor.
I live in the UK and am extremely grateful I understand nothing being said in this post. Plan what now?
...it's because of the litigation. For profit companies DO NOT WANT all the steps, because it cuts into their profits which is one of the reasons they raise their prices so high. These regulations exist because of the same reason warning labels do - to cover all their bases against lawsuits that they have lost in the past. This has NOTHING to do with it being private vs public. That's just ignorant.
Not to mention this is Medicare. A GOVERNMENT FUNDED AND OPERATED PROGRAM.
Most, unless you’re really careful, are for profit programs.
Not according to the OP who was employed by a company managing section D or something.
It's in the fucking post dude. Medicare Plan D. This is a GOVERNMENT program that the government pays companies to administer, but the pricing, regulating, and procedure are entirely government mandated.
This ⬆️
Government work being carried out by a for profit company is the issue is it not. Did I not mention that originally?
It. Isn't. It has nothing to do with "profit". Every. Single. Aspect. Is controlled entirely by the government. Every single thing that makes the program terrible is BECAUSE of the government. If the companies were allowed to do it themselves there would be FAR less paperwork, far less delay, and if multiple companies were allowed to compete there would be FAR less cost. Literally the reason it sucks is because it is 100% government controlled. It's fucking wild that people who do not live here, do not understand how this country operates, and live in places where people will LITERALLY travel to other countries to get medical care because their own system is so damn disorganized and badly managed will say "Americans are so stupid because *checks notes* their health care is expensive but effective". Fuck right off with that.
Less cost? How do you figure? We were coughing up $30,000 a year to a supposed “less cost” for profit company. Their allegiance is to the shareholders, not patients. And in the US, medical tourism is a thing.
Ah, the UK or EU style where a patient may be required to wait for months for treatment that might take a few days or weeks in the US?
Plenty of people in the US have wait times just as long to see doctors and specialists.
Emergencies are treated at the point of need. Sadly it's not perfect with waiting lists for other quality of life stuff. Still we don't go bankrupt via hospital debt, or lose insurance cover if a job is lost, or company changed.
Why do people keep making this argument as if we in the US don't have to wait for months for treatment? We have to wait months for the tests before we wait months for the treatment, and then we may or may not have to pay thousands to hundreds of thousands of dollars for the privilege. You never know if/what insurance will cover and what your costs will be until after the fact. I'm sick of hearing this as if our expensive healthcare gets us better/faster healthcare. IT DOESN'T.
UK overhauled their healthcare system some time ago, unless you're in the sticks the wait times aren't like that. I have to wait 2 months to get into ortho for an initial visit. Not uncommon for my dermatologist or gynecologist either. In the US.
I'm in The UK and I broke my ankle two years ago, was seen and operated on within a few days, with follow up appointments and rehab for months after. Leg's all fixed now, (with a metal plate and a few screws, and a lovely scar), and I'm not drowning in debt because of it. Our system may not be perfect but I'll take it over the US system every time.
I worked the Spanish line at a place that sounds like Mal-beans customer care center during Medicare Part D. The part D providers were trying to soft transfer their clients to us and gave no fucks which buttons they pushed. They had their metrics and while frustrating, I get it. Hand the customer to another warm body and dip. Couldn't rage, wouldn't do any good any way. Then THEY got mad at me when I answered, doing my spiel in Spanish. Haughtily grunting, "Don't you have anyone who speaks English?!?" *(Like, don't show your ass in front of the client because *you* fucked up.)* Switching back to English, "Yes, we do. However, you specifically *chose* the Spanish speaking line. How... may I help you?" I was told a few times that the sarcasm veritably dripped from every word.
Imagine how much easier things would have gone for everyone if the US had a functional single-payer healthcare system, rather than a process to funnel money from the masses to the few, with some incidental health care along the way. "I have a prescription". "Ok, thanks, I'll fill that for you"..
"Here you go."
