I’ll intellectually/emotionally/physically hard as answers. For me its either 12 hours straight “punching tubes” on a very large scotch marine firetube boiler at the beginning of my career or Easter around a decade ago when I was working with troubled teens and had to engage in 5 separate protective holds in one 16 hour double shift. The former was all physical and the latter was a combination of emotional and physical.
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.
Comment 2, shit job boogaloo. Working for the same company, being forced to do Medicaid customer support. Had a new client call cause her psych meds were being denied. Since she was new, she got a courtesy fill for the first month. After that, the med required prior authorization. This woman was pitching a fit like a toddler. I offered to call her doctor and assist the DR with submitting. (The pharmacy denial only showed me the med and pharmacy, not who wrote the RX.) She refused to give me her doctor’s info. She claimed to have tons of paperwork showing she had taken other meds that didn’t work. I offered to give her my private work email so she could send them directly to me and I could put together a direct appeal of the denial. She refused. This woman refused all help I offered. She just screamed into the phone like a child. Then she threatened to commit suicide. When people threaten to kill themselves I am required to get a crisis response team on the line, which only the managers had access to. I called and emailed 10 fucking managers for this info and they all ignored me. Then the lady hung up, and would not answer my call backs. So I called the non emergency police line in her town, gave them all the contact info, and asked them to do a wellness check. An hour later this bitch called back and complained that I sent emergency services to her, which I got written up for.