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 reasonably successful startup in IT, and quit around the time when investors started calling for their returns. It went from the focus being providing good service to selling something, anything, whether we have it or not to boost the books before the end of next quarter. Every quarter. Our sales team who used to be part of the product design process and knew more about our product than some engineers were getting replaced with people who didn’t even know the name of features. They just made up things to potential customers and straight up lied, once the paper was signed they were done.
It was demoralising to see and go through this, I was a tech team lead for one of our core products and the requirements were mad. Every customer started becoming their own product because of all the overpromising, and it was all the absolute bare minimum. Anyhow, I was on good terms with the remaining few old sales people as we had worked together a lot prior to this mess.
I remember sitting in a meeting with some higher management and one of these older sales guys where he was saying he does not know what to do anymore and needs help or we need to change something as it’s impossible to do his job well anymore with these expectations that we just abandon customers as soon as they’re signed and chase new business. He broke down crying during the call while he was explaining how soul crushing it was to have to do this to people - build up a relationship, convince them to pay us and then ignore them immediately. There was an awkward quiet in the room when he finished and the “top dog” in the room just said “try to detach yourself, it’s just business” and then we moved on.
I saw myself becoming that man in a year, maybe 2 tops. I started interviewing the next day and found a new job in about 2 weeks (luckily this was when IT was booming and recruiters were lining up for anyone with engineer in their title). The company has since been sold multiple times and completely exhausted to a husk. The last sale I’m pretty sure was just a large enterprise acquiring staff and some tech.