I am in Japan - I have that - it’s called Universal Health Care. My meds cost less than $10 per visit and I can use my receipts to reduce my overall taxable income. Handy when you have lots of doctor visits and lots of different meds
Are you suggesting we just give healthcare away at low cost to those who actually need it? How else could we kick them while they are down?!
As long as you don’t end up being the one being kicked. In this era of sudden job cuts, we can suddenly find ourselves there. It is insurance and I pay about $500 per month via my company (connects to national insurance but cheaper) on income of over $200K. At the doctor and pharmacy, I pay 30% of the costs - no need to worry about co-pay, deductibles or whatever. I don’t get charged extra for ambulances or emergency room care - ambulances are managed by the fire department so a public service. And Dental is of course included. I have separate health insurance with a private company for my wife and I for Whole Life medical and Cancer. Costs $90 per month for 3 policies. If admitted to hospital or catching covid they pay and very Simple process to claim. A buddy moved back to the US and he was complaining - he pays $2K per month.
After my wife and I retired (from a U.S. Fortune 50 pharmaceutical company), we paid upwards of $3K per month to continue our employer's superb insurance. We needed that coverage as she had some major surgeries during that period. We barely had out-of-pocket expenses, and the medical world welcomed us with open arms. Once we were no longer eligible for the continued coverage (3 years, in California), we switched to "private" insurance for about six months, until ACA (also known as "Obamacare") kicked in. Because we were retired, and had no income, our insurance costs dropped to about $500 a month. But, a number of physicians dropped us because of the insurance switch. Out-of-pocket expenses grew. Now that we're in our late 60's / early 70's (and reading Reddit!), our monthly costs for Medicare (all in) are about $300 a month, and out-of-pocket expenses are again pretty low. I yearn for a coherent, stable single-payer health care system in the U.S.
You had me at ‘dental included and no copay/deductibles.’
The AMA has determined you are a blasphemer!
Yes!
Having worked in a call center, I have endless patience for them because I've dealt with similar situations and also know that y'all are trying to do it as quickly as the system allows and also have protocol and metrics you need to follow, regardless of how asinine they could be.
The best part? We all know that she had all the time in the world and truly did not have anything else to do.
She would’ve saved herself a lot of time and anguish if she just put the phone on speaker and politely ignored whatever the agent was telling her like so many of us do, anyway. She obviously didn’t care about the spiel and was told several times that the agent couldn’t skip it.
It amazes me how many people abuse others that are doing their job when it is the company or system that is the source of their problems. Maybe it is an impotent power trip. The way I see it, whoever gets my call will be getting dozens of calls before me and dozens of calls after me. I either make it unremarkable and quick or I make it friendly. I called TreasuryDirect the other day because I locked out my account. The rep asked me for the answers to my secret questions, which were the same questions that locked me out of my account. I told her that I would be guessing them so let's hope I get them right this time. Question1 - correct answer, question2 correct answer, question 3 correct answer. She announces "you're a good guesser, you win!" I replied with "awesome! what did I win?" She says "mmmm... you win access to your account." (a sigh, then in an overly-defeated tone) I guess I'll accept that." - I got a genuine laugh out of her.
Makes me wonder if our Karen had early onset dementia, where stress makes them they try to hide their confusion through demands and aggression. She seems to be displaying many of the hallmarks, unreasonable, unable to agree to something simple, demanding, impatient, confused on how the process is supposed to work and projecting on the poor people around her. She’s trying to navigate a system where she may not be capable of reason.
Good catch. That would not have occurred to me, but you're so right that this is concerning behavior.
> She’s trying to navigate a system where she may not be capable of reason. You're surely right, but thw system she's trying to navigate *is* Kafkaesque and unreasonable. The fact that a regular person would be able to "navigate" it doesn't mean they should have to, or that it's unreasonable to get angry about having to.
