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.
I walked out on my last couple of jobs before I started working for myself.
At one, I had a coworker who was hyper competitive. She had two friends there who hated me even though we’d barely interacted. It got to the point where they started talking about beating and shooting me. The manager ignored it because he didn’t like me for religious reasons. (He was a conservative Catholic who repeatedly accused me of sexual misconduct because I spoke to male coworkers “too often”. He insisted that men and women speaking to each other unnecessarily is basically the same as sex.) I left and reported it to Security. There was a 3 month long investigation, run by the “Employee Satisfaction Dept.”, which turned up no evidence, so I was told I had to report back to work. I did not. A month after I quit, the ringleader, who had been aggressively competing with me for years, quit also.
The job after that was less dramatic, but was frustrating. I spent 6 months trying to get the CEO and coworkers signed up for a business conference. I needed the CEO to decide who was going to which seminars, since she was paying. I emailed her the relevant info, and emailed it to her husband, and printed it out and gave it to her, all repeatedly, because she kept losing it. I also repeatedly texted her about it. The day after the deadline to sign up, she started to review the info. When a coworker pointed out that we’d missed the deadline, she accused me of misinforming her about when it was. The piece of paper she held up to show me the correct deadline was the original document I’d given her 6 months ago, and the deadline was written in my handwriting. She told me that since it was my screw up, I was going to call the people running the seminar and make them waive the late fee. While I was waiting to hear if the VP of that company would approve the waiver, she kept screaming down the hallway at me every few minutes to ask if it was done yet. I started thinking, you know, I could just get up and walk out of here… So I did. I left the keys on the desk and went to the park to watch some ducks.
The next day, I started working for myself, and that went great until I retired.