When a machine threatens to cut off your health insurance

How much do humans supervise the machines that participate in customer service? One person's experience with Blue Shield of California suggests: "Not much at all."

bshield1.png
A scene from a Blue Shield ad. JCmiscellany/YouTube screenshot by Chris Matyszczyk/CNET

These days, I don't get much snail mail.

If it isn't a few magazines whose subscriptions I always forget to stop or some coupons to my local supermarket, it's letters from local insurance agents, mortgage brokers, and realtors, telling me how they're all the best in California.

It was odd, therefore, to receive a letter last month from Blue Shield of California. I opened it to find a healthy greeting and the information that my health insurance was about to be canceled.

This struck me as both unnecessary and unreasonable.

I have an automated direct debit set up. Blue Shield takes the money, without even leaving a thank-you note. That's what computers are for. So humans won't make mistakes.

What had I done?

Apparently, there was an outstanding balance on my account. I found this information perplexing.

So I tried to call Blue Shield. I hoped to speak to a human being. Instead, a machine told me that call volume was terribly high. Naturally, I took this to mean there weren't enough humans available to field the volume of calls that the automated answering systems had failed to satisfy.

After 45 minutes of waiting, I gave up. I took the next technological step. I sent an e-mail through Blue Shield's internal mailing system.

I received a reply saying I owed for last October. This seemed odd, as Blue Shield had itself made a mistake last October in failing to enter the new expiration date on my debit card. At the time, I spoke to a very nice human being who sorted it out. I had, in fact, never had a problem with Blue Shield before.

Moreover, the amount now allegedly owing couldn't have been for October, as the premium had been a different figure then.

I replied to the e-mail and failed to hear back within the promised 48 hours. Or, in fact, ever.

So I called again. Again, I fought through the machines. After another 30 minutes of waiting, I encountered a human.

A human explanation (Or not)

Mary was friendly at first. She told that me that oh, yes, her system showed there was an outstanding balance.

"For October, yes?"

"Let me see. No, wait. Not for October. It's for March."

"But it's still March."

"Yes, but you're a payment short, so it's for March."

The logic escaped me.

"So why are you sending me e-mails telling me I owe you for October?"

"I'm not responsible for that. And I apologize for those e-mails. So we need a payment for March."

"But it's still March. And you usually take the money at the end of the month."

I could feel her staring at her screen for the answer and perhaps clutching her mouse a touch too tightly.

She came back with: "It looks like we changed IT systems in December, so we forgot to take the direct debit in December. So you don't owe for October, but the payment we took in January was for December, so you owe for March."

I wanted to ask the question that was, by this point, burning my epiglottis: "What are you talking about?"

Instead, I offered the more reasonable (I thought): "So why are you threatening to cut off my health insurance because you made a mistake?" I added: "And why are you sending me e-mails that say I owe you for October?"

After several rounds of trying to explain my frustration, she retorted with: "You don't get it, do you?"

This became a troubling conversation -- for both sides. Mary kept repeating herself, because I didn't get it. I didn't get it, because it seemed as if these people were all relying on information offered by Archie Bunkum.

Another human explanation

I was forced to give Mary more money, because in these situations you cannot win. You will end up with far more trouble than your time is worth and you suspect that your health care provider knows it.

Still, wafting from perplexed to slightly enraged, I tried to contact Blue Shield to ask why the company's IT problems caused me to get threatening letters.

I finally received a call from Blue Shield. The lady was apologetic. I shouldn't have received customer service of this sort, she said. This was wrong.

"But please," I begged. "Why are you sending me threatening letters when you have changed IT systems and made a mistake?"

I was shortly to cease breathing. For she said: "We didn't change IT systems."

"You didn't?"

"No. The representative whom you talked to last October made a mistake in entering your details into the system, so we failed to take your December payment."

The machine ate our homework

Was it easier to blame the human than the machine? How was it that despite this supposed human error, the machine took the right amount in January and February.

I stared into the distance. My living room began to spin in concentric circles. I felt light-headed. After receiving defibrillator resuscitation, I asked: "So if you know you made a mistake, why didn't you just rectify your mistake? Why, instead, did you send a letter threatening to cut off my health insurance?

"I'm sorry," she said. "That was sent by a machine."

"No human supervises threatening letters? No human checks to see whether these threatening letters, accusing customers of being in arrears, threatening that they will have their health insurance cut off within 18 days (in my case), might not contain actual facts? Or, if they do, they fail to account for the actual fact that your company is wrong?"

She continued to sound polite, replying: "I think we need to take a look at our systems."

Do I think they'll do anything? My confidence isn't strong.

They'll probably keep sending automated threatening letters and putting the onus on the customer to sort things out. They'll likely make it difficult for the customer by forcing them to answer a slew of automated questions by phone before being able to talk to a human. They'll not reply to e-mails within the 48 hours promised.

But do I think Blue Shield of California is the only company that does this? Not at all. I've had one of these letters before from a hospital in New Jersey. This hospital had failed to send me a bill, had waited a year and now was, gosh, sending threatening letters.

When I called, did the customer service rep care that her customer had been threatened? Of course not. She just wanted my credit card number.

That's the thing with customer service far too often. The humans have become automated and the machines have become human.

Still, on Saturday I received an e-mail from Blue Shield. What could it be? It was headlined: "Tell Us What You Think About Blue Shield Of California."

I feel sure a machine must have sent that.

 

Join the discussion

Conversation powered by Livefyre

Don't Miss
Hot Products
Trending on CNET

HOT ON CNET

Find Your Tech Type

Take our tech personality quiz and enter for a chance to win* high-tech specs!