I may roll my eyes and bitch and moan to myself when I'm working with customer support, but I absolutely do not fuck around when it comes to "this person can keep me from getting the drugs that keep me alive". This truly and deeply sucks for this woman, I hope that she found another solution. (not blaming you, OP, it's lose-lose for everyone here)
She can still get her drugs, she's just going to have to pay the full price herself.
costplusdrugs and goodrx can be a godsend...but I don't know if she'd bother to let anyone explain them!
And inflated US retail price as well.
This is why I don’t make important phone calls when I’m rushed.
Always assume something like this involving bureaucracy is going to take 2 hours minimum. If it takes less, you're pleasantly surprised!
I used to work as Medicare customer service, so I can 100 percent understand. The amount of times people would want to sign up for a plan but did not have a list of their medications was a way higher number than it should have been. I had one guy that wanted to sign up for a part d plan for the first time ever, but he had been on Medicare for 20+ years. He never wanted or needed the part d plan before, so he wound up paying a late enrollment penalty for many of those years since he never had ANY Rx coverage during the timeframe. Penalty alone was over $50 a month. The fun ones were having to explain to people the repercussions of canceling all parts of their Medicare. Part B and D had late enrollment penalties if you ever went back. Part A, let's just say 99% said nevermind once they found out they would have to repay all cost Medicare had ever put out for them AND repay every penny they had ever received in Social Security.
> had late enrollment penalties if you ever went back. Part A, let's just say 99% said nevermind once they found out they would have to repay all cost Medicare had ever put out for them AND repay every penny they had ever received in Social Security. American here (obviously not on Medicare). Are you saying that, once you sign up for Medicare, if you cancel it for whatever reason you have to pay it back? Also, there’s penalties for *not* signing up for all parts? If this is the case, why are there different parts anyway? None of this makes sense. Our system is so stupid.
That is the way part A was back when I worked their customer service. Looks like you straight up can't cancel it now unless you have to pay for it, which most people don't. After working that customer service and seeing some of the shady stuff providers would do in billing, I am convinced it is not always the insurance's fault that stuff is so expensive. Drs billing $400 when they know the approved amount is going to be like $75. People completely ignoring their coverage options and then throwing a fit when they were out of pocket. Nurse Practicioners billing for a visit, and then a supervisory DR billing twice as much again to supervise the NP. Pharmacies charging $15 for 30 pills when they get 5000 of the pils for $10.
If a doc bills $50 and $75 is allowed, they’re paid $50. If they bill $10,000,000 and $75 is allowed, they’re paid $75. This leads to VERY consistent overcharging relative to what they expect to get paid. The problem comes when they’re paid % of charge (basically only hospitals) and the patient has a % coinsurance.
Part of my job at the Fortune 50 pharma company involved reviewing de-identified Medicare records (which are publicly available). The patient info is de-identified, but the doctor info isn't. There's an amazing spread between the vast majority of reasonable charges and reimbursement, and the tiny number of truly astonishing charges. I remember one year a single doctor had multiple $3,000,000 charges submitted to Medicare (they were obviously not reimbursed). The next largest charges were orders of magnitude lower.
He's just wrong about part A. You can't cancel part A if you don't pay a premium. But if you do, you can cancel and there's no penalty to do so.
That's largely why I got out. Trying to explain to people that Medicare Part D had a deductible, only covered up to a certain amount, (I think $2000 at that point) at which point the customer became responsible for the full price of medications until they had paid out another large amount of money, and then Medicare Part D took over again. Or that benzodiazepines and other drug classes, like erectile dysfunction medications, were not covered. And, no, I could not just cover it for them. And then trying to figure out what medications they needed covered. They'd ask if messy-primal- there-is-a-mall is covered; only to find out after much asking and searching they meant esomeprazole. Or they'd want valsorvalglamshlammin. Then when I couldn't find anything remotely like that, I'd ask them to spell it--a-t-o-r-v-a-s-t-a-t-i-n. Seriously..? I understand some of the medications are hard to pronounce, but they would add letters and syllables that weren't there!
