'I was able to approve 50+ cases before I quit': Insurance employee dismisses company guidelines, refuses to deny claims, then quits

Author image for Eleonora Bader
Eleonora Bader
Apr 20, 2023 1:00 PM EDT

Insurance companies do everything in their power to convince us to get on board with them, assuring us that they will be there for us, through thick and thin, in sickness and in health, till whatever do us part. When sickness does arrive though, they flee faster than a groom or bride who caught cold feet the night before their wedding. Gone with the wind and the dress, they're suddenly nowhere to be found. In other words, when they had said, 'We will cover the cost', what they really meant was, 'We will not cover the cost'.

In this case, u/jthememeking shared his experience working in an insurance company denying claims when he was just 19 years old, despite having literally zero experience, medical or otherwise. It was a grueling, tiresome, and infuriating job that OP didn't feel comfortable doing, so he didn't last very long at it. Before he quit, he was rebuked for 'slacking off' and told to 'work harder'.

These words gave OP an idea — work harder? You got it. OP began approving any and all claims, doing the literal opposite of what he was supposed to do, costing the insurance company a lot of money in the process. Who said a vigilante has to wear a cape? Scroll down to read the (frankly, quite wholesome) story.

For more, here is a boss who was made redundant after he gave absurd orders to his employee. He had wanted to fix something that wasn't broken, and it cost the company a lot of time, money, and effort. Luckily OP had a paper trail of emails and was only given a disciplinary hearing. His boss though? Fired.

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  • 01
    Font - Posted by u/jthememeking 15 hours ago 22 2 Stop slacking off and get to those insurance denials? Sure thing boss S OC This happened a few years ago, but was reminded of it because a lot of it is becoming public.
    via u/jthememeking
  • 02
    Font - Insurance companies are not your friends and will do everything they can do save money, including not paying for your medically necessary services. There's a lot of news coming out about insurance companies using algorithms to deny claims and doctors signing off on them. Before algorithms, they would have minimum wage employees reading over these claims for the doctors instead.
    via u/jthememeking
  • 03
    Font - Thats what I was. I was 19 years old, working for a insurance companies denying claims. I would be the first line for doctors to call and give their case for why they thought they needed a service or medicine. For some reason, 19 year old me when no medical experience was allowed to tell these doctors that services were not needed medically.
    via u/jthememeking
  • 04
    Font - This job was the easiest, yet most miserable job experience I ever had. I was only able to last a few months there. During my last 2 weeks, I was really slacking off. I was just so burned out. I couldn't stand denying yet ANOTHER case where someone needed meds and the insurance company didn't want to pay for them. I was reprimanded for not working hard enough and getting processed.
    via u/jthememeking
  • 05
    Font - Insert malicious compliance. I worked faster than I ever had before. That's because I approved every case that came before. Every doctor I spoke to, I just gave them approval. Every prior authorization I saw was approved.
    via u/jthememeking
  • 06
    Font - During my first week, I did this once and was told to not do it again because I have to follow company guidelines, but I didn't care at this point. I probably was able to approve 50+ cases before I quit. I hope it made it difference to those people. Fk health insurance companies.
    via u/jthememeking
  • 07
    Font - Morgan Rose99 15 hr. ago I worked in a pharmacy for over a year, and the pharmacist I worked with was one of the best in the county (possibly the state). One day she was talking to a costumer and I overheard her say "I've been working here for 14 years and I still don't understand insurance."
    via u/MorganRose99
  • 08
    Font - No offence, but it makes sense that those Prior Authorizations could have been based on someone still young enough to be in highschool basically just going "yeah, sure" or "nah, not good enough." Fik insurance companies, they causes at least 80% of our issues, most likely closer to 90%. Vote Reply Share
    via u/MorganRose99
  • 09
    Font - jthememeking OP. 15 hr. ago It's unreal. I had doctors and pharmacist yell at me a lot for going against them. Their rage was completely understandable. It was rough because the doctors who were going above and beyond for their patients are amazing doctors. Good people doing right by their patients, getting told no by some kid. I would file prior authorizations for them, because I knew a kot of the insider tricks to get them approved. I would
    via u/jthememeking
  • 10
    Font - fax them over to the doctors office so they could submit to us. I was only able to that a few times early on working there before being told I wasn't allowed to do that anymore. Reply Share Vote Morgan Rose99 · 15 hr. ago I had to deny filling someone's insulin because it was a new prescription (for the same fɩ¨`ng medication) and had to get a PA first. Vote Reply Share
    via u/jthememeking, u/MorganRose99
  • 11
    Font - sammyno55 19 hr. ago Where were you this past week? I went to see my GP on Friday afternoon and had 2 prescriptions called in to the pharmacy. I received a message that they were ready for pickup around 5 PM. I arrived at the pharmacy a bit before 6 and one of the meds was denied by the insurance company. I called the insurance company and talked to a person (he may have been
    via u/sammyno55
  • 12
    Font - on the West Coast and was still at work). He indicated that the doctor needed to approve the medication. I asked isn't that what the prescription is? He said that the insurance company needed further approval. I still don't understand what more they need. Reply Share Vote
    via u/sammyno55
  • 13
    Font - jthememeking OP. 19 hr. ago Keep pushing. They're counting on people not escalating the denials. Keep your doctor in the loop what the insurance company is telling you. Hope gets approved! Sorry you have to deal with this bu it Vote Reply Share sammyno55 17 hr. ago I already left a message at the GP's office with the relevant information. I'm still waiting for treatment 3 days later. Reply Share Vote
    via u/jthememeking, sammyno55
  • 14
    Font - DefrockedWizard1 When I was a working physician, the worst part of my life was dealing with insurance stuff. Now that I'm diled and can't work, the worst part of my life is dealing with insurance stuff Vote +2 Vote 18 hr. ago . Reply Share xHappyAcidx. 19 hr. ago This is the best one I've read. Thank you for your service. Reply Share
    via u/DefrockedWizard1, u/xHappyAcidx
  • 15
    Font - farrenkm +3. 19 hr. ago First of all, thank you for serving the people instead of the company! But this raises the question -- what were you allowed to approve that wouldn't get you in trouble? Reply Share Vote
    via u/farrenkm
  • 16
    Font - dsdvbguutres +3 - 17 hr. ago Let's privatize health insurance, and let the insurance company determine whether the insurance company should cover the cost of healthcare. Dictionary definition of conflict of interest. Reply Share Vote
    via u/dsdvbguutres
  • 17
    Font - jthememeking OP. 19 hr. ago. edited 16 hr. ago Prior authorization are what I worked on the majority of the time. The most common issue with a PA was a patient not trying another medication or procedure first. Or maybe the insurance company would want patients to be on a different brand of medication. What I did was look through the PA and see if they including the patients history and whether or not they checked all the boxes to be approved for the new medication.
    via u/jthememeking
  • 18
    Font - Honesty, a lot of the issues were doctors not knowing what other meds or procedures need to be done first. Different insurance companies require different meds to be tried first before getting approval, so a doctor would not even know what specific details to include in the PA. Vote Reply Share
    via u/jthememeking

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management medical insurance deny-claims workplace-stories malicious compliance petty revenge workplace-environment doctors insurance claims company payback insurance-company
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