I’ll go first. I did lots of policy writing, and SOP writing with a medical insurance company. I was often forced to do phone customer service as an “additional duties as needed” work task.
On this particular day, I was doing phone support for medicaid customers, during the covid pandemic. I talked to one gentleman that had an approval to get injections in his joints for pain. (Anti-inflamatory, steroid type injections.) His authorization was approved right when covid started, and all doctor’s offices shut the fuck down for non emergent care. When he was able to reschedule his injections, the authorization had expired. His doctor sent in a new authorization request.
This should have been a cut and dry approval. During the pandemic 50% of the staff was laid off because we were acquired by a larger health insurance conglomerate, and the number of authorization and claim denials soared. I’m 100% convinced that most of those denials were being made because the staff that was there were overburdened to the point of just blanket denying shit to make their KPIs. The denial reason was, “Not medically necessary,” which means, not enough clinical information was provided to prove it was necessary. I saw the original authorization, and the clinical information that went with it, and I saw the new authorization, which had the same charts and history attached.
I spent 4 hours on the phone with this man putting an appeal together. I put together EVERY piece of clinical information from both authorizations, along with EVERY claim we paid related to this particular condition, along with every pharmacy claim we approved for pain medication related to this man’s condition, to demonstrate that there was enough evidence to prove medical necessity.
I gift wrapped this shit for the appeals team to make the review process as easy as possible. They kicked the appeal back to me, denying it after 15 minutes. There is no way it was reviewed in 15 minutes. I printed out the appeal + all the clinical information and mailed it to that customer with my personal contact information. Then I typed up my resignation letter, left my ID badge, and bounced.
24 hours later, I helped that customer submit an appeal to our state agency that does external appeals, along with a complaint to the attorney general. The state ended up overturning the denial, and the insurance company was forced to pay for his pain treatments.
It took me 9 months to find another 9-5 job, but it was worth it.
Less of a rage-quit and more of a rage-promotion. (it’ll make sense, just keep reading.)
I am someone who keeps track of what I do, my productivity, and how much output I’m generating in my work. A company I used to work for decided they wanted to do back-door layoffs by handing out phony write-ups and putting people on performance improvement plans, and they targeted me.
Essentially, I went into a meeting with my boss thinking I was going to get promoted or at least an attaboy, because I knew I was the highest performer on the team.
Nope. It was a writeup. I told them straight up that I was doing more work than anyone on the team, I could prove it, and I wasn’t signing. I fought the PIP with HR too, and the delicious thing was my bosses knew they fucked up, because I breezed right through it.
Ended up interviewing for an internal req that put me in a senior position on another team, and what galled me the most was the insistence of my boss on a going-away lunch, and I hated every second of it. I was gracious on my way out because I didn’t want to burn bridges, but I honestly hope that person is rotting in Hell now, and am very pleased that that company got bought out and sold for parts, so hopefully they all got fired too.
Also, just adding this here, but if you work in a team and have the means you should always keep records of your own productivity and quality.
YES. I’m piggy backing on your post to drive home why you keep your receipts.
I was fired for performance issues after a little over a year of employment. They claimed I was working at a level lower than an entry level new hire. This was a big surprise to me as my most recent review was glowing, my expertise was carrying the department, and no one ever mentioned any concerns. The company was having issues, though, and I was the highest paid person in my department.
Unbeknownst to them, I keep a work journal. I spend five minutes at the beginning of each day reviewing what I did the day prior and what needs to be done that day, then recording it all in a little notebook made exactly for the purpose (I can link anyone if they’re interested). So I spent about 20-25 hours over my time there doing this and had meticulous records of the entire time.
What’s fun about my termination is I was out for 2 months recovering for surgery from a work injury. They fired me the day I returned for unsubstantiated performance issues that I can refute by the day.
Guess who is getting a $150k settlement.
That little notebook, on top of keeping me on track and making work easier, earned me about $6000/hour.