How one manager pushed out a competent medical insurance analyst — and the company did nothing

Uncategorized Jan 26, 2021

The late Congressman John Lewis talked about the importance of saying and doing something when you see something that's not right — getting into good trouble. “I fought too long and too hard against discrimination based on race and color not to fight against discrimination based on sexual orientation and gender identity,” he said. “He (President Obama) is sending a powerful message that discrimination in any form has no place in a democratic society. It also gives hope to the 9 million LBGT Americans and their loved ones who have had to bear the pain and sorrow of rejection, loss, and shame with limited means to make their voices heard.”

 

 


In 2007, a healthcare organization hired me as a military medical insurance analyst, a position I would stay in for 12 years. (I had the same position for 20 years in a different healthcare organization.) For those 12 years, I received excellent job evaluations year after year from my previous managers. I can list numerous people with whom I’ve had great working relationships. My job evaluations were so excellent that I was selected as one of the first remote workers in my department. Working from home gave me the ability to do an extra day’s work per week. Our expected weekly quota was processing 200 claims per week; my average weekly quota was 240+ claims per week. My
personal weekly goal was to exceed the previous week’s quota. The quality of work did not diminish. It increased. My quarterly review scores were excellent. In 12 years, I never received any complaints or less than stellar performance reviews.

All that changed in April 2019 when according to my manager, suddenly “I was stupid.”

Around 2017, management decided all military health insurance billing should be centralized in one department. So I transferred departments and maintained my status as a remote worker under my new manager, who knew nothing about the claims I oversaw. I was always the “go-to guy” if anyone, including the legal department, needed clarification on a claim in my work queue. I always answered questions in a timely and professional manner. I was responsible for processing and analyzing medical insurance claims for current military personnel, veterans, and their families worldwide for four different military agencies. Each agency had different protocols for processing claims.

My manager would not/could not accept or adhere to different procedures in processing the military claims. My manager resented any attempt to keep her informed and updated on new billing procedures. She had to be the primary source of all updated billing information and considered outside information as invalid and incorrect, even when I presented her with new written updated information. 

A previous employee — a Vietnam veteran — confided in me that he could not do anything to please our manager, who constantly criticized him. When I worked in another billing department, I sat next to this veteran and witnessed the constant harassment and nitpicking. She also made it difficult for him to schedule a medical procedure. The manager fired him after 30 years on the job. Two weeks earlier, during an employee assembly and ceremony, he received organizational recognition for his loyalty, dedication, and hard work for the past 30+ years. This dedicated employee was also over the age of 60.

When my boss assigned me claims in a new program, she refused to meet updated and new strict scheduled deadlines despite my sending her a written schedule for medical records. Working conditions under my new manager started to become even more toxic in January 2019 when the insurance companies required more documentation. On top of my workload of close to 1,000 claims, my manager added more locations to my workload. Up to that point and for well over a year, there were no communicated issues with my job performance.

But suddenly my manager instructed me to send a claim for self-pay even when we had medical records to replace a required third party form, ignoring the insurance company's instructions. Per my manager’s instructions, I sent a third party liability form to a patient. The patient send the form back with the note “I HAVE CANCER.” The particular claim was over $103,000. I tried to avoid contacting the patient to avoid adding stress for the patient and per the legal department’s advice, but my boss put up roadblocks that prevented me from doing my job and that ignored third party instructions.

This type of cover-up was against organizational ethical procedures and insurance protocol yet happened numerous times. I did not want to be a part of any cover-up or any attempt to emotional harm a patient. My manager placed me in an awkward and a uncomfortable position: either I followed her misinformed instructions or I placed my patient’s welfare above my manager’s ego. I chose to uphold and support the welfare of my patients.

My manager resented every update I gave her. I thought I was being helpful and doing my job. Starting in April 2019, everything I did was wrong.

In January 2019, my manager hired a 23 year-old woman. Around the same time, I told my manager my laptop was slow and losing internet connection, a problem that persisted for weeks. IT’s advice was to reboot the laptop, even 2-3 times per day. The IT department told me to bring my laptop into the office and let the in-office Wifi refresh the laptop updates. This refresh did not work in the long-term, but I was still able to maintain my daily work quota of 40+ claims per day. IT later determined that my laptop drivers were out-of-date and my laptop was broken. The IT representative admitted that my laptop was outdated and a piece of “junk.”

