Employee Manager: Your policy has changed, Mr. Archibald.
John Q. Archibald: Changed to what?
Employee Manager: Yeah, we recently switched carriers from a PPO to a HMO. It's a less expensive policy, but unfortunately, there are some restrictions.
John Q. Archibald: What kind of restrictions?
Employee Manager: Here's how it works: Non-management part-time employees, such as yourself, only qualify for second tier catastrophic coverage.
John Q. Archibald: No, no. I'm not part-time. I'm full-time. It's just slow right now.
Employee Manager: Sure, but your coverage is based on hours worked and like I said, you only qualify for second tier. And that has a maximum payout limit of $20,000.
John Q. Archibald: [shocked] What? Wha- I-I mean-I mean, you guys have been taking money out of my paycheck every week. I've been paying into this policy for years.
Employee Manager: Right. And that's why we're gonna cover you for the full twenty.
John Q. Archibald: You can't be right. I mean, come on. Alright, let me get this straight: You're telling me that you have dropped me from full-time to part-time. You switched carriers. Now you're telling me I'm not fully covered? Even though I got a policy that says I am?
Employee Manager: It doesn't seem right, does it?
John Q. Archibald: No, it doesn't seem right. I mean, my son is sick. If I'm not covered, I've got a serious problem.
Employee Manager: I understand that, uh, but there's nothing I can do. Look, you can file for an appeal.
John Q. Archibald: Yeah?
Employee Manager: [hands John an appeal application] Here you go. That takes about seven working days.
John Q. Archibald: Changed to what?
Employee Manager: Yeah, we recently switched carriers from a PPO to a HMO. It's a less expensive policy, but unfortunately, there are some restrictions.
John Q. Archibald: What kind of restrictions?
Employee Manager: Here's how it works: Non-management part-time employees, such as yourself, only qualify for second tier catastrophic coverage.
John Q. Archibald: No, no. I'm not part-time. I'm full-time. It's just slow right now.
Employee Manager: Sure, but your coverage is based on hours worked and like I said, you only qualify for second tier. And that has a maximum payout limit of $20,000.
John Q. Archibald: [shocked] What? Wha- I-I mean-I mean, you guys have been taking money out of my paycheck every week. I've been paying into this policy for years.
Employee Manager: Right. And that's why we're gonna cover you for the full twenty.
John Q. Archibald: You can't be right. I mean, come on. Alright, let me get this straight: You're telling me that you have dropped me from full-time to part-time. You switched carriers. Now you're telling me I'm not fully covered? Even though I got a policy that says I am?
Employee Manager: It doesn't seem right, does it?
John Q. Archibald: No, it doesn't seem right. I mean, my son is sick. If I'm not covered, I've got a serious problem.
Employee Manager: I understand that, uh, but there's nothing I can do. Look, you can file for an appeal.
John Q. Archibald: Yeah?
Employee Manager: [hands John an appeal application] Here you go. That takes about seven working days.
Employee Manager : Your policy has changed, Mr. Archibald.
John Q. Archibald : Changed to what?
Employee Manager : Yeah, we recently switched carriers from a PPO to a HMO. It's a less expensive policy, but unfortunately, there are some restrictions.
John Q. Archibald : What kind of restrictions?
Employee Manager : Here's how it works: Non-management part-time employees, such as yourself, only qualify for second tier catastrophic coverage.
John Q. Archibald : No, no. I'm not part-time. I'm full-time. It's just slow right now.
Employee Manager : Sure, but your coverage is based on hours worked and like I said, you only qualify for second tier. And that has a maximum payout limit of $20,000.
John Q. Archibald : [shocked] What? Wha- I-I mean-I mean, you guys have been taking money out of my paycheck every week. I've been paying into this policy for years.
Employee Manager : Right. And that's why we're gonna cover you for the full twenty.
John Q. Archibald : You can't be right. I mean, come on. Alright, let me get this straight: You're telling me that you have dropped me from full-time to part-time. You switched carriers. Now you're telling me I'm not fully covered? Even though I got a policy that says I am?
Employee Manager : It doesn't seem right, does it?
John Q. Archibald : No, it doesn't seem right. I mean, my son is sick. If I'm not covered, I've got a serious problem.
Employee Manager : I understand that, uh, but there's nothing I can do. Look, you can file for an appeal.
John Q. Archibald : Yeah?
Employee Manager : [hands John an appeal application] Here you go. That takes about seven working days.
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