Burned-Out 19 Y.O. Tired Of Denying Insurance Meds For People In Need Approves 50 Cases And Quits
Interview With Author
Hey, I get it. Sometimes you really need the money. You gotta work that soul-sucking job until things get better and get out of there ASAP. But maybe you can do some good, even if the door hits you on your way out?
Reddit user jthememeking shared the story of how they got fed up with their health insurance job and right before quitting, they simply approved any and every insurance claim they got.
More info: Reddit
Denying health insurance claims for people who desperately need medical help must be up there with some of the most draining jobs
Image credits: Mikhail Nilov (not the actual photo)
The poster was a 19 y.o. working in a health insurance company, approving or denying claims
Image credits: jthememeking
Image credits: Oregon Department of Transportation (not the actual photo)
As insurance companies want to save everywhere they can, the poster had a miserable time on the job
Image credits: jthememeking
About to quit and being fed up with the job after being reprimanded, they got revenge by simply approving any claim they got
Jthememeking was 19 at the time, working at a health insurance company, with most of their job being denying insurance claims. It’s good that we don’t use aliases at work, though, imagine having your claim rejected by the meme king themselves.
Doctors would call and they’d usually reject them, while the MDs would be going over and above the call of duty to get their patients the care they needed.
Understandably, they loathed their time there, feeling burned out and dreading having to say “no” to someone who just needed medicine again.
So when they were putting their 2 weeks in and got reprimanded over working slowly, they would simply approve every single claim they got, totaling more than 50 by the end of their time there.
To get more insight about the story, Bored Panda reached out to jthememeking and asked them some questions, which they gracefully responded to.
The poster told us that they weren’t in a top-level position that required clearance or anything like that – they were one of the many workers coming and going. Because of the nature of the job, the turnover rate was very high. “From my training class, I was one of the last ones to leave. During my time there, more would come and go,“ they said.
If you didn’t know, insurance companies are required to have a doctor who would review these cases. There was a doctor on site at all times, but OP and other employees like them would be doing the reviewing. The doc would sign whatever they had decided on, without talking about or reviewing the decision.
When doctors would call to demand to know who was making those changes, they had the option of being referred to a supervisor, who, unsurprisingly, also isn’t a medical professional, but has the power to consult with the doctor. “But it’s very difficult to actually talk to a doctor if you were calling us,” the poster finishes.
Image credits: David Hilowitz (not the actual photo)
“I feel like you have to be a certain kind of person to work there long-term. The people who work there for longer than a few years seem so detached from the actions they’re doing,” OP said when asked about if there were people who would stay on the job for long stretches of time.
The job did have some silver linings, as they would usually be helping and guiding doctors with questions involving prior authorizations (PA). “The best times there were when there was a simple solution,” OP says. These would be the times when a procedure or medicine wasn’t on the PA. “I was glad to help when I could.”
According to the comments, OP would understandably have a lot of doctors and pharmacists rage at them, sometimes even letting them in on some tips and tricks to have their claims approved more easily. Once management caught on to them doing it, it was over, though.
According to WorldAtlas, the United States remains the sole country in the developed world without universal healthcare, with about 10% of people without any health insurance coverage, according to 2022 reports. This works out to about 27 million people who have much more difficulty getting help if they need medical assistance.
And for those in the States with coverage, the American Association for Justice (AAJ) published a report titled “Tricks of the Trade: How Insurance Companies Deny, Delay, Confuse and Refuse.”
The report is incredibly scathing, attempting to reveal the shady practices of insurers. “Some of America’s most well-known insurance companies—the same ones that spend billions on advertising to earn your trust—have endeavored to deny claims, delay payments, confuse consumers with incomprehensible insurance-speak, and retroactively refuse anyone who may cost them money.”
It’s a recommended read from us, but what I’d like to focus on is the finishing statement of the report which has also been uttered by OP in a comment. “And most of all, do not give up: Insurance companies count on you giving up. Fight for your rights.”
OP’s story simply exploded, netting almost 13k upvotes and about 700 comments from impassioned readers who shared their own insurance woes. Share your own stories, happy or sad, about dealing with insurance providers in the comments below!
Commenters shared frustrating stories about insurance of their own
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Wow. I'm glad to be a doctor in Germany. I get to say which medication or procedure a patient needs. Insurance only needs to approve if a procedure is 'off-label', as not intended to be used for that illness, but something else. And rehabilitation needs to be approved by the pension insurance, which it usually does as it's a lot cheaper for them to fund a rehab than to fund pensions prematurely.
