When Did You Know Something Was Wrong?

This is my response to question #6 in Rachel Hollis' book "What If YOU Are the Answer?" The question is: When did you know something was wrong?

I love this question. I've heard her talk about this before, and I think it's such an amazing question for us to think about the times we felt that gut feeling telling us that something was off...and we ignored that feeling. A lot of people who are people pleasers (hello!) do this. It could be something little, it could be something big, it could be something where you don't have any evidence that something is wrong, but you just feel it. We often push through these feelings because if we were to give push back about something, it could cause friction between us and someone else. We don't want to cause drama by saying "Look, this isn't right". Or, we don't want to look "lame".

I could think of several instances where I knew something was off about a situation and I ignored that feeling. Today, I'm going to talk about one that has been on my mind because it's been a year now since it happened. The company that I was working for had a lot of red flags that I saw, but ignored. When did I see the first red flag? I kind of had a little bit of a feeling during the interview, to be honest. But, when we are looking for a job, we need money, and I ignored the signs that were very small at the time. The job was a remote bilingual health coaching job. It was the first time I had taken a risk to use the Spanish I had taught myself for a big part of my job. I was really excited about that. It was also my first job in the nutrition field in years. I had worked in nutrition right out of college for a few years in North Carolina, but when my husband and I moved back to Ohio, I got a job in the social work field for a few years. So the health coaching job was my first soiree back into nutrition, and my first time ever using Spanish in a professional setting. All this to say I was really excited and I really needed a job. During the interview, one of the people - I think she was the clinical manager - was not a warm and fuzzy person. The other person on the interview - who was going to be my direct supervisor/health coach lead - love her. I got great vibes from her from the start.

I got the job and was really happy. I knew from the interview that I would be doing health coaching calls for patients who mostly have Medicare, but other insurance companies as well. What I didn't fully realize (because I don't think they were very transparent about it) is that it would be cold calls. Every day, we would log on and have this person called our "dialer", who would go through the list of all the patients that were enrolled in our program through their insurance. We had nurse practitioners, nurses, health coaches, and care navigators (I can't remember exactly what term they used for the care navigators, but that is what they were). At the beginning of each new month, the lists of people to call would refresh, and the dialer would go through and see which patient was due for which type of call that month - whether they needed to speak to a NP, RN, health coach, or navigator. The dialer would go down the list and cold call them. If they got someone on the line, they would say "You're due for your monthly call, may I transfer you?" A lot of the time, even though the patients were enrolled in our program, they did not know who we were. Many of them were signed up through their insurance without really understanding what they were being signed up for. There were some patients who enjoyed the service and welcomed the call, but there were many who ignored our calls or did not show a lot of enthusiasm when they answered our calls. We would be sitting waiting for these calls from the dialer, which I thought was a little weird. My opinion is that, if I imagine myself as an older person and get a phone call that I'm not expecting, I'm not going to answer it. I mean, I ignore all unknown calls now, so of course I understand that a lot of older individuals are also going to ignore unknown callers. Many of them thought we were spam (especially since we literally showed up as "spam call" on their phone). A lot of patients would answer, be irritated, and say "Let's just get it over with because if I don't do it now I know you're going to keep calling". These calls were obviously not very productive because the patient didn't actually want to speak to us and were not engaged. And I don't blame them! What was I supposed to do - force them to tell me all the areas of their life they want to work on and then make them come up with a goal they want to achieve and how they are going to achieve it? All on a random Tuesday morning when they had no idea I was calling? I don't blame them for being hesitant or unwilling to have an extremely deep and potentially difficult conversation with a complete stranger. I did not like this - it made me feel scummy. I wanted to engage with patients who actually wanted to be a part of the service. I wanted to have scheduled calls, but they told us no, we had to cold call them. This all felt icky to me from the patients' perspective.

