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  • Will Never Claim Ignorance

    | San Antonio, TX, USA | Coworkers, Employees, Health & Body

    (My daughter has had an insurance claim denied due to pre-existing conditions. She had an allergic reaction to a routine vaccination she had the previous day. I work as a claims processor for the company we have our insurance through. I even process employee claims on occasion, and I know all the rules and regulations for pre-existing conditions as they apply to our insurance plan. I call the company to find out why they denied this claim.)

    Me: “Hi. I’m calling to find out why you denied my daughter’s claim.”

    Customer Service Rep: “Okay. It looks like it was denied for being a pre-existing condition.”

    Me: “Yes, I know it was denied as a pre-existing condition. I’m trying to figure out why it’s a pre-existing condition. You see, I also work for this company and process claims like this on a daily basis. I know that there are certain CPT codes that are supposed to be looked at for pre-existing conditions. I also know that before a claim is denied for being pre-existing, the processor is supposed to research through the member’s history to see if there are any related claims that have been denied or paid or have documentation attached to prevent denial. I also know that if the processor had done their job correctly, that they would have seen a routine doctor’s visit the day before and would have made the connection between the vaccination and the allergic reaction. Plus, I also know that allergic reactions are not considered pre-existing when there are no other claims in the member’s history for a similar reaction. And now, the most important point: according to California law, pre-existing conditions can only apply for the first six months a member has a plan with a health insurance company. I have been employed by this company, with full benefits, for over a year and a half. There is absolutely no reason that this claim should have been denied.”

    (There is extended silence.)

    Customer Service Rep: “Oh. Okay, we’ll get that fixed and paid as soon as possible!”

    (The claim was paid and I never had a problem with the company denying any claims for pre-existing conditions again!)

    Dropped The Ball On That One

    | Newton, MA, USA | At The Checkout, Employees, Rude & Risque, Themed Giveaway

    (I frequented a store and have had a few run-ins with a strange male employee. He speaks in a monotone and wears a plastic glove on only one hand. I’m buying two chocolate eggs and some sleeping medicine.)

    Me: *puts items on counter and one egg rolls quickly toward the cashier* “Oh, no!”

    Cashier: *catches the egg from falling* “Don’t worry. It didn’t fall on the floor.”

    Me: “Awesome!”

    Cashier: “And it didn’t hit my balls either.”

    (I am speechless and cannot make eye contact. After the rest of the transaction is completed, I go to leave.)

    Cashier: “Goodbye… for now.”

    Not So Handy Handbook

    | NM, USA | Bosses & Owners, Rude & Risque

    Boss: “…so I had to help write the employee handbook because this company, being so new, didn’t have one yet. Now, if you’ll notice, the only reason we have the section on sexual harassment in the handbook is so you know if you are sexually harassing someone correctly.”

    Totally Wackopedia

    | Australia | Employees, Extra Stupid, Ignoring/Inattentive

    (I am pushing my two-year-old daughter around the stalls at our annual agricultural show. One of the stalls is selling encyclopedia sets. As I am passing, a salesman gets in front of me.)

    Salesman: “Excuse me. Would you be interested in our encyclopedias?”

    Me: “No, thank you.”

    Salesman: “I see you have a child. It would be an asset to their education.”

    Me: “Yes, I agree, but I’ll wait until she’s actually old enough to need a set.”

    Salesman: “Don’t worry about that. Everything she will ever need is in this set. You might as well get it now for her because it will still be up to date when she’s older. There won’t be any changes in it.”

    Me: “So you are telling me that everything has been discovered? That there will be no new discoveries over the next 10 years or ever?”

    Salesman: “Yes, that is right.There’s nothing left to be discovered.”

    Me: “Nothing will ever change?”

    Salesman: “That’s right. If you just come over here I’ll sign you up and take your details for payment.”

    Me: “I don’t think so. Goodbye.”

    Radio Inactive, Part 2

    | Detroit, MI, USA | Employees, Family & Kids, Health & Body

    (I’m at the hospital about to have major surgery to correct a birth defect. I’ve been getting x-rays quite a bit over the previous few months and am asked the same questions every time.)

    Tech: “Is there any chance that you could be pregnant?”

    Me: “No. Look, I realize you have to ask but I’m 13 years old and have my mother sitting right next to me. If there was a chance, do you REALLY think I would tell the truth?”

    Tech: “…”

    Mom: *almost falling over laughing*

    Related:
    Radio Inactive


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