Can I move in with you? America let's us die.
Load More Replies...
The American system is WEIRD! I am increadibly greatful that I live in a civilised and social country, or I would have been dead many years ago
I have read that, on average, around 600,000 people in the USA declare personal bankruptcy due to medical bills. That's well over 1600 people a day! But bring up single-payer systems or universal care, and brainless nincompoops belch propaganda about every wino getting a free liver transplant.
Load More Replies...
Health insurance is the scam you pay $100+/month for, in the hopes that you'll need it for the last 3-5 years of your life, so they can deny you life saving medical treatment while you slowly fade away, so they don't have to pay anything. It's literally "pay me so I don't have to pay you back".
Luv, that's not even the half of it in the USA. Have you ever heard of Agent Orange? In Vietnam, the US used chemical weapons that also affected US soldiers. The government denied it for nearly 30 years. I worked for Aetna health insurance which the US government contracted to "ameliorate" the claims by vets serving in Vietnam. If these vets could prove they had been adversely affected, through extensive documentation (often difficult to obtain from the military hostipal archives and the VA). If these servicemen could prove that their ailments were not from family history or current lifestyle, they "might" receive some financial compensation, which was rarely more than a few hundred dollars-nothing that would cover the expenses they had incurred as civilians, and well, Veterans Administration is a joke. I worked documenting these service men and women, their medical histories, their financial abilities (oh, because if you could work, you weren't considered sick).for a company
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My husband is on a prescription where the insurance company will only allow him 9 pills at a time - auto refill every 9 days. Our works schedules are such that is a MAJOR inconvenience to do this way. To get six weeks at a time through insurance is $30. If we pay for it, it would be $200. We are fortunate and able to pay that, so I showed up at the pharmacy willing to pay the $200. Girl behind the counter asked why I was doing this. When I explained she said "that's just wrong", punched some buttons on the computer and went to see the pharmacist. I don't know what happened, but I paid $30 for the pills.
I have became an expert at navigating insurance companies denials. Unfortunately my wife is very sick and needs certain meds. When they make a fuss, I simply take her to the E.R. every few days. She should go there anyway, but we have learned to deal with it at home so she doesn't have to spend all night waiting (not only we pay through the nose, but we wait interminably). After a few E.R. visits I call the insurance back and usually they allow for the medication or procedure. I tell them straight out "I can take her to the ER twice a week forever, but if you approve the meds/procedure/etc/) that will go away"
The point of health insurance is for the insurance company to make as much money as possible by denying claims. They don't give one single, solitary f**k about you or anyone else; they only care about their bottom line.
I used to work as temp. I really enjoyed it; especially if I got to stay at a good company for a while. But one company I worked at broke my brain. It was a contract company that was formed specifically so insurance companies had a company to outsource *their* claim workload to. That contract company hired temps - not permanent employees - to handle the claims. And the people who worked on the claims were told, “deny, deny, deny, deny, until the doctors scream loud enough.” So the medical professionals, meant to save lives and health, instead had to spend hours and hours and drown in seas of paperwork to even try to get a life-saving procedure for their patient, only to have it knocked back infinitum. By temps. At a tempoary company. Subcontracted by the insurance company. This is why the American medical system quite literally kills people.
👋👋👋👋👋👋 applause. More ppl need to act like Robinhood. American healthcare is fukt up. Can't get weight loss drug until after I'm diabetic!!
I absolutely appreciate what this young man did to help others! 19 years old. Think about that. What were you doing at 19? I wasn't risking my job to help people I don't know that's for sure! Hell I wasn't even aware that was a thing at 19! Thank you for doing what you could to help as many as you could! I have a s**t ton of respect for you! For the people saying he should have stayed and did it until he got fired. Now he probably wasn't in his career field at this time, regardless getting fired can have a negative impact on your future!
So no, he definitely shouldn't have risked his lively hood on it. Unfortunately even the people he did get approved doesn't even make a dent in the population that needs help! This kid needs to go be the successful young man he's going to be and the country needs to take better care of our people. Not some random 19 year old that has his entire life to live! Sad where our country is! I despise corporate America!!
Load More Replies...