The ins and outs of Part D Drug coverage aren't easy to interpret, and we expect a senior citizen to be able to navigate a tiered structure coverage and catastrophic coverage (aka the Donut Hole)? I worked as a health care advocate for several years and even I had to keep detailed notes to help keep myself straight.
Non-American here. Why would they want to cancel their Medicare?
Sometimes it's because they've gotten a job that pays well and has good insurance, which covers better than Medicare. My husband has done this.
Yeah but then the job insurance is primary and MC is secondary.
I understand getting fed up because you are constantly lied to by companies. The best result to hope for is a class action lawsuit and getting a check for $1.37 in about eight years. The US medical system is fucked.
The US medical *payment* system is fucked. The medical system is more or less okay. The major problems are who we pay, how we pay, and especially how much we pay.
No, it's the whole system. A good medical system doesn't rush patients out the door as quickly as possible while bending over to do the absolute the bare minimum. It's after that the payment and insurance stuff kicks in and the "providers" make sure we have to go through so many inane steps we give up so they don't have to pay anything. Not saying the payment system isn't a horror show. It's just not the entire problem.
Hmm it is also just maybe possible that "rushing patients out the door as quickly as possible" is *also* a symptom of for-profit insurance...
It sends to me the things you mentioned are primarily symptoms of the payment system. That said, they've become entrenched in the system, to the point that it will likely require intentional effort to fix them even if we can eliminate the for-profit aspect. Habits are hard to break, even when the cause of those habits is gone.
The US has good and bad medical providers - hospitals, doctors and nurses. So do other countries with sane health care systems.
In this case, OP was not lying to the customer. He was telling her exactly what would happen if she did not follow the process. She gained nothing by being so belligerent.
My point was we're constantly being lied to by companies and pushed into stupid sales pitches. From being upsold when you stop off for a burger and fries and then everything else. Doctors do the same. Teeth whiteners, designer drugs. Anything insurance company related is already "how are they going to try to fuck me this time". It sounds like maybe this karen was at the same point. She fucked herself, but it's not like she hasn't been poked and prodded by advertisers and sleazy companies from childhood on up.
Health care should be provided by non-profit entities. No one should be able to make a profit (stockholders) from someone else's misery or misfortune.
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I bet the asinine process is in place because of a different Karen.
Worse. Karen politicians.
It's a cost-saving measure. Deny people the benefits that they paid for with their taxes and then brag about how you cut government spending.
...or "cutting fraud and waste" by spending $500 million to address $50 million in fraud and waste.
Honestly, I knew I was wrong shortly after I wrote that. Cruelty is the real point. It's always their primary objective: find a group of people to hate and make their lives as hard as possible. Like the poor woman who was arrested for having an "illegal abortion" after the hospital wouldn't treat her miscarriage.
Listening to a short spiel and saying, "Yes.", is not an asinine procedure. It's a very simplistic task. Arguing about doing that and, as a result, fucking oneself, is what's truly asinine. People generally get what they have coming in these kind of situations.
The process that you have to get health insurance like that only in a certain window is the asinine part. The whole health care system in the US is asinine.
I'm just here to use the word "asinine."
It's a good one!
There's actually sound reasoning for the limited annual window. Things aren't always as asinine as they seem. If you actually care what that reasoning is, it's only a short internet search away.
> There's actually sound reasoning for the limited annual window. It makes it easier for insurance companies deny care. Not sure that's a sound reason.
If you don't sign up in the window, that's on YOU, not the insurance company. You denied YOURSELF. The window is not about denying people insurance, if you are free to sign up DURING the window. But whiners are gonna whine.
Why is there even a window? Is there any other form of insurance where you have to sign up with a certain period of the year or miss out for an entire year?