From my perspective, I'm sitting there all day long waiting for calls from the dialer. When I would get a call, the dialer would say "Hey, I have this patient on the line, here is their member ID, then I had to look them up in a matter of 20 seconds and say "Alright transfer them!" without having any idea what they talked about last month, no idea what their goals were, no idea whether they usually even enjoy our calls or not. No preparation whatsoever. And this was what we were told was the norm. That is not how I do things. I understand that you can't fully prepare for an appointment with someone, but at least knowing what they talked about last month would be helpful, especially if you are trying to do true health coaching. We need to know their previous goals, setbacks, and where they currently are in the process. But no - we had the pressure to pull up their chart and take the call within 30 seconds, because sometimes if you took more than that the patient would get impatient and hang up on the dialer before the transfer (also don't blame them). And sometimes, a couple would be enrolled in the program, so the dialer would say "We have So-And-So and his spouse So-And-So on the line - ready?" Then I would need to open two patients' charts and scramble to try to find something worth talking about. And if they were Spanish-speaking?! A whole other layer of panic. My anxiety sitting there all day waiting for the dialer to call was awful. Sometimes, when the dialer was out for the day and they didn't have another dialer available, we would need to self-dial. I liked this better because I could actually prepare for the call beforehand. However, management didn't like this because I took too long getting prepared before making the call. They wanted us to spend a maximum of 1 minute reviewing a person's chart before making the call. I would tell them "I think of these patients as actual people, not just a number". But management didn't care - they just wanted us to call as many patients as possible so that we could bill for as much as possible without "wasting" any time.

I should have known then. I should have known at several points, that if I'm feeling this uncomfortable and I don't agree with how they operate, then I shouldn't stay here. But no, I pushed through because it was a good opportunity to practice Spanish, I was back in the nutrition field, it was fully remote, and the job market was horrendous. It took months for me just to find THAT job, so I did not want to wait months before being able to find another job. So I thought "I'm just going to keep going".

Then, they hired more managers. The micromanagement worsened. There was a much bigger focus on quantity over quality. You needed a certain amount of calls a day, a certain amount of calls a month, and they had a formula for how much time you were allowed to spend charting after a call. They told us we had to speak to the patients for a minimum of 5-7 minutes before we are able to bill their insurance for the call, so management would be upset if we were not able to keep them on the phone for that long. The metrics and expectations were insane. I kept asking "How am I supposed to force someone to stay on the phone for 5-7 minutes when they don't even want to speak to me for 10 seconds?" And if I did manage to keep them on the phone for a few minutes, the quality of the conversation was not actually good. But management didn't really care about that - they just wanted to be able to bill for it. I understand a business needs to make money, but come on. It was so much pressure to force these (mainly) elderly patients to stay on the phone with me. If they didn't want to talk to me, I was not going to force them. There were other health coaches that were more...aggressive about it...and did a lot "better" with keeping these patients on the calls. I don't know how they managed it, but it was very salesy and became sort of a competition among everyone on who could make the most calls. The health coaches that actually met the company expectations were so focused on reaching a set number of calls, and didn't seem to mind the "salesyness" of it all. But for me, I would sit there so stressed out thinking "This person doesn't want to talk to me, what am I supposed to do?"

This type of pushiness and salesy focus kept increasing, and my discomfort with it kept increasing as well. My direct supervisor was all about quality over quantity, but upper management was all about quantity (even though they claimed they cared about quality, but their actions did not align with this). My supervisor would say "Listen, you're doing an amazing job. Don't listen to them". Upper management wanted us to complete 8 calls a day, then 10, then 12, then after a lot of push back they would drop it back down to 8-10. Did they realize or care how difficult it was to even get to 8 calls a day at times through all these cold calls? Especially towards the end of the month when the list of people who needed a call got smaller and smaller. Sometimes I would complete 5 or 6 high-quality calls that I would feel really good about, but management would say "Why did you only complete 5 calls today?" It was so confusing for me and would make me feel like I was a terrible health coach, even though I was doing a great job.