At the beginning of a staff meeting in April 2019, I asked my manager about how a new healthcare company would impact us. My manager asked “Why? Are you thinking of applying for a job with them?” I said (off of the top of my head) “No, I don’t think they would hire a 68 year-old gay guy.” Her eyes widened, and her eyebrows went up. Her response/look made me uneasy. Toward the end of the meeting, she asked if we had any issues. Again, I brought up the topic of the third party liability request from the insurance companies requiring medical records for claim processing. Once again, she ignored me.

Three hours after this staff meeting, my manager called me into a conference room. The supervisor was also present. Out of nowhere, my manager accused me of taking 90-minute lunches. She asked why I was going to lunch two minutes early at 12:58pm and why there were gaps in time during my workday. She asked why it was taking me so long to status a claim that should only take five minutes and why I was sending and requesting so many medical records. They were all false accusations. I felt ambushed. I sat there in stunned silence. The supervisor took notes of everything I said, I tried to explain, and my explanations were dismissed instantly. The supervisor left the conference room. I said to my manager “I never had problems with my job performance scores before.” She said “they (the job scores) were all wrong.” (My manager previously signed off on my excellent job scores.) This point was the beginning of her constant gaslighting and harassment. I felt that all my hard work for the past 12 years was wasted. I was being held to different standards.

My manager wouldn’t listen when I said that I told her numerous times my work laptop was slow and disconnecting from the internet. She said “well, my laptop works fine,” as if that’s relevant. I did what the IT department told me to do when I lost internet connection. I was told to reboot the laptop. I rebooted the laptop, sometimes numerous times during the day, and it took time to reboot.

She put me on a two-week probation period before my next quarterly review. The next day, I received an e-mail from her listing all my faults — a smear campaign of false accusations and what seemed to be an attempt to either fire me or get me to quit. She used these same tactics on other employees in the past who she fired, forced to quit, or forced to transfer to other departments. 

Per my manager:

  1. “There were unexplained gaps in your daily work flow and not following work flow processes.” I communicated internet connection problems and corrected procedures. I was never late signing in despite my laptop issues. She was looking at the time I sent email to her, not the time I signed in or out. The difference in the two times was about one to two minutes.
  2. “Accounts reviewed were not difficult and shouldn’t have taken more than five minutes to complete.” False. I spent time looking up claims online, updating registration, verifying eligibility, cross-referencing claims, updating other claims for the same patient, and taking clear and concise notes. I gave her copies of claims that took more than five minutes to process. She ignored me. There is no such thing as a “five-minute claim.” How does my manager know how long a claim takes to analyze and correct for processing? 
  3. “Lunch breaks begin minutes before 1pm.” Yet for the past 12 years, my lunch break has always been 12-1pm, not 1-2pm. Another false accusation, just to have it on the record.
  4. “We should not send medical records for appealing.” That point makes no sense. I followed instructions from the insurance companies, including following guidelines for third parties' requests. If the insurance company did not receive the requested medical records, then the claim would not be processed, and therefore no payment was forthcoming. Military insurance claims required medical records for claims over $10K. I only sent medical records when they were requested. I gave my manager this requirement in writing, and it was written by my manager as a part of the department's standard operating procedures. My manager contradicted herself and ignored our company’s code of ethics. My manager’s behavior was morally and ethically wrong: another attempt to gaslight me.
  5. “After checking the website and there is no change in status, the next step would be to call and speak to a customer service rep.” Yet if I called, sometimes I was on hold for hours. That’s wasted time and money. When possible I used the automated phone system and online chat feature to obtain claim information, such as claim status and benefits eligibility. Yes, I called the insurance companies when it was necessary. One insurance company I worked with did not have a website, automated phone system, or a secure e-mail. I had to call to receive claim information. My manager said I was forbidden to use the insurance automated phone system or the online chat service. The online chat system was like using a telephone. I received the exact information as if I used a phone. The wait time for an online chat was usually less than one minute. I could print out my online chat instead of wasting time taking notes. Printing online chat responses made my claim notes more efficient and accurate. My manager’s instructions made no sense — another attempt to sabotage my efficient work flow and to gaslight me. 
  6. “Communication with (one particular insurance company) must be done through the secure e-mail address created especially for claim status inquiry.” Yet I never worked certain military claims. I worked claims with a similar name, and that company’s email system never worked. With this particular insurance company, I had to call customer service to obtain claim status. I gave my manager proof that this particular e-mail system was not secure and did not work. The proof was ignored, again.
  7. “Within the past three weeks, your quarterly review scores have declined.” Why did it take three weeks for my manager to tell me that my quarterly review scores declined? It was three weeks earlier that my boss found out I was gay, that I was 68 years old, and that I contradicted her work instructions in a staff meeting. A few days after the April 2019 staff meeting, my manager began to give my work to a 23 year-old who just passed her initial new hire 90-day probation period. This woman had no prior experience in military insurance billing. Three weeks previously, I brought up to my manager concerns about a number of claims billed to another federal insurance program. These claims were paid, but the claims should never have been billed in the first place. Because the claims were billed and paid in error, I was concerned about potential ramifications to me because they were in my work list, and I was ultimately responsible for these claims. I told my manager about the claims that were billed in error. I gave my manager the list of claims paid in error and were due a refund. My manager told me not to give the federal agency a refund. She knew that I knew that her instructions were unethical and potentially illegal (fraud). My manager gave me a look that clearly said “don’t question by authority or instructions.” I did not want to be a part of any type of alleged cover-up. My manager intended to keep the unlawful payment. She told me no refund until this particular military program paid the claim. We can’t bill two federal agencies for the same claim. Three weeks later, a few hours after a staff meeting, she began with the false accusations, harassment, discrimination, nitpicking, and gaslighting. I finally realized everything happened at once, and it all began when I questioned my manager's billing instructions concerning federal agency refunds, when she found out I'm gay, that I'm 68 years old, and that I filed a complaint with the human resources department. It was at this same time my manager started to give my work to a new hire. 

These points were clearly her smear campaign, an attempt to wear me down so I would quit. The constant nitpicking and gaslighting was almost a daily occurrence.

My manager always left the office by the exit route behind her desk. After April 2019, she began to use the main office aisle that was behind my desk. My desk was on a high traffic aisle, so everyone in my part of the department had to walk by my desk. My manager started to walk by my desk a number of times. I felt I was being unduly monitored and spied on. Twice I caught my manager standing behind me, looking over my shoulder. It was unnerving and creepy. I never saw my manager do this to other employees. 

Within three weeks of an April 2019 meeting, she assigned my work to a newly hired employee, a 23-year old with no prior billing experience with these claims. The transfer of work at the same time as criticism of my work could not have been a coincidence. Bringing on younger employees with less pay looks like age discrimination. Perhaps she wanted an employee who wouldn’t question her procedures or inaccurate policies, which she changed on a whim. She had a long-standing pattern of abuse, fear, and intimidation. This change happened after she asked me if I was looking for another job and after she learned I am gay and 68 years old. I was the oldest employee in my department.

Two weeks later, my boss ordered me back into the office. She rescinded my remote working privileges. 

From the end of April 2019, my boss constantly criticized and nitpicked my work and me. My supervisor revealed that my manager was reviewing every account note I made during the previous work week: 200+ claim notes I made per week, looking for anything to criticize. Other employees were not subject to such scrutiny and micromanaging. 

For about 2-3 weeks, I had fewer than 40 claims in my work queue for the entire week (I usually have 200+ claims in my work list per week). Claims over $10k were not reviewed for about four weeks. My manager had me take a 10-week “refresher course.” She told me all employees would take this refresher course, but they never did. My supervisor was in charge of the refresher courses and always had someone in the room who took notes whenever I spoke. They singled me out. It was humiliating to have my co-workers see me in a refresher course. Every time my manager called me into a conference room, I felt I was on trial and always guilty of made-up accusations. My supervisor knew even less than my manager about my type of work.

