I worked at United for 7 years and Magellan for 4 years. There was a quotation for denials in both places. They worst case i had( this was at United)was a lady who only lived off of 1000 a month and her life saving cancer medicine cost that much. I could not deny her so I got in trouble but someone else did and she called me back crying that she was going to die if this was not reversed. I referred her to the state to file a complaint as I couldn’t do anything but cry with her. United took very good care of me as an employee but at the cost of people dying. It was not worth it so I left amd even though im poorer than ever at least I’m not contributing to the murder of people day in and day out as their claims get denied.
We need Universal Healthcare and now!
very helpful post for an outsider like me to have a better understanding of what goes on in the industry.
One minor issue, I assume you mean there was a “quota” for denials, not a “quotation” for denials. I have to wonder if such a quota is legally actionable and if United and Magellan could be prosecuted or sued by the US or State Governments, or sued by private citizens.
I have lived through so many denials and fights.
History. I endured an injury of potential med malpractice during an elective surgery. I was also a brand new attorney just getting my feet wet with loads of student loans. No one wanted to treat me because it could be malpractice and I was an attorney. I eventually got fired because i was having a hard time working in pain but couldn’t afford to quit.
I then had to pay higher Cobra premiums. Luckily my parents covered both State and fed Cobra health benefits until they expired and then I went on state high risk insurance. I had to move home (to a different state) and while the cobra ins took premium payments from out of state, as soon as I tried to get back surgery they dropped my coverage which almost screwed me out of qualifying for high risk ins. I won the fight to not get canceled but my surgery was denied as ‘experimental’ even though the FDA had approved the medical device to be used.
In the mean time I filed for Soc Sec Disability which of course was denied and i had to wait 5 yrs for my appeal to be heard and was eventually approved by a judge. Once on medicare i got back surgery approved but now 7 yrs had gone by, some of the nerve damage was permanent and my career was destroyed. BTW I picked one of the privatized medicare advantage plans because I wanted Aetna which was the only company at the time covering the surgery I needed. l
Later, on a Blue Cross Medicare Adv plan it took a year of fighting basic PT claims. The PT office accidentally used the wrong billing code but the ins denial said i had exceeded my benefits which was blatantly false. by the time I figured that out and convinced the PT office to fix the code the ins then denied it again as a duplicate billing!!! SMH A yr later they finally paid.
Then I had to fight for a treatment that used home durable medical equipment. I had to fight and eventually had a hearing before an administrative judge and got it approved. I only got that hearing because Medicare rules still apply to the privatized plans.
Years later, now i needed an iUD as an alternative to have surgery to remove my Uterus. Of course Denied after the expensive IUD was implanted. Again had to fight for coverage, and won.
My blood pressure goes through the roof any time I think about calling my insurance. Too much PTSD!
painful to read, but thanks for sharing it.
I have often said that when I die it will be arguing on the phone with a health insurance company. I just say it for effect though. Actually, there’s a decent chance that I will die when I refuse to argue the point with an insurance company.
I am so sorry for all the insurance companies have put you through, this is horrible! You’re an incredibly strong person to have persisted. How are you feeling now? 
Thx for asking but it is not easy to answer and not really the point.
I just listed crib notes specific to the topic of insurance denials in my life, as examples, because it is in the news with UHC and while many folks deal with it … there are also many folks lucky enough to stay healthy or get normal responses within the insurance system, but everyone should be concerned, it could be you next.
But in reality, so much more was happening alongside with what I mentioned. There is a domino effect on your whole life. I relate to people re student loan issues. I went into default. It ruined my credit. I could no longer rent an apt. Your social life suffers. Add in some side effects from medicine, including weight gain. Not being believed by some doctors. And single when it happened so no chance of being in a serious relationship with all that shit going on. The prime if your life gone and you just exist. It goes on and on.
So when Bernie came along … I was like wow… someone who gets it for a lot of people and a lot of situations. A once in a life time great politician with empathy and integrity.
And I know people have it way worse than me. When I was a law student I briefly volunteered for indigent folks getting evicted in DC, there were some heartbreaking stories, super unfair situations and unbelievable bad luck situations all facing slumlords and real crime in dangerous living conditions. Stories I will never forget!
I understand what you are saying; it affects every aspect of your life, and it’s hard to keep moving sometimes. Trust me, I really do get that. Your story is important. In terms of the prime of your life, well, that’s just a myth. Don’t let arbitrary rules and numbers hold you back or keep you down. There are a million ways to live life, and the most enjoyable ones don’t focus on what our Colonized and Patriarchal White Supremacist society says is important. Please don’t take that as me minimizing what you’re going through or what you’re saying, I just want you to know that you have a ton of wonderful things ahead and so much to offer.
@sciguy24 started a discussion post for this exact topic. Anyone who has experience or knows someone who has experience with insurance denying claims and basically making life hell should post there. I think it’s a great idea so we can all see how many of us are affected by this. We can support one another, not feel alone, and work to fix all the shit that is broken in our fucked up health insurance and healthcare systems.
When I was fighting for back surgery I wanted artificial disc replacement surgery instead of fusion for multi level disc injuries.
I learned about a 2001 policy directive for Federal employees and their federal health ins plans. If the FDA approves a medical device the insurance company can no longer call it experimental and investigational for any fed employee with a fed health ins plan. See attachment below.
Unfortunately this federal directive does not apply to everyone else with private employer provided ins.
When Obamacare did not address this issue I tried to work up the chain of the volunteer group Obama for America. One of the paid staffers here in my area even ended up in the Obama Admin.
When Obama’s Sec of Health and Human Services came to Waukesha WI for a campaign stop I asked one of the paid staffers to show this FEHB policy to her with a short note why it should apply to everyone. They refused to show her.
Then when I was a Dem delegate at the state convention, I saw Milwaukee Congresswoman Gwen Moore sitting at a table next to me. I politely approached her to explain this policy loophole but her handlers brushed me off. They love taking selfies but they sure do not like hearing anything of substance.
Also when I was living in San Diego I accidentally found myself in a hearing with Republican Congressmen Brian Bilbray and Darryl Issa who where holding a hearing with the medical device manufacturers. Reps Bilbray and Issa were trying to blame the FDA for these medical device companies not being able to grow, but they utterly failed to understand that it was the insurance industry blocking progress!!! When one of the device guys laid blame on the ins industry instead of the FDA, I cheered and they all looked at me in the audience. (I was there as part of protest action with local Dems, but when I found out the topic of the hearing, I went inside to listen!)
now when looking for the above policy from the OPM /FEHB, I found this more recent info on a 2024 task force. It gives me a glimmer of hope. I’m not sure who backs this vs opposes it in the political world.
WOW, I didn’t even know they could do artificial disc replacement, which is something I will likely need in the future because I’ve had widespread osteoarthritis since adolescence and it’s really messed up my back (and everything else). I’m going to be the bionic woman someday. 
The idea of disc fusion seriously scares the hell out of me. This does sound promising, though. Is disc replacement still an option for you? What happened when they hurt your back initially? It sounds awfully painful!
I did get 2 levels of lumbar artificial discs. I had it done in 2007.
I do not know whether artificial discs have become more common or not. Back then I went to one of the surgeons who participated in 100s of FDA clinical trials for Charite and ProDisc. I did not want to be a guinea pig for a surgeon just learning the procedure.
The idea was to have more flexibility on the spine so there was less stress on the adjacent levels over time.
But you would need to do a lot of research to find out whether it has become standard or still limited in practice. I had to meet with a few surgeons. Some would only discuss one but not all options because they likely got kickbacks from one manufacturer.
The surgeon I chose said biologics was the future. I would research whether there are other options available.