Aside from monthly phone calls, we also provided RPM (remote patient monitoring) to patients who qualified. This included blood pressure monitors, scales, and pulse ox. The patients' readings transferred to our care team so they we would know if their vitals were within range. There were a lot of patients who did benefit from the RPM piece of our company. If a person's vitals were abnormal, it would trigger an alert for one of our nurses to contact the patient to make sure they were ok. I am all for this. But, the problem was that if a nurse called someone to check on them due to an abnormal reading, this would not count towards the patient's monthly call. Therefore, if they were still technically due for a monthly call from a NP, RN, health coach, or care navigator, the dialer would still call them - often on the same day they received a call (sometimes multiple calls) about their vitals. Sometimes within the same hour. So I didn't feel comfortable bothering them yet again with a call from the same company. However, the dialer couldn't see that they had just received a call from one of our RN's to check on their vitals. Even if they did see this, they were told to call them anyway. Several patients would be angry and say "I just spoke with you guys!" I would be like "I know I am so sorry." When I would be self-dialing, I would check to see if they had received a call from our RN regarding their vitals. If they did just receive a call that day or even the day before, I would move on to someone else. I just personally did not feel comfortable calling them again. It felt like harassment to me. There were also video appointments with the nurse practitioners that patients were supposed to complete every 6 months; we called these biannuals. These appointments were essentially like a physical that someone would go to their primary care provider for. Many patients were uninterested in these appointments because 1) They are elderly and did not want to do video visits and 2) They already see their primary doctor for physicals. If a patient completed a biannual appointment, this for some reason did not count towards their monthly check-in, which means that if someone completed their biannual we were still expected to call them. Even if they had just done the biannual the day before. This drove me insane.

There was one time when I had received a transfer from a dialer for a Spanish-speaking patient. I of course barely had any time to review her chart before the call was transferred to me. I asked her how she was doing, and she immediately broke down crying and screaming at me. I was still pretty new at using Spanish for my job, and this was the first time I was yelled at in Spanish, over the phone - which adds another layer of difficulty since the phone quality isn't always the best. I understood maybe half of what she said, and what she said was not good. She was yelling at me because she had just received a call from our team the day before, and said "You people keep asking me how I'm doing. I just buried my husband. Stop calling me!" I was absolutely mortified. I had no idea because I had no time to read her chart. This was mentioned in one of her previous appointment notes, but her chart was not flagged or anything so I didn't see it right away. I was just sitting their sobbing. I felt terrible. After I finally got off the call, I messaged my supervisor and told her "This is what I've been saying. I had no time to read her chart prior to the call, and here I am asking her how she is when she just spoke to us and told us that she had just lost her husband and is mourning." My supervisor understood, but the company did not change how it operated.

Time went on, and I continued to stick it out. The micrgomanaging got worse and the expectations became more unrealistic. Even if we had meetings, we were still expected to complete the same number of calls as we did on days with no meetings. I was actually told by upper management to skip meetings so that I could make calls instead.

Months went by, and we had hired so many new employees. When I had first started, it was a pretty small company. I think there were 8 health coaches, and then all of a sudden we were at 35 health coaches. They hired a bunch of the other positions as well. Every week we would get an email saying "Welcome our new team members!" and there would be a list of like 10 new people. I remember telling my husband "This is really strange that they are hiring so many new people all the time". They were telling us that the company was growing, but the number of employees they were hiring still seemed excessive.

I had started this job in October of 2023. In December of 2024, one of the major insurance companies we were contracted with dropped us. It was the insurance company that covered the majority of my region of the country that I was working with. So I had to move to a new "pod" and be on a new team. Management kept saying "It's not our fault", but what actually happened was that the insurance company did not see the value in our services. I truly believe the only reason they had remained contracted with us was because of the RPM services we offered. But eventually the insurance company decided they could just offer RPM to their own patients instead of paying us to do it. Management kept sweeping it under the rug, saying it wasn't our fault. But I had a bad feeling. This was a huge loss for our company. Even though management kept acting like everything was fine, the pressure they put on us continued to increase. And even though the job was remote, we could sense the tension.

A couple months later, we lost our contract with another major insurance company, and they had to restructure our teams yet again. The CEO and upper management team kept acting like everything was fine, but we knew it wasn't.

