Health Insurance Workers Fearful Amid Public Anger After Slaying of C.E.O. (HAHA! GOOD!!)

[HiramMcknoxt]

34. Man on the inside

So I dropped out of college to take a field director job for the AFL-CIO to canvass and lobby to get our senator (Blanche Lincoln) to vote for the PPACA (she was the last democratic holdout). After that office closed I was offered a low paying job in a much more expensive state across the country so I took a job in health insurance since I had experience in health care policy and no degree yet. 15 years later I finished my undergrad and graduate studies and now I’m a Director in Regulatory Operations for one of the largest carriers. I work specifically on the Marketplace product my company offers and I oversee the grievance, appeals, and broker fraud investigations units. This is very close to home for me. I was in school to get a PhD in sociology and teach, I always wanted to be a professor but by the time I finished my master’s I was making more than my advisor, now I’m making over double. So I’ve stayed for the money. My wife is also chronically ill. She takes 56 pills a day. We had six miscarriages before we had kids and we needed fertility treatment to make it happen. I’ve kept myself close to the devil because I need what the devil has. I’m at peace with that fact. I’m convinced that if I didn’t have the insurance I have I wouldn’t have kids and my wife would probably have died several years ago.

And I know that’s fucked up. I know this whole system is fucked up. I’ve known it my entire adult life. I see the worst of it. And I see myself as an agent of accountability working within the system. I’ve always liberally applied rules, looked for loopholes, purposely ignored cases submitted outside of the timely filing period, truly advocated for people. I’ve always fought hard to get stuff approved. I got into a shouting match one time with a medical director who tried to deny a person’s ER visit due to a gunshot wound because our plans don’t cover injuries incurred during the commission of a felony and “how do we know he wasn’t shot committing a crime”. I got that overturned. I love making calls to families to tell them I’ve gotten stuff approved. Knowing what I know about fertility claims, I’ve coached people on how to file claims to get fertility treatment covered “now if you file with a ex of infertility it will reject, but if you file it as treatment for the underlying cause of infertility it will pay.” And now that I’m upper management I get to just tell people what to do. I don’t have to even look for loopholes. I just do the right thing and concoct an argument for if an auditor ever asks about it. And this is the attitude I train my entire team to adopt. We’re people’s last hope a lot of the time, let’s help them. Let’s do what we can within the system to make it work. And it shows in our numbers, I won’t say which one but we’re well below the national average in denial rate.

But we also get doxxed. We had an MD receive a mailbox bomb over an adverse review. In some states grievance and appeals workers have to give their names and phone numbers in letters. There have been several occasions where people have shown up to the office to confront them, found them on social media and harassed them, and even doxxed them and sent stuff to or showed up at their house. These aren’t like at an epidemic level but everyone in this field has at least one story if there ever done member facing work for a year or so.

This ain’t it fam. We need systemic change. In the hours after Brian Thompson’s murder UHC had their investor day and their stock price went up 2.5%. This changes nothing. Things are in fact going to get worse when the EAPTC expires and millions lose their insurance at the beginning of 2026. But we need to reckon with the fact that not you have voted for a major party candidate in every election, you have never voted for a pro-single payer candidate. Harris didn’t offer single payer or even a public option, then go down the line. Bernie did, but we had to give the 2020 nomination to Joe, and Hillary in 2016. Obama was pro-public option but we can’t have nice things. We need systemic reform. We need to be mad at the people we trust to write the rules for this system and oversee it, not at the system for functioning the way we’ve designed it, and not at the workers who are maintaining the system we vote cycle after cycle to preserve.

Workers need to be protect. There are laws on the books that expose their identity needlessly that I’m working to change.