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 was a freelancer for about a decade, and only ever walked off of one job site. It was because of safety concerns and one asshole. I was a stagehand, setting up lighting, decking, and audio gear for a musical in a local megachurch. I was in charge of a crew for this job, through a local labor company; Church hired the company to provide labor, who hired me as a subcontractor to make sure things went well, track workers’ time, etc… The load in was set to last three days, with them rehearsing in the evenings. Then they’d open that weekend.
I ended up attaching myself to the lighting crew for the first day, because decking and audio crews already had people who knew what they were doing. Plus if I’m in the catwalk, I can usually keep a pretty good eye on what is going on around the room. Some catwalks are easy to get to. They’re designed thoughtfully, with the expectation that crews will need to access them regularly. Other catwalks are… Not so easy. Maybe it was designed to be easy at one point, but then engineers added more structural beams, HVAC installers added air ducts, electricians added panels and conduit across doorways and walkways, architectural lighting got added in walkways, etc… Basically, the construction was a bunch of different crews, and none of them talked to each other to keep the catwalks accessible.
This church’s catwalk was unfortunately in the latter group. Getting to it involved a combination of a six-story-tall spiral staircase, army-crawling under an air duct, climbing over some electrical conduit, and squat-walking on a steel mesh grid to avoid some overhead beams. Needless to say, we made the trek up there once, and immediately decided that we weren’t going to be carrying our lights the same way we got up. Hell, lots of our lights wouldn’t even fit the same way we came up, due to the army-crawling section.
So we throw a rope down from the catwalk. Our lights are heavy, and it’s about a 7-story-tall lift to get from the audience to the catwalk. But many hands makes for light work, right? I ask who knows their knots, because we need someone on the ground to tie the lights onto the rope. One of the newbies (who I had never worked with before) raises his hand, so I send him down to act as ground support. His job is simple. We send the rope down from the catwalk, he ties the light to it, and then we haul the light up while he watches from the ground, making sure we don’t knock into anything or scratch the ceiling of the theater. Lather, rinse, repeat. This dude has the easiest job in the entire goddamned building, because all he has to do is tie a knot every few minutes, then watch the rest of us work.
So we send the rope down. A minute or so later, he calls back up that we’re good to lift. So we haul this light up. It’s heavy. It sucks. Many hands makes for light work, but we can only get a few hands on the rope due to the way we’re positioned in the catwalk. But we muscle this light up. One down, only 90 more to go.
But then as we set the light down on the catwalk, we realize that the “knot” we had lifted it with was basically just a bunch of loops with the tail pulled through. It fell apart as soon as the tension on the rope was released. Apparently our knot-tying ground support lied about being able to tie knots, and just went with the “if you can’t tie a knot, tie a lot” method. Except his “tie a lot” part wasn’t even safe, because he ended up just making a tension knot that completely fell apart as soon as the tension was gone. So I send someone else (who I have worked with before, and actually trust) down to the ground, and they send him back up.
All of this was simply to say that we were already a little bit on edge regarding this lighting install, because if that “knot” had come undone midway through our lift, we would have dropped a thousand dollar ~120lb light onto the audience seats, from about 90 feet in the air. So I want you to keep that part in mind when I bring up this next part…
After we get thirty or forty lights lifted, we’re feeling the strain. These lights are heavy, and my guys are smoked. The catwalk is hot (because hot air rises, this is in Texas in the summertime on a sunny day, and we’re basically pressed against the roof,) and we’ve all soaked through our shirts with sweat. For every light, once we get to the edge of the catwalk, we basically have to manhandle it up and over the railing to avoid scratching the decorative ceiling panels that are below us.
In the meantime, the church’s audio guy has shown up. He is sitting in the audience, chatting with another church employee. He apparently brought his son to work today. His son was like 5 or 6, and was suddenly running around in the audience, directly underneath us as we’re lifting these damned lights. Again, we’re already worried about dropping one of these lights. Even if we have the best knots in the world, accidents happen. I have seen clamps, handles, and hard points break off of lights before. I have seen ropes break. I have seen steel cables break. So there’s always some measure of “this could all go wrong and there’s nothing we can do but watch it fall” in the back of your mind with every single hoist. We already watched a knot fall apart that morning. And now there’s a fucking child playing underneath us.
So I call down, something along the lines of “Hey, can someone get that kid out of the way? We’re working up here!”
The sound guy almost immediately shouts back “how about you parent your kids, and let me parent mine!”
Like I said, my guys were already needing a break. We had already told ourselves that we were going to take a water break soon. As soon as that dude’s response had stopped reverberating around the (now dead silent) auditorium, I called out “Okay {company name}! Make it safe, then tools down! Take 20, then meet me on the dock!” Simultaneously, all ~40 crew members got the exact same glint in their eyes as they realized what was going on, finished whatever they were doing, then walked away for a smoke break.
In that 20 minutes, I called the company owner (who I play board games with nearly every week), and let him know what was going on. This was ~90 minutes into an 8 hour day. But notably, the crew had a 5 hour minimum. Meaning they’d get paid for at least 5 hours regardless of how long they worked. The intent is to ensure every job is worth the drive; without a minimum, nobody would take a 30 minute job if they had to drive 45 minutes to get there. And he said I could give the crew a choice. They can stay for the full 8 hours, or they can take the minimum and walk away right now. Next, I talked to the church’s main point of contact, to let them know what had happened, and what I was about to tell the crew. And when my crew came back after their break, I gave them all that choice. Every single person on the ~40 man crew took the minimum and walked away for the day.
The show’s load in was delayed by a day, and the church’s sound guy wasn’t present for the rest of the week’s load in and setup.
My blood pressure just kept rising, the further I read…
I’m glad you all walked away; a pissed off client is FAR better than a hospitalized kid on your watch. (though it sounds like the client was understanding anyway)
All it takes is one asshole to ruin a whole production. The funniest bit is that the church could have told him “hey Dave, they’re working hard, and they have a point. Take your kid to the back or something until they’re done”, but couldn’t be bothered. Great story.
That Dave guy shouldn’t have a kid if he doesn’t give a shit if a light falls on them. The “you don’t parent my kid” thing is insane. If someone tells me my kid was in a danger zone, I’m moving my kid.
The church may have had previous problems with the guy bing a negligent ass, and finally told him to fuck off.