I believe that as we were getting farther and farther away from when the pandemic hit, there was less of a need for remote healthcare services. There was a huge need for our company back when COVID started, but as time went on, I think our telehealth services became less needed. There were a few times when the government shut down billing for telehealth services. Through all of this, management kept saying everything was fine and they would figure it out. But I was definitely skeptical, and had a gut feeling everything was not fine.

Of course, everything remained tense, uncomfortable, and the expectations were crazy. Employees were getting blamed for not doing a good enough job and not getting enough billable calls. I was having meetings with management where they would tell me I'm not doing well and that if I don't complete more calls, then there would be disciplinary action. As if I'm lazy or just not doing my job. And the way they would talk to us was so condescending. At one of the meetings at the end of May 2025, I received a verbal warning. Then after the meeting, somehow my verbal warning became a written warning, even though they had just assured me it was only a verbal warning. I was livid.

So what did I do? I wrote a rebuttal letter. This letter is one of my best pieces of writing, I must say. I still have it. Maybe I'll share it one day. But I pretty much told them all the reasons I disagree with them, and that it is not my fault that they have a poor business structure and misspent millions of dollars. I told them that I think what is really going on is that the company is financially failing and will go bankrupt, and they are trying to put the blame on the employees. I went off on them, but in a professional matter of course. I had solid evidence, examples, and did not hold back on my opinions. I sent it to my direct supervisor (even though she was not a part of the management meetings and thought I was doing a great job - I had included her so that she was aware of the situation), the clinical supervisor (who was the condescending person that I can use a lot of explicit language to describe), other peojple in upper management, and the CEO.

I never received any response from any of them. And I know that they received it. I know this because during one of my next meetings with management, one of them slipped and said "I saw on your calendar that you weren't making calls the other day because you were working on something..." then she tried to backtrack and avoided saying what exactly I was working on. I had even put it in my calendar as a time block with the title "WRITE REBUTTAL LETTER". I just sat there smiling at her, waiting her out, making her feel uncomfortable just like they made us feel uncomfortable all the time.

Soon after, during a clinical team meeting, the CEO tells us that he just happened to "misspend" 2 million dollars, and that he owes our investors so much money that he can't afford to pay back. They laid off a bunch of nurse practitioners with no warning - completely blindsided. They could no longer afford them. This was one of the most awkward meetings I have ever been a part of. Management assured us our positions were safe.

After this, they started making us call patients that we had already called THAT SAME DAY, but had been unable to reach. They wanted us to call 2-3 times on the same day to try to get the patients to answer our calls so we could bill for it. I was at the point where I physically, emotionally, spiritually, mentally, and above all - morally could not do it. I told them "This is not ethically right. This is harassment. I quit." I gave them like an hour notice, and they did not seem to care (and I know why). This was on a Thursday or Friday. The following Monday, I heard from my fellow teammates that the company laid off half of the health coaching team in one day. They put 15 minute meetings on the health coaches' calendars and laid them off one by one. I knew in my soul that I would have been one of them. A part of me was like "Dang, I could have gotten a severance package and unemployment". But I heard the severance package was crap, which makes sense because they had no money left. And I also didn't want to go out that way. I did not want to be laid off. I wanted to leave on my own terms. Shortly after, they did another round of layoffs. They even laid off my direct supervisor - who was the health coach lead - even though they still had some health coaches left on the team.

I kept my eye on the company and continued to hear from the employees that were still there. By November of 2025, the company officially filed bankrupcy and sold whatever they had left to another company who we had actually worked with before. The CEO of our company got a lower position at the company we sold to.

I knew that I had been right the whole time. From my first icky feeling about the company. I knew for so long that the company was not going to make it, but I had stayed. I think the main reason I had stayed was because all the horrible things aside, it was still an excellent opportunity for me to get real-life exposure and practice with Spanish. But I should have been looking elsewhere. I was loosely looking at other jobs, but I should been more serious about my job search before I had left. I was unemployed for months. The next job I got was the only thing that was available and did not pay a livable wage. Luckily I was able to get out of that and into a better-paying position somewhere else. However, it was a huge struggle.

So, when did I know something was wrong? At the very beginning. Sometimes you have to go through with something, like a job, because you need it. But at the same time, I should have been actively searching for something else.