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 worked for a pretty big university here in the U.S. Not a premier research school, but pretty big nonetheless.
About a week before classes start, I get a call from the department head. They’re cancelling the classes in the specialization I teach due to low enrollment. He’s shuffled my schedule (expected) but one of my classes will be one I’ve never taught before and have absolutely no business teaching.
Now, mind you, this university has been going down hill for a while. Tenure was eliminated in all but name. Funding slashed. Class sizes exploded. Pressure increased to get federal grants to “make up the funding losses” while the school gives you absolutely no support in navigating the federal grant maze. No raises for years, except one small boost to make our salaries match a “sister school” that really wasn’t.
I told my department chair I couldn’t teach a course I knew nothing about. He relented and agreed to shuffle things around some more and put me in an old class I taught years back. I pulled out my old course materials, opened the textbook, started updating my old syllabus, and realized I just didn’t care anymore.
I’d been repeatedly fucked over again and again by these people and I was done. Honestly, I broke down and cried on my spouse’s shoulder for half an hour.
I called back the department chair and told him I quit. He said he didn’t blame me and wished me luck.
The silver lining? I now run my own software business (SaaS), get up around 10 am, add features whenever I feel like it, and draw a modest paycheck. My stress is way, way down and I’m learning to love my boss (me).