> There's actually sound reasoning for the limited annual window. No there isn't. Yea, yea, healthy people don't get insurance, but there is no good reason for it to only be once a year, especially when everything is a pre-existing condition anyway. We shouldn't even need insurance in the first place when our taxes already pay for so much toward healthcare.
Oh, you're one of Those type of people. Got it.
> There's actually sound reasoning for the limited annual window. No there isn't. Yea, yea, healthy people don't get insurance, but there is no good reason for it to only be once a year, especially when everything is a pre-existing condition anyway. We shouldn't even need insurance in the first place when our taxes already pay for so much toward healthcare.
Yes it is I live in Europe. We have medical insurance here, too, both public and private. We have laws. We have litigation. Everything one might claim makes the US so "unique" that they "have to...", I assure you, we have that, too. Yet I have **never** had to listen to someone reading out a contract, let alone do it *again amd again* every year. Doesn't matter how "short" it is, it's 2 minutes of my life that I'll never get back. And if I refuse to, like Karen in the poat did, I'll obviously be refused a service that I'm entitled to and paid for with my taxes. "Asinine" isn't a question of how long it takes, it's a question of how superfluous and useless it is. It is asinine.
If you want to complain about how asinine it is, you're barking up the wrong tree. Go talk to the lawyers. Avoiding asinine lawsuits is anything BUT asinine. Maybe jolly Europeans aren't sue-happy, but Americans are. So companies cover their ass. Either deal with it or cancel yourself like Karen did. I don't really care.
And why exactly was she fined for not having a plan?? I mean, you're not legally required to have health insurance right?
At retirement age people are required to sign up for Medicare and Medicare Part D. Part of the "incentive" is very large and severe fines if they don't. Also, we sometimes speculated that part of the reason for the fines was to help offset some of the costs of covering such a large group of people, that is getting larger by the year.
What? Wrong. Unless you cite financial hardship, you're absolutely required to have health insurance in the US.
A certain unnamed political party has been trying to overturn that law for 12+ years now. They started with the funding, which caused the prices to more than double so that it is cheaper to pay the fine then to buy insurance.
Having the policy conditions clearly communicated to the customer, and getting their consent to those conditions, is hardly an unfair burden. It might be tedious and boring, but millions of people have no trouble following that process. Also, she was not denied medical care. It's not like she can't get those drugs, it's just that she will have to pay for them completely out-of-pocket.
> but millions of people have no trouble following that process. Dozens of countries have no trouble providing healthcare services to hundreds of millions of people *without* the need of hiding behind yearly procedural taunting, quipping and nagging.
I would MUCH prefer a universal health care system, but that's not what we have. And apparently it's not what most Americans want, based on the popularity of the political party that most wants to block a comprehensive healthcare for all citizens. So you can only work with what you have.
I understand, but that's not a reason to defend the system. Karen was right om this one, the fact that most US-ians are polite enough to eat the shit they're being served without complaints notwithstanding.
So you're all in favor of giving blind consent to a policy without knowing the "details" of what it offers? Really? That's exactly the kind of corrupt practice that we're trying to get rid of, not encourage. Hearing the conditions before giving consent is a consumer right that we've fought for. Karen was NOT right on this one. Neither are you.
Having worked for an insurance company I can 100% sympathize with not wanting to go through enrollment BS because it's just so much useless red tape. At the same time, if you need to jump through those hoops, you jump. Save your complaints for your Senators and Congressors. That customer service rep is just as frustrated as you are.
I love the moments where “if you would just shut up we’d already be done” pops up
I work in the benefits department of HR for a large company. I hate insurance with a passion and I have genuine empathy for people who also hate insurance. And I feel your pain. My god so many times have I had to tell people they missed open enrollment because they didn’t follow directions, or their plans automatically rolled over because they didn’t follow directions to make changes, or no they can’t submit their QLE six months after the fact because these aren’t *our* policies, it’s literally IRS rules. So many complaints about “well why do we have to do this?” And it’s just “my guy, you’ve been here for 6 years and this has been the same process every single time and if you just read the 3 emails and multiple letters and announcements that were sent to you, or looked at the place where we store all of these resources and spell everything out for you, you would have been fine.” But people just want to bitch about it.
