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’ve never rage-quit, but I put it out there a few times.
I had a district manager in a burger flipper hell decide to go through all the employees one by one and yell at them about their ‘faults’ in a successul clean restaurant with decent sales/waste.
When he got to me and raised his voice, I handed him the spatula, said if you’re going to stand here and berate me now, you’ll need this because i’m walking the fuck away. I’m open to criticism, but you’re not going to treat me the way you treated all these other people. He frowned, told me I didn’t use grill salt enough and moved on to the next person.
20 Years later, I was working in IT at a healthcare company. I had just finished an exchange migration from a desktop computer to a bona fide bare metal cluster. We got the license for webmail, but never ordered the licensing for ISA, which was specially designed to secure their OWA. My boss said, “Just hook it up, we’ll order it later. The ‘big boss’ is here and I want to hand it off to him”. Me: I am NOT putting that thing on the public internet without a proper firewall, we are constantly in a stream of attacks. Boss: Just do it, nothing will happen, I’ll take the heat. Me: I’m our HIPAA contact, no fucking way. Boss: I’m ordering you to do it. Me: You want my job, decide right now, You can hook it up, go show it off, i’ll find somewhere else. He grumbled and walked away. I had more system failures on that job from him pushing me to do shit wrong, fast and cheap. That place, of anywhere I’ve ever worked, had way more danger to the public of things going down and information being lost.