You probably wouldn’t choose to get an elective surgery if you knew you were going to have to pay for the hospital bill out of pocket.
In today’s story, an employee thinks her insurance will cover the surgery, but then she is told otherwise.
Her boss takes care of the situation, but the insurance company is the big loser in the end.
Let’s see how the story escalates…
Deny My Employee Claim and Tell me If I don’t Like It, I can leave? Ill Withdraw Everything from your company and watch you disintegrate
I am a typical simple guy who just likes relaxing and was born with the proverbial silver spoon in my mouth.
I am the black sheep of my family and a middle child to boot (double whammy) but I at least have a little brains and some luck which I kind of use on a day to day basis.
Due to my parents’ connections I managed to get into lucrative schools in my country, did my military service and was promoted Upward to Captain and later on was shipped off to college out of country.
I have never been too close with many people apart from my circle of friends and I prefer it that way.
After my College, I was employed in government (you guessed it, Family Connections) and after a few years was able to use my “name” to get ahead and meet people who helped me set up several businesses in my area (A coastal City) where this story happens.
The money I used was generally allowances, small inheritance from my late grandma, some investments, a fund that was started when I was a baby and money gifted to me by family basically an attempt not leave me broke enough to embarrass them even though am a simple low maintenance fellow lol.
OP shares the benefits he gives his employees.
My Businesses are booming since the coastal area we live in attracts a lot of tourists (Local and International) and of course some locals who wish to mingle with the tourists to get green cards, pen pals, spouses and such. (typical coastal city I guess).
The incident:
As a proprietor of my businesses, I have most if not all of my staff on salary since it’s the best way for them to gain benefits and is easier for me as a business owner tax wise (Tipping is more of a gift typically since we do not have a tipping culture) and I have my staff on Comprehensive Medical Insurance which has additional dental and optical on top of the National governmental healthcare medical scheme (Our government hospitals provide all services free but wait times for elective surgeries are exhausting).
We also have a mandatory legal requirement to provide employees with retirement benefit savings, minimum of 21 working days leave (I give 30) and my businesses offer paid overtime, unhindered medical leave for surgery and serious conditions which can be extended as well as allowances to seek treatment such as chemo or dialysis.
One employee scheduled surgery.
One of my female employees (an older lady who is brilliant and had moved up the ranks to manager and was adored by all) was booked for a hysterectomy since (as she told me) she was at risk of cervical cancer as her mother had passed from it a few years back and since she already had 4 kids it was the most logical step.
She did her due diligence and found a private hospital which was in our system where she could have the procedure done.
On the planned date she applied for leave days which we obviously rejected since this fell under the scope of medical leave.
She went on to have the procedure successfully and had a quick recovery time. The bill was to be catered for by the company insurance and we had made sure to get all the necessary pre-authorizations.
Insurance didn’t cover the bill.
A few months later she came to work looking distraught and in all honestly, we thought that she had been told that she had gotten cancer since she had asked for a day off to go for review and tests but what happened was much worse.
She had been given a bill by the hospital since the insurance had refused to pay for it citing that it was not in the scope of cover.
We were livid since we had made sure everything was in effing order.
OP tried to get answers.
I sent my accounts manager to go have a talk with the insurance people as we tried to calm her down.
The manager came back super angry and told me that basically after showing them the evidence the insurance people just told him to buzz off.
I decided to personally go visit that office and get a clear understanding of what was happening.
They kept me waiting for an hour and even after that had the audacity to inform me the director from the head office who was in the area had declined to meet me because he was quote unquote “Busy”.
OP went to the insurance company’s main office.
I was pi**sed to the high heavens so I decided to go to their Head office in the capital city, a 2-hour flight.
The head office was no help and informed me that they had revised their policy and that it was not covered.
I asked when the policy was revised, they informed me a month prior. I informed them the surgery was done 5 months prior and we had all the documentations.
They claimed that it was 12 months retrospective.
OP still didn’t get any help.
I inquired why I was not informed of it since this was big news and I have held policies with them.
They told me that they had informed their “Large clients” and would inform the other clients when their insurances were due for renewal.
