John Q.2002

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.