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.
This was years ago, I was working a supervisor position at a certain green mythical sea lady themed coffee chain. I was sitting in the parking lot before my shift enjoying a shitty chili dog from sonic way more than I should have been. Previously that day, I’d recieved a text from my manager asking me to go in early, I elected to ignore it, I’m off the clock I have no obligation to text back or even acknowledge the message. Back to the chili dog. So, I’m scrolling through my phone and I see a message in the group chat for my store where someone asked some kind of question, probably something was broken idk. I replied with an answer and immediately had a text from my manager that said something along the lines of “how you gon reply to that after ignoring me all day?”
I walked in and gave him a shaky nervous lecture (I have really bad anxiety and hate confrontation) about how he doesn’t own me or my time when I’m off the clock, he has no authority over me when I’m off the clock, and it’s bullshit that he’d be whining in my inbox about petty stuff like that when he could’ve talked to me in person about it five minutes later when my shift was scheduled to start. I ripped the key off my chain and threw it at the ground in front of him and said to “work the shift your fucking self”.
Yeah, I was immature. There were a million better ways to handle it, but he happened to catch me in a critical time between being radicalized and learning emotional intelligence. Sorry dude, you got all my corporate rage in one go.
Whatever, left the worst job I ever got koolaided into enjoying that day.