As a healthcare provider can l say THANK YOU from not the bottom but EVERY pay off my heart. I don't even order MRI anymore because l know two things. One, is going to get rejected and two any appeal is a waste of time. I'd rather spend that time helping my patients. Physical therapy doesn't FIX anything! It may sorry term relieve pain but it out you on a merry go round of needing it forever or makes it worse. But, they want you to do it for six weeks. Our system needs a serious overhaul but it won't happen as long as Big Pharma is in charge
I don't even know where to begin so, I guess I'll just say that I'm lucky to be alive. It's because of the Insurance Companies here in America that I have swore off even going to a doctor. God help me if I come down with another Kidney Infection! June 2003, I was 31 yro at the time and feeling ill. Not with allergies or flu. (I'm usually fairly healthy) It felt like someone literally stabbed me over and over in my left kidney. So I called my Drs office to be seen. Luckily, they said to come in that day. I get there and find out that I had a kidney infection. Go to leave and the receptionist informs me that my insurance company decided they weren't going to pay for my office visit or my prescriptions. My policy states the insurance company pays 100% for office visits, no copay and 100% prescription costs. Long story short, It was10 days before I could go in to the hospital! Nearly died! FY Anthem!
I am a pharmacy tech for the NHS and just, disbelief that this goes on. Our system is also flawed (people want prescriptions for Everything “it’s my right, I don’t have to pay.”) which still costs the NHS and can lead to dangerous polypharmacy. But to put that on an untrained non-clinical not-quite-kid? Wow.
Of course they're crooks. Why blue cross blue shield is being sued for not taking out the government allowance only policy people were paying for through the government website. I was one of them. That's why I called them when I got my first bill. It's like $50 higher than it's supposed to be. They tried to pull one over on the government.
I agree f- medical insurance companies and some car insurance like progressive which will try to say your car was already damage before an accident.
My childhood best fried did this exact same job for a bit had had to quit as well. She was so mad and felt like she was self studying for med school just to do her job while coworkers just "deny, deny, deny." I can't imagine doing it long term if you had any empathy at all. McDonald's would be better for minimum wage, imo. My sister works on the other side of this and legit goes up and beyond to help people. Kills her call time rate but she also isn't disciplined for basically holding her caller's hand through the process. She has great customer satisfaction rates.
I've known about the algorithms for over 20 years. My father was diagnosed with cancer and denied treatment when I was in college. I spoke to my Professor about the situation and he told me about the algorithms... Sad.
Sorry but insurance companies deciding medical issues is crazy. If a doctor says a patient needs a medication then there is s reason for it. America need to look at their systems, for a first world country they think very third world
This isn't insurance-related, but: I spent a while doing background checks for firearm purchases for my state. One employee there put in her two weeks notice, then spent those last two weeks approving every single background check without actually running them, so a bunch of people who were not supposed to have guns ended up with guns. They (a) had to rerun all her checks, (b) had to send out a bunch of agents to try to get some of the guns back, and (c) arrested her for dereliction of duty.
The approvals "may have" been overturned. If anyone checked your work, the approvals could have been isolated and updated. While I disagree with the step-therapy, it makes sense in some cases. Especially when drug companies are pushing the latest, greatest and most expensive drugs.
Am I allowed to correct one thing? His last sentence to be exact. „F**k US health insurance companies“.
In South Africa we have a list that by law the government and health insurancws have to cover medical and surgery in so.e cases.any emergency medical condition; a limited set of 271 medical conditions (defined in the Diagnosis Treatment Pairs); and 26 chronic conditions (defined in the Chronic Disease List).
The 19 year old child/near-teenager is lying through his teeth!!! At 19, he was "processing paperwork (ie bills)" NOT approving or denying ANYTHING. He didn't have any authority to do anything other then input the patient's name, ID number, diagnosis, ICD:10 code and send it up the line for a nurse reviewer to Approve or seek additional information. He had no "authority" to "override" anything! Yes, insurance companies can be @ssh0!es, but this guy is stroking his own ego and lying in the process of self-aggrandizing! He was probably let go because this is data entry and he couldn't do it fast enough. Gosh, I despise liars! Who knows how often he tells this BS story tcover up being fired!
You're completely ignorant of how the US healthcare system works
Load More Replies... Maybe someone can help answer my question. This does sound like the US, except the part about doctors calling insurance companies. I’m sure that happens occasionally, but I’m pretty sure none of my doctors have talked to my insurance company in all my decades of adulthood. Is this a thing? I know they bill the insurance company, but if something is not approved, it’s up to me to fight it. Also, this is not malicious compliance (getting to hate this term), it’s just an F*U.
The MC part was going from slacking off to going into warp speed but not the way they wanted
Load More Replies... Wow. I'm glad to be a doctor in Germany. I get to say which medication or procedure a patient needs. Insurance only needs to approve if a procedure is 'off-label', as not intended to be used for that illness, but something else. And rehabilitation needs to be approved by the pension insurance, which it usually does as it's a lot cheaper for them to fund a rehab than to fund pensions prematurely.
