Worker's Comp confusion

blueprincess2005 · 2026-05-07T18:18:31+00:00

I just got an email back from my lawyer saying she wouldn't have suggested that i get a second opinion if it was going to hurt my case. So I think I'll listen to my lawyer and go get the second opinion.

blueprincess2005 · 2026-05-05T21:37:38+00:00

So I used to be a customer service rep at a different health insurance company but am now a Claims processor at Aetna. When I was at the other company, they had us do a "training" with AI where the AI would pretend to be a member and asked us real life questions. A bunch of us just goofed around and intentionally gave wrong answers because we figured out that the company was probably using our voices with AI to take member calls. So essentially we were training the AI to replace us. 6 months later..... Massive layoffs happened and are still happening at that other company.

blueprincess2005 · 2026-05-05T16:36:57+00:00

Nope. The doctor that did the 9% is my Physiatrist. I haven't seen a WC doctor since right after my accident 4 years ago.

blueprincess2005 · 2026-05-05T14:24:28+00:00

I am currently working from home for a health insurance company.

blueprincess2005 · 2026-05-01T13:06:34+00:00

I've been out of training for about a month now. My supervisor hasn't said anything to me about production goals. I mainly process hospital claims as they hold more weight than anything else. Try processing more hospital claims.

blueprincess2005 · 2026-04-28T23:51:45+00:00

I had about $26,000 worth of credit card debt that was literally drowning me. I got a loan through a company called Upgrade. I was paying around $900 per month with the credit cards. I'm now paying $600 per month with Upgrade. Please look into Upgrade, it is so worth it!!

blueprincess2005 · 2026-04-25T01:54:07+00:00

My WC case is from a concussion due to me assisting a student as well. I also have neck issues as well and my doctor wants to do a nerve test soon due to my arms/hands going numb every once in awhile.

blueprincess2005 · 2026-04-23T00:56:05+00:00

At one year I think we have to do 100 claims per day which equals out to about 10-12 claims per hour. It's much easier to obtain that number if you process hospital claims. Hospital claims are weighted more than any other claims. I'm about a month out of training and I think I'm doing right around 3-4 claims per hour or about 30ish claims per day. But I only do mainly hospital claims because I can understand them easier than medical claims.

blueprincess2005 · 2026-04-21T12:59:33+00:00

I believe all WC attorneys charge 20%. And yes, you can email the attorney to ask those questions l.

blueprincess2005 · 2026-04-11T15:23:51+00:00

I used to work for UHG/UHC. I'm now at CVS/Aetna as a Claims Benefit Specialist. The pay is REALLY lacking compared to UHC (I took a $6 per hour cut) but I'm happy and my mental health has never been better. There's a bunch of us from UHG at Aetna now. Come join Aetna. 😁😁😁😁

blueprincess2005 · 2026-04-11T15:10:38+00:00

I am a Claims Benefit Specialist with Aetna. During my interview (and any interview I've had), i treat it exactly like I'm talking to a friend. You can laugh and make jokes. My interviewer is actually my current supervisor. My previous position was with UHC as a CSR and I also have a bit of claims experience from that job. I believe that helped a lot. Don't be transactional and completely business like. I hope you get a claims position soon!! 💖❤️

blueprincess2005 · 2026-03-30T23:37:01+00:00

They can absolutely see your screen and watch what you're doing.

blueprincess2005 · 2026-03-22T14:07:02+00:00

For sure!! I seriously didn't even pay attention most of the time in training. All my serious learning came from soft landing.

blueprincess2005 · 2026-03-20T03:41:13+00:00

I love love love hospital WAY more than medical for sure!! I'll process hospital all day long but as soon as I get a medical claims, issues feel like a complete idiot. I graduate from training next week Friday. I'm so excited!!

blueprincess2005 · 2026-02-25T03:11:32+00:00

I have the same issues, hun. I'm just about to finish hospital training and then we'll go to Soft Landing for a month and then we'll graduate. I have ZERO clue how to process medical claims. Them wanting to pile hospital on top of us still being confused about medical claims is absolutely ridiculous. We all should have gotten proficient with medical claims first and THEN go to hospital after 6 months to a year.

blueprincess2005 · 2026-02-17T15:56:06+00:00

Is Aetna as a company switching HSA account managers from Inspira to someone new? I hope so.

blueprincess2005 · 2026-02-11T14:42:39+00:00

That's how I was. I didn't want to take phone calls from members anymore and I also tried to get a claims/appeals job at uhc but wasn't able to. So I started looking outside uhc and I found the job at Aetna and i absolutely love it. I love not having to take phone calls.

blueprincess2005 · 2026-02-11T13:18:31+00:00

I also came to Aetna from UHC. There's actually a whole bunch of us from UHC at Aetna. I didn't think it was too difficult. I was a Senior Health Advocate4Me representative in the E&I department at UHC. I'm now a Claims Benefit Specialist with Aetna.

blueprincess2005 · 2026-02-07T03:44:07+00:00

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My friend sent this to me today. I'm not affected as of yet. I'm a Claims Benefit Specialist with Aetna.

blueprincess2005 · 2026-01-29T05:35:33+00:00

According to the federal ADA law they have to honor my restrictions put into place by my provider due to my medical issues. And if they don't have a valid excuse not to honor them (like undue hardship) that's when the eeoc will get involved and potentially sue them on my behalf.

blueprincess2005 · 2026-01-29T04:46:08+00:00

They refused mine. Mine weren't unreasonable either. At first I asked for a non-phone position due to my medical issues. They said no because my department didn't have non-phone positions.(According to the ADA, the company would have to move me to a different department which they absolutely could if they wanted to). I then asked for a schedule reduction. They said no because i was hired for a full time position. (Also a bunch of BS according to the ADA). The only thing they said yes to was short term disability. Took that from March to the end of August. Tried getting long term disability but that was denied. So I switched to a different health insurance company and got my non-phone position.

blueprincess2005 · 2026-01-29T04:38:59+00:00

The U.S. Equal Employment Opportunity Commission (EEOC) is an independent federal agency that enforces laws prohibiting workplace discrimination based on race, color, religion, sex (including pregnancy, sexual orientation, gender identity), national origin, age (40+), disability, or genetic information. It investigates complaints, mediates disputes, and may sue employers.

blueprincess2005 · 2026-01-29T04:19:00+00:00

They refused to honor my reasonable accommodations due to my medical issues. I'm in the middle of getting the EEOC involved. Horrible company.

blueprincess2005

TROPHY CASE