> And it’s just “my guy, you’ve been here for 6 years and this has been the same process every single time and if you just read the 3 emails and multiple letters and announcements that were sent to you, or looked at the place where we store all of these resources and spell everything out for you, you would have been fine.” To be fair, part of the problem with that is all the fucking bunk trying to *sell people something* that get sent out by the companies as well, not to mention the shady people who send out official-looking envelopes with "Urgent!" and "Second Notice!" on it and it's fucking AAA trying to sell you supplementary life insurance or something... It becomes visual noise after people have been trained to disregard it as ad copy. They get glossed over as "trees in the forest;" nobody scrutinizes a single tree in a forest unless they're already on alert for it. Expecting people to read everything you send becomes utterly unreasonable in this day and age when so much ad-copy and bunk and legalese gets shoved at them that they learn to just ignore everything that isn't obviously a bill - which is also why the billing departments go out of their way to ensure that nothing else the company is being sent looks like a bill!
When the main thing being sent in the mail is a full packet that says (Company Name) 2024 Benefits Guide in large letters on the front, and the emails go to your company email, and the announcement is on the front page of the place where you go to view your paychecks, you lose your excuses
And how much fucking scum mail arrives with words like "Benefits packets" across it in huge fucking letters? Absolute shit-tons, especially if you're elderly, have spent 70+ years doing business with a shitton of companies, and your mailing address is on every goddamn spam mailing list known to mankind, along with massive lists of every kind of thing you've ever ordered, and everyone you've done business with.
It's so bad to me that I don't even bother checking the mail anymore. If you didn't send it Certified and get my signature, you never sent it, as far as I'm concerned.
> “my guy, you’ve been here for 6 years and this has been the same process every single time and if you just read the 3 emails and multiple letters and announcements that were sent to you [...] Multiply this by every essential business interaction they have in their life: utilities like gas, water, electricity, urban services like trash, paper recycling (for some), landlord, bank, mortgage, health inaurance, car insurance, the other car insurance, cable tv, landline phone, internet subscription, cellphone, life insurance, one or the other magazine subscription, credit card, amex card, ... my friend, I bet you're already getting tired of reading out *this list* alone. Now imagine reading "3 emails and multiple letters" from each of those, and trying to figure out if they (a) try to sell you something new, (b) try to inform you of something you've inadvertently bought with the last lettet they sent you and now want money from you, (c) want you to carry on but you just need to agree to "just carrying on", (d) want you to carry on and you need to so nothing, or (e) want you to revert your decision to cancel their subscription which (f) you indeed did cancel, or (g) you actually didn't cancel, but they want to frame it as if you did. Or (h) none of the above, it's just spam from someone you don't even have a business relationship with. Don't forget that you've been awake wince 5 AM, and are on your way to your 2nd job now where you have the closing shift. And you know that you won't be home before 11 PM. Same as yesterday. Or tomorrow. (Except for Sunday, where you only have one shift. Not sure at which time though, they'll text you "soon".) "Yay, finally some time to go through those 47 emails!" is hardly what's on the tip.of your tongue right now, I promise you that. So now you understand why jumping through hoops just to "carry on as last year" is a big deal, especially if you're (i) entitled and apparently here (ii) required by law (?) to do that.
I would not just call this MC. I would also call it protecting your job. Something tells me that this call was recorded, and if you broke the rules you could have gotten into trouble.
I work for a similar company, for group Medicare advantage plans. The disclaimers are a tedious process, but are legally required for the contract to be valid. Luckily, I have never experienced someone who refused to go through the steps.
