So, here’s a little background:

(A lot of abbreviations so I’ll try to keep them short and sweet).

I work as a CSR (Customer Service Rep,) Supervisor for health insurance. You most definitely get your fair share of assholes & entitled people within you normal 8 ours.

Please note that if a caller requests a supervisor (referred to as Sup calls), I am one of the ones’s who then will take over the call. This means that the callers are already upset when I greet them.

For those who don’t know, all parties involving medical information have to abide by federal HIPAA (Health Insurance Portability and Accountability Act) Laws that protect a person’s PHI ( Personal Health Information). This means that when speaking to a CSR, to get any information you have to be the member or an Authorized Representative (AP) of the member, or obtain verbal consent from the member if they are at least the age of 18 and is not a dependent of anyone on the policy.

With all that, I think I have enough background for this story. Karen is obviously the EP, Me is me (for those who are Karen’s lol, and Mbr is the son of Karen who is well over the age of 18 - mid 30’s).

I answer phone is my usual way when I’m placed on a Sup call.

Me: Thank you for your patience. My name is rebelcee970, supervisor on the floor. How can I assist you?

Karen: I’m trying to find out if my son’s bill is caught up, but the idiot that transferred me to you is too incompetent to tell me.

(Side note: Before every Sup call, we are briefed on the situation. This allows us to know what is going on, prepare how to handle it, and do any necessary research.)

Me: Okay, Karen. I see here that the previous rep had stated that you were attempting to get information on the account, however you are not an AP. This means that we can’t give you information on the policy without authorization from Mbr.

Karen: (begins to get loud because this was already told to her by the past rep) This makes no sense at all. I pay his god dammed bill and I am his mother. Why can’t I get this information?!

Me: Well, the HIPAA laws that we have to abide my states that-

Karen: Excuse me, but I already know about HIPAA. I was a licensed Insurance Agent for 10 years.

Me: Well, Karen, you should then know that the HIPAA laws that were placed into effect since 1996 states that anyone that is not authorized to speak on a Health Insurance policy can not obtain any specific information for said policy. They can only obtain non-specific general information which you are not asking for.

Karen: But they also state that the parent of their child’s policy could obtain ANY information.

Me: That would only apply if Mbr was a minor on a Child Only Policy, however Mbr is in his mod 30’s meaning that he can speak for himself. Also, seeing that you are not authorized to speak on the account, the fact that you pay doesn’t grant you that authorization.

Karen: Well what in the fuck are supposed to do?! I need to know if his account is up to date.

Me: If we can get him on the phone, we can gain a verbal consent from him stating that he gives you permission to speak on his account for this one call. For future calls, you would need to be listed on an PHI Authorization form, listing you as an AP.

Karen: Well he’s at work, so I can’t call him. Can I just get the form in my e-mail? It’s [email protected].

Me: I can’t do that seeing that he is not on the phone stating that we wants you listed as an AP & requesting a form, let alone to be sent to any e-mail address other than his own.

Karen: So you can’t tell me any information, I can’t get the stupid form, and you’re not helping me. Why can’t you just be good customer service and give me the information.

Me: Because that would violate a Federal Law that could cost the company thousands ($20,000) at the least, and a lawsuit facing federal prison for anyone who broke said law, at worse. (She would know that if we was truly an Insurance Agent for 10 years).

Karen: This is complete bull shit. I’m gonna get my lawyer and call the bureau of insurance.

Me: If you choose that route, that is your choice, however, if you can’t get Mbr on the phone, I can not assist you.

Karen proceeds to hang up the phone. I then have to file a report stating that a caller threatened legal actions against the company. This process forces callers who do this to speak to our legal department until the issue is resolved. Depending on how serious the accusation is, the company my counter suit for various reasons, but mainly slander and failure to abide by their contract required to be signed by the subscriber of the policy. This means that some who were just bluffing my then have to actually get a lawyer.

In the end, this call lasted an hour, nothing got done, and now Karen can’t speak to regular CSR’s for a while. Also, she may have to cough out high dollar for a lawyer, which she probably wasn’t going to get in the first place.

Trust me, EP’s always pay when it comes to my job.

I’ll post more if liked.

(The Moar Channel has permission to share this story)