Confessions of a benefits manager: Candid tries to make a PMI claim

I wouldn’t mind if I had spent the weekend bungee jumping or rock climbing, but all I did was get on the wrong side of my pillow. I haven’t just got a stiff neck; it is completely locked. I can’t move my head sideways at all, and to look behind me I have to turn my whole body. I need to get it sorted.

It seems like a good idea to put this through the health plan. I am paying enough tax on the benefit; I might as well use it for a change. I realise that although I have been responsible for this plan for a couple of years, I have no idea how to go about making a claim. And it is not as if I can ask anyone. How embarrassing. I consult the booklet that I give to new starters. It is not at all clear what I need. Oh dear.

Confessions of a benefits manager

Although I have a morbid fear of it, I am going to have to call the customer service line. Gulp.

The first thing it does is demand my plan number. Well, all I have in front of me is the booklet, which doesn’t have a number on it. The letter with the number is probably at home. How about if I give my date of birth? That doesn’t work. The customer service line has a strict script to work to and you can’t miss out any of the steps.  

The irony is that the last time I called it, it treated me like a member when I wanted to talk to it as a scheme administrator. Now I am actually calling as a member, it refuses to acknowledge that I am one. 

I ask my colleague Lazy Susan to find my plan number, because it must be on one of the lists she maintains. It is, so I call back and give my number. Step one completed.

Vague statements about claims

The customer service representative cannot tell me if osteopathic treatment will be covered, so I have to consult the booklet again, which has a lot of vague statements about outpatient claims. Either way, it seems I will need a referral from my doctor.

Step two will have to wait until the morning, because my doctor has this new system where the only way you can get an appointment is to call at eight in the morning. As all the local unwell are calling in at precisely that time, it is impossible to get through, and you have to be feeling quite robust to keep trying.

You can also call in the afternoon, but the receptionist, whose personal charter is to prevent people from actually seeing the doctor, will cross-examine you and if your complaint is not serious, urgent and positively life threatening, she will tell you to call again in the morning.  

At length, I get referred and visit a specialist to have my neck miraculously snapped back into place. I am still sore, but I can move normally again.

The claiming process

So onwards for step three: the claiming process. I complete the form and send it off along with the receipts for the treatment. And I wait. And wait. There is nothing for it, but to call the customer service line again. Geez. This time I am armed and ready with my plan number. It still takes it an age to find my record. It has indeed received my paperwork, but it is still being assessed. Still being assessed? It has had it for six weeks. I am not impressed. Does it realise I am the company contact for the scheme? Clearly not.

Unexpected personal excess

I call again a week later. Yes, it has received my paperwork. I know that. Yes, it has assessed my case. That’s good. But there is no refund due. Eh? How can that be? I am ashamed to say I get quite shirty with the poor person on the line. She tells me there is a personal excess on my policy that is more than my claim. No there isn’t; I am adamant. She insists that there is, and will not be moved.

It is true that we have one department that came from another company where the scheme has an excess, but I have always been in the main group. I quiz Lazy Susan who maintains the lists. She looks confused, but then she always looks confused; that is how her face is.

It turns out that she didn’t see the point of maintaining two lists for the head office, so she merged them into one list to be more efficient. More efficient? Since when has Lazy Susan considered anything in terms of efficiency? It was less work, more like. Now, everyone in our location is going to be charged an excess in error. I am surprised I haven’t had complaints about it already.

I’m going to have to call the customer service line again to straighten out the scheme as a whole. I give my plan number, but then they go straight to my claim record and don’t seem to understand that I am calling as the company contact. Ready to scream, I ring off and start again asking to speak to sales.

Additional premium

Eventually I get through to an account manager who tells me it is going to affect the premium. As we told it 100% of the potential claimants were subject to an excess when, in fact, only 5% should be, we are going to have to make a substantial extra payment. Big Bad Boss isn’t going to like it, and worse, because I have brought it to his attention, I will get the blame, rather than Lazy Susan. There are times when I think I would be better off working alone.

Next time…Candid tries the EAP.