Insurance Haters

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Specializes in Utilization Review, Critical Care, OR, SNF.

I work for an insurance company in a combined UM/inpatient case management role. I don't know about ya'll but I am so very sick of the "insurance haters" out there who think that insurance companies, and those who work for them, are lower than....well, you know.

I see lots of threads here about "how to get a case management job", but not so much about how we FEEL about what we do.

Any takers. I'm interested.

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I'd like to learn more about what you do, and how you feel about your job. Please begin . . .

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Specializes in ED, ICU, MS/MT, PCU, CM, House Sup, Frontline mgr.

GonzoRN, I have not worked for an insurance company, but I do give bad news to patients regarding insurance coverage and I know what you mean and how you feel. It is hard to be the face of a patient's coverage. We are not the insurance company and that it is not our choice if something is covered. In fact, in many cases it was the patient's choice as to what is and what is not covered because he/she choose the insurance company and coverage!

It may help that when talking to people about your job, explain that you are a nurse first (emphasize that point) and that you assist with receiving needed equipment, treatment, and medications based upon his/her coverage. Also, when denying or confirming coverage (and if you are allowed), just read the coverage information to the CM or patient and in no way interpret the information for the patient or CM so that he/she comes to his/her own conclusion, because this takes you out of the equation.

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Specializes in Utilization Review, Critical Care, OR, SNF.

I really appreciate your comment. I was having a moment of frustration :) Almost all of my interactions with members have been positive. The negative interactions that I've experienced have come from providers. Particularly hospital discharge planners and MDs. I regret that they see us as a barrier. I want the member to move to the next level of care as much as they do, and try to assist in whatever way I can, however, the negativity is there. Unless they are desperate for me to approve and set up a flight across the country, in which case, LOL, I'm their new best friend. Have an awesome day, and again, thanks for the great feedback.

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Specializes in Utilization Review, Critical Care, OR, SNF.

I do out of plan CM/UM for acute hospitals, acute rehab, LTACHs, and SNFs for a regional health system. Our health plan serves about 500,000 members across all lines of business. I work remotely, 100% phone and computer based. I absolutely love what I do, and wild horses couldn't drag me away. I'm paid very well, and have great benefits. I do have frustrations, obviously, but overall, life is pretty good.

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Specializes in Public Health, Maternal Child Health.

With love from an insurance hater: I have nothing against good people that show up to work and do their job and follow the policies of the company they work for. Im sure you are a very nice person! What I have a problem with is our country's system of private sector insurance, the unreasonable cost of medical care in our country, and I hate the CEOs of insurance companies who set the policies of what medical care they will grant or not grant to their paying customers. I dont understand why a liter bag of normal saline costs $800 and why a person living nearly in poverty would have to pay 20% of that cost.

I believe with every part of my soul that health care is human right. Not a privilege. Im not willing to change my opinion on that. So thats why Im probably a person who trash talks how unfair insurance companies are. Sorry!

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Specializes in Utilization Review, Critical Care, OR, SNF.

I also believe health care is a human right. I would LOVE a single payer system. I would LOVE to be put of a job in that way. Do I think that it will ever be allowed in this country? Nope. And that is a very sad, sad thing. The problem is so incredibly complex and so intensely political that it boggles the mind. I don't think the big, bad insurance companies are at the root of it--it's a zillion-headed hydra that begins with those that "have", and want to remain in that so-called exalted position. So, I'm going to continue to do the best I can do for the members and the community I serve. I really do appreciate your comment, and no need to apologize.

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They can hate me all they want. I am enforcing contracts and business rules.

It is my JOB to keep an eye on the checkbook.

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Specializes in Managed Care, Onc/Neph, Home Health.

Thats just it, you are only enforcing medical benefits that the individuals company (their HR) have purchased, because they don't know how, they aren't medical. However, they put the medical benefit package together. Its like they went grocery shopping for benefits, and here Aetna, Humana, or whomever, now you guys explain it, and apply guidelines on our behalf, and don't approve too much, cause we ain't gonna cover it. That's the plan sponsor talking. And here you are on the ph, trying to apply clinical to move'em out, and they having a cow, yelling..."the insurance company" when you are doing your job....

I know some yrs back, I worked for a "reputable" HMO in the community, and they got in hot water, well the employer settled. an employer's kid had CP, The plan had like 100 PT visits only, OP. The benefit exhausted, and no more visits could be approved. No medical director could approve them. Was nothing to approve. It was the dad's insurance. Well dad went to his HR, who "purchased the benefits". it got very ugly....the president of the company got involved....our company was in the middle because we were enforcing/applying the employers benefits. shame shame shame. Needless to say, he got all the PT he needed for his CP. That's just why you will never never see a documentary about the inside of a HMO, like the big boys, Aetna, the Blues, and WellStar, on 20/20, and the others, and how they operate, from soup to nuts....:no: telling too much...

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
Any takers. I'm interested.
I'm starting a case management position at a well-known insurance company in about a week and a half, so I'll be following this thread with much interest.
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Nothing personal, but what's not to hate about the health insurance companies??

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Specializes in Psychiatric Nursing.

It is horrible that insurance companies are running medical care. It's part of capitalism of course but the whole notion of people making money off people being sick is flawed. I predict (and I've seen this talked about on student Doctor network) that over the next 20 years the insurance reform called the Affordable Care Act will become too expensive to maintain and the Single Payor will come in. Salaries will drop for physicians and then others. Who knows what else will change but the current system is not sustainable.

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