I demanded to speak to their boss, Company Vice President since the CEO was not around and they boldly told me he had no time for me and frankly that (in verbatim) “We are a large company and have no time to argue semantics with low end clients. If you don’t like it, you can frankly leave and find a new insurance company”
OP paid the employee’s bill.
The Revenge:
If I had been initially upset, I was full blown mad. I was livid and filled with rage.
In all my years I may have experienced some disrespect and I accepted it not to make problems, but this time it went too far. I decided in the heat of the moment to switch everything and be done with them.
I flew back home and just plain went to the hospital and settled the bill in full and took the receipt to my employee who initially insisted that she would do anything to pay me back, but I refused since it was no way her fault and I’ll be da**ed if she pays for something that was way out of her control.
OP picked a new insurance company.
I had a few days to cool down and talked with my directors. The words still etched on my mind.
I asked how long it would take us to switch to another insurance.
They went ahead and checked out a few large rivals of the insurance we had and discovered that if we switched it would take 6 months for the new insurance to provide full coverage.
The firm we picked, who I’ll call new insurance, offered us a way better deal to the one we had and not only comprehensive cover, Dental and optical they also included mental health cover, Physiotherapy and occupational therapy cover, Rehabilitative services, mobility device acquisition (prosthetics and wheelchairs for some of the disabled employees), smart cards for direct payment on outpatient visits (kind of like a debit card) and a dedicated team of relationship managers, Death and funeral benefits and an expanded coverage area plus up to 6 dependents plus spouse cover.
OP was happy to switch companies.
It would cost me a little more but I didn’t really care.
The people who dealt with us from our previous insurance who I’ll call old insurance, seemed unfazed that I was pulling my company from them since they thought it was just a small business. They looked puzzled when I came in with several people and a few boxes of documents.
What they failed to realize was that apart from that one business which is a restaurant, I have 3 popular bars, a cab company, a hotel resort, cleaning service chain, a building and residential guard service and several rental buildings in the town and around the country.
When the old insurance company realized who OP was, they were sorry.
Their shock was compounded when they were informed by the lawyer just who I am and the shock, awe, confusion and panic when they heard my family name was an extremely satisfying sight.
Cue the pleading and attempted negotiations and apologies. It was so big that the news reached their Head office who sent not only their director, the one who was apparently too big to see me, but also their Chief Legal Officer, Chief Financial Officer and President of the company.
I somehow also earned a personalized call from their CEO who was abroad.
No amount of sweet talking was changing my mind, and by the end of six weeks we had completely removed ourselves from the old insurance. It was now a waiting game to the beginning of the new insurance cover and we really really hoped that no one would become unwell by that time, but we were ready just in case.
OP’s family also switched insurance companies.
In that waiting time and after the new insurance commenced, I talked to my friends and my family on one of my holiday visits (my older brothers kids adore me and my family kind of realized they were a-holes to me and are trying to re-enter my life) and thought that was that.
Aftermath:
My friends and family took my words and also pulled their businesses from the insurance to other insurances.
The company took such a huge hit and when Covid came around and was a big deal they were barely floating.
They went into receivership soon after and were acquired by the insurance I had moved to who happened to be their greatest rivals.
OP ended up buying the building the insurance company had been in.
The directors and CEO were given their golden parachutes and resigned and most of their employees were luckily retained apart from the senior executives (including the ones who told my manager to buzz off)
In a cruel twist of Irony, the building they were operating on in our town was sold and if you guessed I purchased it you would be absolutely correct.
I decided to remodel the inside and turn it to a business rental space.
All in all, it was a bit of a sweet payback and wherever they are I hope those disrespectful guys learned that everyone is human and they are not above anyone and remember that Karma is a cold and heartless witch….
The insurance company definitely messed with the wrong person. If they had just informed all of their clients about the policy changes, things could’ve been a lot different.
Let’s see how Reddit reacted…
This reader called OP a “hero.”
Another reader is picturing the expressions on the faces of the people at the insurance company.
Another person praised OP.
This reader feels better about the world after reading this story.
Here’s a summary of the story, and praise for OP.
Now THAT is how it’s done.
Nuclear revenge!
If you liked this post, check out this story about an employee who got revenge on a co-worker who kept grading their work suspiciously low.
