Servicing your Customer Service Rep

It was at a recent party where myself and fellow customer service reps laughed about the frustrations of our jobs when it hit me: Wouldn't it be useful for the customer to know just how stupid they are? I'm not being a bitch here, okay probably a little bit, but when you read my tips you too will understand. Most of these are directed at people who call into health insurance companies yet I feel the lessons can be universally applied.


Be prepared. Sounds harder than it is, I know. But when you call in to a company it makes the call go by so much more smoothly when you know what the hell you're doing. Don't call if you don't have your member ID/account number handy. You've just created like five extra steps for the rep to go on an expedition to find out who you are which will delay them helping with why you actually called. Also verifying your information insures the rep has pulled up the correct person. Why be a jackass about confirming info that we already have?

Use your head. I can't tell you how many people mistake us for fortune tellers.

Member: Did you pay my bill?
Rep: Date of service?
Member: I don't know.
Rep: Provider's name?
Member: I don't remember.
Rep: Dollar amount you're being billed?
Member: Not sure. So, can you tell me if you paid it?

The above example is a regular occurrence. Sad but true. Or they want to know if a provider is participating yet they don't know the name or location of said provider. Well that should be easy to confirm!

Watch your tone! It's okay to vent, that's actually part of a customer service reps unofficial job description "listen to incessant bitching". You hate your benefits, you think it's unfair something wasn't paid, your cat just died. Let it out. IT IS NEVER OKAY TO THREATEN. Remember these few simple things if you do decide to make a threat: your threat was made over a recorded line, the person you threatened has your name/address/and employer, the person you threatened has every right to notify proper authorities about your actions.

Put blame where it belongs It's your employer's fault your benefits suck. Most insurance companies have hundreds of plan choices and if yours is a bit slim on what's covered then it's because your employer is too cheap to get you the good stuff. If you use a benefit without FIRST checking to see that you have that benefit and your claim denies, you only have yourself to blame. If you go to a provider WITHOUT checking to see that they accept your insurance and you got stuck with a huge bill, once again look in the mirror buddy. If your provider billed you directly and never submitted a claim to us, well how exactly is that our fault again? I'm trying to follow your logic but I just can't manage to get my head shoved that far up my ass.



What did you say?! It's honestly above my comprehension why a provider's office would put someone on the phone that barely knows English or has an accent so thick it sounds as if they don't know any English. This is not a prejudicial comment in the least because if someone has a primary job function to communicate they need to be able to communicate. That's like hiring a guy in a wheel chair to guide a rock climbing tour.

Laziness. Office staff that do half-assed jobs such as 100% relying on a computer to do their job for them. If there is a discrepancy with what your patient is telling you and what your system is telling you, how about going the extra mile to verify it with the insurance company with a quick phone call? Gasp, I mean treat your patients like actual human beings....what an amazing concept! Instead send your cardiac patient into a panic attack by telling them their insurance was terminated when in reality it was a system glitch.

Exercise some common sense.

Rep: How can I help you?
Provider: I'd like to see if the member is eligible for a vision exam.
Rep: Would you also like the benefits?
Provider: No, I only need eligibility.
Rep: My system shows they're eligible
Provider: Can you tell me the copay and if they are allowed to get hardware?
Rep: So you want the benefits?
Provider: No, just copays and hardware info.


Yeah...kind of scary these are the people your doctors trust to handle your medical records. Some of them don't know what a member ID means, or a claim form is, or that they need to give the member's information to the rep in order for the rep to help them out. This is why we are losing the war against drugs.

There are member's that will legitimately ask questions like "Will you still pay for services I receive after my policy has terminated?" and "I have to pay a copay EVERY time I see my doctor? Even if it's for the same thing?" and "Why do you need to look me up to answer my question about my policy?" and the best one of all "If I have insurance then it should be covered no matter what!"

Shut up and listen. Sometimes calls get misrouted. Actually quite often and this is usually because the caller didn't want to use the automated system to get properly routed. Then when you inform them they are in the wrong area one of two things tends to happen: outrage (once again this is most likely their own fault for being too inpatient to use the proper channels) or they'll just continue talking after the rep has already told them they are in the wrong area. Some helpful advice, please clean the shit out of your ears BEFORE giving us a call. Thank you!