Admitted to fraud - idiot!

[tilly101]

So as most people will now know, I work in the health insurance industry, mainly in the call centre [oh joy ]

So this woman calls in, and the following lovliness ensued...

Me - Hi, thanks for calling, how can I help...

*interupts me*

SC - Yes you people sent me a letter saying you wont pay my claim! I ALWAYS get this paid, so you people need to fix YOUR mistake right NOW, this is a JOKE! I've been a member for over 20 years, how DARE you treat me like this!

Me - Ok ma'am, one moment while I check your policy

*I bring up her policy. She has been declined on claiming "beauty therapy" - yes, things on the receipt include eyebrow waxing, haircuts and blowdrys, pedis and manis etc...so I go back to her*

Me - Ok ma'am, I've had a look - the fund does not actually pay towards 'beauty therapy'

*she interrupts me again*

SC - EXCUSE ME, I just TOLD you that I ALWAYS get paid for my beauty therapy! How DARE you try and tell me otherwise! I'm a VIP member and I get special treatment!

*NOTE - within our company we do not have 'VIP MEMBERS', and the rules are the same for everyone, as per legislation. so already what she is saying is sounding like complete BS. Nevertheless....*

Me - Okay, just one moment, I'm going to have a look through your claims list and have a look to see how they've been paying for this all this time, one moment thanks ma'am

*I have a look and come back to her...*

Me - Okay, thanks for holding ma'am...

*interrupts me*

SC - YES, I've been on hold for almost half an hour!

Me - Okay, well we actually have an 'on hold' timer and you were on hold for about 3 minutes? In any case, we have never once paid on any claims for 'beauty therapy'

SC - YES, you HAVE! You paid them on this date...and this date...and this date...and THIS date

*She starts listing all of these dates, and as she is talking I'm looking them all up*

Me - Okay ma'am. So to clarify, on each of those dates, you're saying you claimed on nothing but beauty therapy?

SC - YES! Listen here, I am a VIP member and you are WASTING MY TIME!

Me - Okay ma'am. See the problem we have here is that on each of those dates you have lodged claims for physiotherapy. You've just advised me that those claims were all fraudulent

SC - *deadpan silence*

Me - So what happens now is that your policy is referred through to one of our managers, who will calculate the total amount owing on those fraudulent claims. Based on what I can see right now it looks like you've been doing this for a number of years. The bill to repay those claims will be sent to the address you confirmed at the start of the call. I strongly advise that you immediately cease sending in these claims to avoid this issue escalating further

*her voice is now quiet and timid*

SC - I didn't know...I mean...I pay all this money for my premiums and so it's onyl fair that I recoup it in some way, right? I mean, can't you cut me a break? I'm a single mother and I work two jobs, and I needed money, but I mean...I didn't know what i was doing was wrong!

Me - I'm sorry ma'am but what you've been doing is against the law

*suddenly screaming into the phone*

SC - WELL YOU CAN ALL GO GET F**KED, I WONT BE PAYING A CENT BACK, YOU HEAR ME?! YOU CAN ALL GO TO F**KING HELL, ILL TAKE WHATEVER I WANT FROM YOU C*NTS AND YOU WONT GET A CENT BACK!

And then *click* as she hung up

Will have to see how this one turns out , but form past experience, her details will be passed to police.
Stupid woman, if she had of admitted fault and repaid the money , the company would have left it at that I'm sure

As an FYI, she would normally submit receipts that were indeed from a company that provided beauty services, but they always said that she was getting physio done. This latest one just said beauty therapy and listed the thigns above. The typing was *slightly* different so it would appear that in the past she had changed the receitps herself - no idea why she got lazy this time, but it led to her undoing!

[Sapphire Silk]

She should have just shut up and paid that one bill, then gone back to her scam.

Of course, we all know sucky customers aren't smart and don't know how to shut up.

Good catch! Bitches like that are part of the reason why health care costs so much.

[BeenThereDoneThat]

Oh yeah, I'm sooooo sure she had no idea she was doing anything wrong. Have fun in court, lady...

[LillFilly]

Oh, man this was SO AWESOME! I cannot wait for an update; want to bet she calls back when she gets the official paperwork?

[fireheart]

Wow....the woman was so lazy she wanted insurance to pay for her BEAUTY?!

On that note, something like what you mentioned above would be VERY hard to pull with my insurance company...most places have on-the-spot claiming, although a couple of services still require you to take your receipt to your insurance provider. But they do check

[pzychobitch]

Epic pwnage is epic.

[dalesys]

Since she'll be doing without her beauty therapy, wouldn't it be ,,,

Epic Prunage

???

[NateTheChops]

SC - WELL YOU CAN ALL GO GET F**KED, I WONT BE PAYING A CENT BACK, YOU HEAR ME?! YOU CAN ALL GO TO F**KING HELL, ILL TAKE WHATEVER I WANT FROM YOU C*NTS AND YOU WONT GET A CENT BACK!

Well your kids are going to be a lot better off when you wind up in prison. But don't worry. My mother (who was a prison nurse) assures me that women's prisons are full of experts in "Beauty therapy".

[Andara Bledin]

Wow.

I wonder if her beauty therapy spot was helping her engage in fraud and they started cleaning house or something.

^-.-^

[taxguykarl]

SC - I didn't know...I mean...I pay all this money for my premiums and so it's onyl fair that I recoup it in some way, right? I mean, can't you cut me a break? I'm a single mother and I work two jobs, and I needed money, but I mean...I didn't know what i was doing was wrong!

Typical EW. I was once asked seriously (or at least with a staight face) if makeup was deductible.

On that note, something like what you mentioned above would be VERY hard to pull with my insurance company...most places have on-the-spot claiming, although a couple of services still require you to take your receipt to your insurance provider. But they do check

In his insurance agent days, my dad forgot more scams than these huckers knew. He was also not shy about referrals to the local pubilc prosecutor.

I wonder if her beauty therapy spot was helping her engage in fraud and they started cleaning house or something.

Probably not as the receipts were altered. Also most have a license from their state (or province) that would be yanked if they knowingly participated in fraud. This scammer just got lazy and cocky.
Keep us posted, tilly. I doubt that you've heard the last from her.

[PepperElf]

Typical EW. I was once asked seriously (or at least with a staight face) if makeup was deductible.

Only on your taxes. (and that's only if you're a beauty technician, makeup artist etc)

[taxguykarl]

Only on your taxes. (and that's only if you're a beauty technician, makeup artist etc)

or a model or entertainer.

[MoonCat]

Oh my freakin' gods. Eyebrow waxing? She wants to claim that on her health insurance?

No wonder everything costs so damn much in the health care industry. I knew people sometimes made claims for medical treatments they hadn't really gotten, but it never occurred to me that they would do it this way.

[Sonoma]

I feel your pain, for I too work in Customer Service for a health insurance company.

I did have one person with a similar issue. There was a claim that paid to her in error, because the provider's office billed with an out-of-network ID, which would cause us to pay the member directly. As soon as they corrected it, we paid the Dr's office, and sent a notice to the member, letting them know that the payment to them was sent in error, and that we had paid the Dr's office directly. It gave instructions to return the overpayment, as it was sent to her for her to pay the Dr. herself.

She called in, got me, and refused to send back the overpayment. I explained it was sent to her to pay the doctor, which we had already done. She then informed me that she used it to pay her household utility bills, and was not going to return the money.

I forwarded that request to our Recovery department.
It was several thousand dollars that she collected in error. Our plans do have provisions stating that if we make a payment in error, the money is to be returned.