Can I move in with you? America let's us die.
Load More Replies... The American system is WEIRD! I am increadibly greatful that I live in a civilised and social country, or I would have been dead many years ago
I have read that, on average, around 600,000 people in the USA declare personal bankruptcy due to medical bills. That's well over 1600 people a day! But bring up single-payer systems or universal care, and brainless nincompoops belch propaganda about every wino getting a free liver transplant.
Load More Replies... Health insurance is the scam you pay $100+/month for, in the hopes that you'll need it for the last 3-5 years of your life, so they can deny you life saving medical treatment while you slowly fade away, so they don't have to pay anything. It's literally "pay me so I don't have to pay you back".
Luv, that's not even the half of it in the USA. Have you ever heard of Agent Orange? In Vietnam, the US used chemical weapons that also affected US soldiers. The government denied it for nearly 30 years. I worked for Aetna health insurance which the US government contracted to "ameliorate" the claims by vets serving in Vietnam. If these vets could prove they had been adversely affected, through extensive documentation (often difficult to obtain from the military hostipal archives and the VA). If these servicemen could prove that their ailments were not from family history or current lifestyle, they "might" receive some financial compensation, which was rarely more than a few hundred dollars-nothing that would cover the expenses they had incurred as civilians, and well, Veterans Administration is a joke. I worked documenting these service men and women, their medical histories, their financial abilities (oh, because if you could work, you weren't considered sick).for a company
Load More Replies... My husband is on a prescription where the insurance company will only allow him 9 pills at a time - auto refill every 9 days. Our works schedules are such that is a MAJOR inconvenience to do this way. To get six weeks at a time through insurance is $30. If we pay for it, it would be $200. We are fortunate and able to pay that, so I showed up at the pharmacy willing to pay the $200. Girl behind the counter asked why I was doing this. When I explained she said "that's just wrong", punched some buttons on the computer and went to see the pharmacist. I don't know what happened, but I paid $30 for the pills.
I have became an expert at navigating insurance companies denials. Unfortunately my wife is very sick and needs certain meds. When they make a fuss, I simply take her to the E.R. every few days. She should go there anyway, but we have learned to deal with it at home so she doesn't have to spend all night waiting (not only we pay through the nose, but we wait interminably). After a few E.R. visits I call the insurance back and usually they allow for the medication or procedure. I tell them straight out "I can take her to the ER twice a week forever, but if you approve the meds/procedure/etc/) that will go away"
The point of health insurance is for the insurance company to make as much money as possible by denying claims. They don't give one single, solitary f**k about you or anyone else; they only care about their bottom line.
I used to work as temp. I really enjoyed it; especially if I got to stay at a good company for a while. But one company I worked at broke my brain. It was a contract company that was formed specifically so insurance companies had a company to outsource *their* claim workload to. That contract company hired temps - not permanent employees - to handle the claims. And the people who worked on the claims were told, “deny, deny, deny, deny, until the doctors scream loud enough.” So the medical professionals, meant to save lives and health, instead had to spend hours and hours and drown in seas of paperwork to even try to get a life-saving procedure for their patient, only to have it knocked back infinitum. By temps. At a tempoary company. Subcontracted by the insurance company. This is why the American medical system quite literally kills people.
👋👋👋👋👋👋 applause. More ppl need to act like Robinhood. American healthcare is fukt up. Can't get weight loss drug until after I'm diabetic!!
I absolutely appreciate what this young man did to help others! 19 years old. Think about that. What were you doing at 19? I wasn't risking my job to help people I don't know that's for sure! Hell I wasn't even aware that was a thing at 19! Thank you for doing what you could to help as many as you could! I have a s**t ton of respect for you! For the people saying he should have stayed and did it until he got fired. Now he probably wasn't in his career field at this time, regardless getting fired can have a negative impact on your future!
So no, he definitely shouldn't have risked his lively hood on it. Unfortunately even the people he did get approved doesn't even make a dent in the population that needs help! This kid needs to go be the successful young man he's going to be and the country needs to take better care of our people. Not some random 19 year old that has his entire life to live! Sad where our country is! I despise corporate America!!
