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.
Wow, after reading your story, my ragequit is peanuts in comparison. I almost don’t feel like posting it!
Normally I’m a lot more humble than this, but you’re all strangers on the Internet, so you’ll just have to take my word for it, but… I had performed extremely well at my software development job. “Exceeds expectations” kind of performance review. I had led the architecture of several large efforts, and consistently delivered features.
Promotion time comes around, and I get a 3% raise. Eh, whatever. At least it meets inflation.
I find out a bit later that one of my coworkers (quite talented in her own right, don’t get me wrong) got a title increase and a much more meaningful salary bump.
So I talk to my manager about why she was promoted and I wasn’t. We both had similar performance reviews, had led similar projects, and so on. I was prepared to accept it if there was a good reason. There wasn’t. There was only budget room for one promotion, and she had been hired at a more senior position than me, though I had been promoted to match soon after I started. That’s it. No logical reason other than seniority.
I was butthurt, and started looking for a new job right away. Ended up snagging a great gig in a few weeks.
I keep in touch with my old co-workers quite regularly, and I guess some activist investor forced through policy changes and gutted the satellite office I worked at. I guess I dodged a bullet there.
This sparks joy. Sometimes the only way to get a raise is to jump ship. It makes me happy that you know your worth, and you fight for it!