I didn’t go to nursing school to become an insurance appeals specialist. Here’s What Nobody Tells You About Nursing Until You’re Already In It…
Nobody does that. You go to nursing school because you want to help people. Because something in you responds to the idea of being present with someone in their most vulnerable moment and actually making a difference. That’s the story we tell ourselves on the way in. And it’s true, for some part of every shift.
But there’s another part nobody warns you about.
I spent a decade working in the ER as a case management nurse. And while the patient bedside work was everything I hoped it would be, I spent a significant portion of my career doing something I never trained for and never signed up for: fighting insurance companies for care that my patients needed, had already received, and were being denied coverage for.
It went like this. A patient comes in. We assess, we diagnose, we treat, we document. Then days or weeks later, the denial lands. The insurance company disagrees with the attending, with the clinical evidence, and with the care plan that multiple trained professionals built together. And now someone on our team has to fight back. That someone, a lot of the time, was me.
I want to be honest about what that actually felt like. It wasn’t just frustrating. It was demoralizing in a specific way that’s hard to explain to someone who hasn’t been in it. You know the care was right. The patient knows it. The physician knows it. But you’re now spending one to two hours building a written case to prove it to someone at a payor who is constraint to a checklist. And you do this knowing that if you don’t get it right, if you miss a detail, use the wrong language, run out of time before the appeal window closes, the patient absorbs the financial hit for care they needed and received.
That’s a weight that sits on you. And we carry it alongside everything else.
The part that finally broke something in me
I remember a specific kind of moment that happened more than once. You’ve spent an hour on an appeal. You’ve pulled the documentation, organized the clinical evidence, and written the letter. You submit it. And then you go back to the floor, because you have patients. You haven’t stopped having patients. The appeal didn’t pause your shift. It just took from it.
That’s the invisible tax of denial management. It doesn’t replace your workload. It adds to it. And over time, that accumulation takes something from you, not dramatically, not all at once, but steadily. You start dreading certain cases because you already know what’s coming. You get faster at appeals because you’ve had so much practice, and you’re not sure whether that’s a skill to be proud of or a sign that something is wrong.
For me, it became a sign that something was wrong. Not with the nurses but with the system that had quietly decided this was our job too.
Why I stopped absorbing it and started doing something about it
I left hospital nursing with a lot of things. Gratitude for what the work gave me. Real grief for leaving it and a specific, focused anger about the administrative machinery that had spent a decade chipping away at what made that work meaningful.
I co-founded Authsnap with Dr. Wael Khouli, a physician executive who had watched the same dynamic from the hospital leadership side, watching clinical staff exhausted by appeals, watching recoverable revenue disappear because teams didn’t have the capacity to fight for it, and watching good nurses leave jobs they loved because the paperwork became unbearable.
We built an AI that does the work of an appeal, ingesting the clinical documentation, mapping it against payer criteria, and generating a structured case in a fraction of the time. Not to replace nurses. To give them back the hours that were never supposed to be theirs in the first place.
What I want every nurse to know this week
Nurses Week is full of appreciation, and I mean that sincerely — nurses deserve to be celebrated. But I also think we owe nurses something more than gratitude. We owe them systems that don’t treat their time as endlessly absorbing. We owe them workplaces that recognize the invisible labor of administrative burden as a real cost, not just background noise. And we owe them the honest acknowledgment that what many nurses are experiencing, that hollow, ground-down feeling that doesn’t go away on days off, is not a personal failing. It’s a design flaw.
You didn’t go into nursing to fight insurance companies. Neither did I.
The fact that so many of us ended up doing it anyway says everything about the system, and nothing about us.
Guest post by Gretchen Heinen, RN, PHN, BSN — CEO & Founder, Authsnap, Inc.
Gretchen Heinen, RN, PHN, BSN is the CEO and Founder of Authsnap, Inc., an AI-powered healthcare technology company focused on insurance denial management. She spent over a decade in clinical nursing, including emergency and case management roles, before co-founding Authsnap with Dr. Wael Khouli, MD, MBA. Learn more at authsnap.ai.
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CALL TO ACTION:
If you are a nurse who works in a position away from the bedside, please contact me and let’s tell your story here. If you’d like to write your own post or answer a few questions so I can write it, please let me know. We all know how hard we work, and the toll it takes on our personal lives as well as our professional careers. Let’s help each other discover new ways to help and heal.
Thanks,
Kathy