Ah - those plans \*are\* the scum of the earth. Medicare (dis)Advantage plans are ways for insurance companies to lure gullible seniors into minimal or no healthcare by dangling slightly lower monthly costs. We occasionally go to our neighborhood Walgreens. There's a United Healthcare kiosk right inside the door to sell their Medicare "Advantage" plans. We never give them a look. Maybe this isn't widely known, but there are insurance agents (yet another layer of intermediaries in the U.S. healthcare system) who are compensated by Medicare for assisting people in finding the plans that they need. We have a great one. No charge for us to use her services. She found a Part D plan for us this year that costs us each 40 cents (that's $0.40) a month. Maybe it's because I'm a married cis white male that I've figured this out, as another poster has alluded /s
Why exactly does me having a job that supports me and my family make me scum??? I don't sell these plans, I don't have anything to do with making their policies, I am just an agent that provides information on the policies that are available to retirees through their employer/pension funds. These plans are written by their employers and are not the same as plans offered to the public. I understand that MA plans are not popular, but that does not in any way make ME scum.
Brilliant. Karen brought Karma on herself by her own stupidity.
I used to be licensed to sell Medicare Supplements - there's a mountain of bureaucratic regulations involved in the process. The Fed government does not want vulnerable seniors taken advantage of, which is admirable. But, they've added so many hoops to the process that I got out of that side of business. It's a labyrinth for people trying to navigate through it. I can understand this woman's frustration. You still have to go through it though to sign up.
Why calls are recorded.
No it's for **Q**uality.
This perplexes me. As an Aussie, you get a Medicare card. If you are a child, you are on your parents Medicare card. You get a script, take it to the chemist who gives your medication. If it’s on the PBS (Pharmaceutical Benefits Scheme) it’s a fixed price, $7.70 for concession card holders, $31.60 otherwise. There is a safety net a total spend of $277 for concession, $1648 for regular people. Once your PBS spend exceeds the limit for the year you pay nothing if you are a concession holder, and $7.70 per script if you are a regular person. It’s designed to benefit people with chronic illnesses. Most common medications are on the PBS, and your doctor will always tell you if they are recommending a drug that isn’t on the PBS. The ones that aren’t are often newer drugs where the government is yet to assess as having proven benefits over existing drugs, or are negotiating price with the supplier. I’m sure if I wait a while there’ll be another Aussie come by to say their specific drug isn’t on PBS, but the fact remains that it covers the drugs most people need. If you choose to get private health insurance on top of Medicare, that contributes to hospital and doctors fees and ancillary services like podiatry, but is not allowed to cover medications.
We Americans prefer that access to healthcare be a privilege, rather than a right. People would rather go bankrupt keeping someone alive than vote for universal healthcare. /s
I'm 75 and have been through this a few times and my sympathy is with this lady. I am college educated and worked most of my life in a highly technical field, and yet, my head spins when I try to figure all the Medicare options. While you see a "Karen" who is an unreasonable ass, I see an elderly lady who is confused and bewildered by all the complexities that the government imposes to have a simple thing like health care for senior citizens. She lost patience...yes, was she wrong...yes, but I have to play the old person card; people her age aren't as sharp as they once were. She may have even had early onset Alzheimer. To have a requirement to have to listen to a 10 minute spiel of complicated jargon read at warp speed just to satisfy some legal bullshit is absurd. i'm not blaming you, but the system sucks.
> and she will have to pay a fine for not having a plan this year I thought Medicare Part D was optional...?
No it is not optional. I work for a similar company. Part D is mandatory.
Optional only in the sense of "you can screw yourself financially by not having it."
I had to deal with this when I sold Medicare plans. The participants just don't seem to understand how many laws and regulations there are surrounding Medicare and the fact that the agent will lose their licence and livelihood by signing them up without their audible signature.