One day, my manager told me she didn’t want anyone outside of the department to talk to me, visit, email, or call me to ask questions about my work. I was to direct all outside inquiries to her instead, even though she knew nothing about how to handle my claims. I felt like an outcast and totally worthless. My supervisor reminded me of this odd instruction via email the next day and forbade me from answering inquiries from anyone, especially inquiries from the legal department staff members with whom I had great working relationships. I caught my manager twice standing behind me, looking over my shoulder, trying to view my monitor while I worked. When I turned around, she just walked away without saying anything. It was extremely unnerving and intimidating. 

My manager did not think I would file a formal complaint with HR or with anyone in higher management. But in May 2019, I emailed HR to ask for assistance. I told the HR rep assigned to my case the facts. She said if I did not calm down, she was going to end the conversation. Between two phone conversations, she asked three times “does this mean you are going to retire?” She scheduled a meeting with my manager and me for three days later. I had no one-on-one meeting with the HR rep, and my manager lied during the meeting. HR sided with my manager, and there was no investigation. The HR rep’s goal was to protect my manager at all costs despite numerous complaints about my manager from others. 

Because of her intimidation and harassment, I knew it was time to leave. In June 2019, I transferred to another department. My new manager’s wife worked with my previous manager. My new manager did not want to make waves with my old manager or with HR.

On September 29, 2019, I was rushed to the Salem Hospital emergency room with congestive heart failure and PTSD. The stress of working for a toxic manager caught up with me. I suffered a heart attack due to the constant stress, badgering, gaslighting, and harassment by my manager. I was humiliated, embarrassed, and depressed by her actions. While I was waiting to be admitted to the hospital, I was told by four different doctors that if I had waited another day to come to the ER, I would have died. One doctor wanted to know if I was willing to donate my organs if I did not survive the night.

On January 15, 2020, I was fired, by e-mail, one day after my family medical leave ended. My boss successfully forced me out of my position. Zero accountability, justice, and fairness — and undue stress. The undue work stress by my manager led to my heart attack. The healthcare organization I worked for agreed in writing that relentless unwarranted work stress can lead to a heart attack. In my organization's code of ethics handbook, it clearly states that as employees, we have an obligation to report abuse of power, waste of resources, and any type of discrimination. Our ethics guidebook clearly states there will be no retaliation if we report, in good faith, any type of abuse or misconduct. In November and December 2019, I brought my concerns to the attention to the director of my department, the director of Human Resources, and the CFO of our organization. In my written concerns to upper management, I said that I fully expected to be retaliated against because I dared to criticize my manager and human resources. I was retaliated against because I spoke truth to power. I was fired one day after my family medical leave ended. So much for my organization's non-retaliation policy.

As of January 2021, I am still dealing with the stress and anxiety.

It appears a series of practices with discriminatory impact were at play. But could I prove them? Could I re-traumatize myself, damage my health even further, and subject myself to more lies if I tried to sue? I have proof. I have documents, e-mails, co-worker verification, and even Human Resources' confirmation of my claim of being bullied, harassed, and intimidated. Human Resources admitted that my manager should be fired or at least retrained. The HR executive I spoke to admitted that my manager may have broken state and federal anti-discrimination laws:

  1. Sexual orientation discrimination. Harassment started within three hours after my manager finding out I was gay on April 16, 2019. In a landmark ruling, the Supreme Court found that civil rights law protects LGBT workers from discrimination. I was the only openly gay employee in my medical billing department. Libelous accusations led to a hostile work environment. The constant stress eventually contributed to a heart attack and firing. In addition, Americans with Disabilities Act (ADA) benefits were not provided to me, even though ADA benefits were provided to other employees. My congestive heart failure is considered a disability by the Social Security Administration, yet they let me go eight working days after I sent HR an e-mail about my conditions for returning to work. I was more than willing to return to work, but ADA working conditions were not provided. I filed a complaints to HR on November 17, 2019 and December 30, 2019. I was let go on January 15, 2020. I was fired for filing two complaints to HR and for having a heart attack. I was not offered a leave of absence option except for short-term disability (90 days). My cardiologist insisted that I attend cardiac rehabilitation classes twice a week. I was not provided with the option of working from home AND attending cardiac rehabilitation classes.
  2. Age discrimination. I am 68. My manager gave my 12-year job to a 23 year-old with no prior work experience with my type of work. A high percentage of employees over the age of 60 have systematically been removed by this manager.
  3. Retaliation for filing a complaint with HR and blowing the whistle about the money/revenue/resources wasted/lost because of mismanagement. My boss denied my paid time off and wrote me up for doing my job and for filing a complaint with HR. The employee relations HR director told me that this manager should be retrained or fired. HR failed to correct the hostile work environment. The manager’s attitude was to bully, harass, and intimidate employees who went to HR. My manager did not want upper management to know what was going on in the billing department. My manager wrote me up for exposing the cover-up of wasted resources and for the emotional harm done to patients. During a phone conversation for which I have the transcript, the employee relations HR director admitted that my former manager may have violated state and federal laws. Employment discrimination violated Title VII of the Civil Rights Act of 1964, the Age Discrimination in Employment Act of 1967 (ADEA), and the Americans with Disabilities Act of 1990 (ADA) when without justification, the HR rep asked me twice if I was going to retire. This manager is currently harassing, bullying, and retaliating against a co-worker and friend. 

This manager uses employees toward her own ends — ruthlessly and efficiently, with no tolerance for dissent or resistance. My boss’ constant micromanaging ruined that department. Her abuse of power is a liability, not as asset. Why did management never hold her accountable? Why did they give her a pass on the amount of time and money (likely tens of thousands) wasted in her department? Why did HR protect her?

My manager wanted passive employees — with our heads down and mouths shut. She punished employees if they spoke truth to power. If an employee went to HR to file a grievance, she retaliated. She denied a PTO request. She wrote me up for the first time ever because she did not want upper management to know about the time, money, and revenue she wasted on just one claim. She wrote me up for mentioning her name in a claim note, even though we always included the name of a co-worker if it’s needed to complete the claim information or if a procedure needed clarification.

The employee turnover rate our department was high. It’s a waste of time to constantly post job positions, hire, and train new employees. 

I never saw other managers socialize with my boss. She destroyed many of her working relationships with co-workers over the years. Other managers reported her reputation is not very good with other managers.

I never knew what she was going to do next or what false accusations she would throw in my direction. It would be her word against mine. The stress became so intense working with her that I wouldn’t get into the elevator alone with her. I would leave the office kitchen if she walked in. 

She could accuse me of anything, and HR would believe her. I felt threatened, bullied, and intimidated by my manager. She managed her department with fear, gaslighting, and intimidation.

I lost job control and was at the mercy of my boss’ uninformed directives. The result: billing errors and likely tens of thousands in lost revenue. Why is the morale in that department so abysmal? Why is there such a high turnover rate in that department? Is there some type of cover-up going on preventing my manager from being held accountable for her behavior?

What’s more important: my boss’ fragile ego or wasting time and money and the welfare of patients? How many more complaints does management need before something is done to stop this waste and abuse of power? My healthcare organization sent all employees a directive in 2017 requesting that all employees find ways of saving money and ways of preventing waste. My healthcare organization admitted they needed to save money by any means necessary, including firing employees. 

This statement is on the organization's website. One way of saving money is to get rid of older dedicated employees who are at the top of their pay grade and who use company health insurance benefits more than younger employees. One way of getting rid of older employees is to bully, harass, and intimidate them into quitting. I was on the receiving end of my manager’s constant false accusations. After 12 years of doing the same job the same way without any problems, suddenly I became the worst employee in the organization according to my manager. I was suddenly “stupid.”

My integrity, honesty, and reputation and the goodwill of my fellow employees was completely trashed and ruined by one dishonest, unethical, and corrupt individual. The statewide well-respected healthcare organization I once respected is now forever tainted in my memory and my soul. Shame on all those individuals who allow this type of behavior to continue and allow the lives of numerous employees to be unjustly ruined.

My voice is one of a once-dedicated employee whose primary job was to do the tasks at hand in a timely, professional manner. I always had the patient's best interest in mind. My manager’s primary goal was to protect her job at all costs. My manager admitted that she did not want upper management to discover that she was incompetent and emotionally (and maybe financially) harming the patients.

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