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.
A gas station chain as a client and the type of work that came with it. I was working as a help desk tech subcontractor and already had about 20 different clients. I’ve been doing this for a decade but because the new ones always messed up their work, we had tons of reminders and automated tasks in Teams. So I was already on edge because of the constant Teams notifications and all the triple checks.
Then they introduced this new client, a gas station chain, with hundreds of locations. I already worked in gas stations when I was a teenager and hated it. I hated the constant beeping for pumps to be unlocked when someone wants to buy gas. And I certainly didn’t want to have stressed teenagers on the phone telling me it’s super important that all their pumps are working on a Sunday afternoon while my instructions were to simply convince them to wait until the next business day if all we tried didn’t work. Fuck cars. Fuck oil companies. I can usually tolerate working with Microsoft even if I hate it, but Microsoft + oil companies. Fuck no.
I still haven’t found the will to get a new job, but my bank account is now starting to push me with insistance.