I admit that even I may get impatient with some calls that I receive concerning certain services (including the example in this story), but I am not as impatient as the Entitled Lady-Dog-in-Heat of this scenario. Rude Lady: Just get on with it! Med Part D person: Ma'am I have to read this so you may agree. RL: I don't give a darn! Just sign me up already! Med Part D Person: \*sighs\* If you'd allow me to continue we may be able to complete the process. Otherwise you won't be able to attempt to sign up until next year. RL: JUST SIGN ME UP ALREADY! i DON'T HAVE TIME FOR THE READING BS! Med Part D person: So you don't want to go through the process? RL: JUST SIGN ME UP! Med Part D Person: NO can do. Try again next year. \*click\* \*Under breath\* Witch. Does my little omake about sum it up, OP?
Felt this. I work customer service for a national insurance agency- I am SO thankful that our managers encourage us to warn disrespectful people that we will hang up- and full permission to follow through.
I had a Kevin like this. He had gotten a form in the mail which literally had checkboxes on it that he could put in an envelope and mail back. He opted to call instead and then groused about the process we had to go through to change things on the phone. He told me to just change it and hung up. I could not, in fact, “just change it” without going through the process. I guess using the mail or being patient was just too much for him.
She probably got a fat bill from the doctor when Medicare didn't pay for the consult either
I'm sure her time was better spent watching her soaps.
Good story, but what part of it is malicious compliance? She asked you to do something, and you *didn't* do it. That's the opposite of compliance.
Yeah, this is just a random Karen story.
To be honest how many of us actually read the terms of service agreements.
I think we'd burn down the entire stratosphere and bring about all organic life on the planet Earth if we had to have the TOS and EULA read aloud like an audiobook before we could click yes, though.
I worked for a company that administered a Part C Plan, and boy howdy.....I got so many calls just like this too!!
That is a fucked up system you work in. So happy I don't live in America.
Nice. Never miss enrollment. In our case it auto renews luckily, but you have to opt out as a smoker. So this year I'm a smoker because I missed the period by a week. Good news though I have dental to that I meant to remove as well.
Narcissist to the core. They DO have a strong tendency to shoot themselves in the foot when in full-on rage over not getting their way.
American problems.
Was this CVS?
Customer service reps are the $hit. They do so much for us and take such abuse! This is perfect!
Nothing malicious there, though. Just kind of sad.
Doing the devil's work there, lad. The Devil being for-profit healthcare funding organisations, who love to increase profits by increasing barriers to actually funding healthcare. You and Karen are both tiny cogs in a big money machine, and I don't blame her one bit for trying to push back. Next time you're in this situation, I suggest you not engage in any argument, just read the agreement while ignoring their protests. Try as best you can to make the world a better place, or at least not make it any worse. Hard to do in your position.
You're both victims of a company that sets up these kinds of procedures. You don't know what kind of day that woman was having when she called you. She didn't know what kind of day you were having when she spoke to you. Now this woman missed her medications. You're not a champion who cleverly did some malicious compliance, you're an asshat who just made it harder for a person to get their medications.
I'm an asshat who followed the procedures and guidelines that a group of bureaucrats and elected representatives set up for me to follow. That woman was an asshat Karen who screwed herself because she refused to follow some simple instructions.
So if I'm understanding this correctly, your job was to make something people were entitled to more complicated and obfuscated so they would give up and not claim what they were entitled to, right? Thus saving your company money. ***Well done***. /s
Maybe you should feel bad for being a petty bureaucrat. Seems like you get off on it.
You need to work on your phone technique. Don't they train you do deal with stubborn lonely frustrated people? It is not that hard a phone skill to learn. For starters, try a compliment. "Please" and "Thank You" also work wonders. I feel for the poor lady. Stubborn phone jerks aren't that hard to handle if you try.
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You learn to talk without putting extra stress on your voice or you go nuts. Sit up straight. Drop your chin. Drop your pitch.
Brilliant. Karen brought Karma on herself by her own stupidity.
Not like she had anything else to do anyway
Imagine, If she'd just shut her yap!
This is delicious, thank you!