Load More Replies... As a healthcare provider can l say THANK YOU from not the bottom but EVERY pay off my heart. I don't even order MRI anymore because l know two things. One, is going to get rejected and two any appeal is a waste of time. I'd rather spend that time helping my patients. Physical therapy doesn't FIX anything! It may sorry term relieve pain but it out you on a merry go round of needing it forever or makes it worse. But, they want you to do it for six weeks. Our system needs a serious overhaul but it won't happen as long as Big Pharma is in charge
I don't even know where to begin so, I guess I'll just say that I'm lucky to be alive. It's because of the Insurance Companies here in America that I have swore off even going to a doctor. God help me if I come down with another Kidney Infection! June 2003, I was 31 yro at the time and feeling ill. Not with allergies or flu. (I'm usually fairly healthy) It felt like someone literally stabbed me over and over in my left kidney. So I called my Drs office to be seen. Luckily, they said to come in that day. I get there and find out that I had a kidney infection. Go to leave and the receptionist informs me that my insurance company decided they weren't going to pay for my office visit or my prescriptions. My policy states the insurance company pays 100% for office visits, no copay and 100% prescription costs. Long story short, It was10 days before I could go in to the hospital! Nearly died! FY Anthem!
I am a pharmacy tech for the NHS and just, disbelief that this goes on. Our system is also flawed (people want prescriptions for Everything “it’s my right, I don’t have to pay.”) which still costs the NHS and can lead to dangerous polypharmacy. But to put that on an untrained non-clinical not-quite-kid? Wow.
Of course they're crooks. Why blue cross blue shield is being sued for not taking out the government allowance only policy people were paying for through the government website. I was one of them. That's why I called them when I got my first bill. It's like $50 higher than it's supposed to be. They tried to pull one over on the government.
I agree f- medical insurance companies and some car insurance like progressive which will try to say your car was already damage before an accident.
My childhood best fried did this exact same job for a bit had had to quit as well. She was so mad and felt like she was self studying for med school just to do her job while coworkers just "deny, deny, deny." I can't imagine doing it long term if you had any empathy at all. McDonald's would be better for minimum wage, imo. My sister works on the other side of this and legit goes up and beyond to help people. Kills her call time rate but she also isn't disciplined for basically holding her caller's hand through the process. She has great customer satisfaction rates.
I've known about the algorithms for over 20 years. My father was diagnosed with cancer and denied treatment when I was in college. I spoke to my Professor about the situation and he told me about the algorithms... Sad.
Sorry but insurance companies deciding medical issues is crazy. If a doctor says a patient needs a medication then there is s reason for it. America need to look at their systems, for a first world country they think very third world
This isn't insurance-related, but: I spent a while doing background checks for firearm purchases for my state. One employee there put in her two weeks notice, then spent those last two weeks approving every single background check without actually running them, so a bunch of people who were not supposed to have guns ended up with guns. They (a) had to rerun all her checks, (b) had to send out a bunch of agents to try to get some of the guns back, and (c) arrested her for dereliction of duty.
The approvals "may have" been overturned. If anyone checked your work, the approvals could have been isolated and updated. While I disagree with the step-therapy, it makes sense in some cases. Especially when drug companies are pushing the latest, greatest and most expensive drugs.
Am I allowed to correct one thing? His last sentence to be exact. „F**k US health insurance companies“.
In South Africa we have a list that by law the government and health insurancws have to cover medical and surgery in so.e cases.any emergency medical condition; a limited set of 271 medical conditions (defined in the Diagnosis Treatment Pairs); and 26 chronic conditions (defined in the Chronic Disease List).
The 19 year old child/near-teenager is lying through his teeth!!! At 19, he was "processing paperwork (ie bills)" NOT approving or denying ANYTHING. He didn't have any authority to do anything other then input the patient's name, ID number, diagnosis, ICD:10 code and send it up the line for a nurse reviewer to Approve or seek additional information. He had no "authority" to "override" anything! Yes, insurance companies can be @ssh0!es, but this guy is stroking his own ego and lying in the process of self-aggrandizing! He was probably let go because this is data entry and he couldn't do it fast enough. Gosh, I despise liars! Who knows how often he tells this BS story tcover up being fired!
You're completely ignorant of how the US healthcare system works
Load More Replies... Maybe someone can help answer my question. This does sound like the US, except the part about doctors calling insurance companies. I’m sure that happens occasionally, but I’m pretty sure none of my doctors have talked to my insurance company in all my decades of adulthood. Is this a thing? I know they bill the insurance company, but if something is not approved, it’s up to me to fight it. Also, this is not malicious compliance (getting to hate this term), it’s just an F*U.
The MC part was going from slacking off to going into warp speed but not the way they wanted
Load More Replies...
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