by Robin Cook
For a brief moment Brian let his eyes drift away from Roger’s masked face as a minor flash of anger consumed him. He’d developed a distaste for this bureaucrat on their last meeting and his current holier-than-thou attitude was reminding him why.
“I suppose you are going to tell me you didn’t see the email,” Roger continued derogatorily.
After a short pause to control himself, Brian said: “You are correct. I have yet to see that particular email from Peerless. As it is, I’ve been busy trying to help my wife, who is not doing all that well. Is the ED bill the reason you asked to see me?”
“No, it is not,” Roger snapped.
“Well, perhaps you can tell me what it is then.”
“I’m afraid I have more bad news for you. When I was informed yesterday by our Chief Medical Officer that your wife was going to be discharged, I put together a preliminary hospital bill. Because we have had a history of such bad luck with Peerless Health, I wanted to get it to them ASAP. Well, my efforts were rewarded with Peerless informing us that they will not be covering any of the currently estimated $161,942.98 in-house bill, either.”
For a few moments of stunned silence, Brian’s mind tried to wrap itself around two incredible facts: the sheer size of the in-house hospital bill and the idea that a health insurance company would contend it wasn’t going to be involved with a sick patient’s required care. He didn’t know which was more outrageous.
“What am I supposed to gather from your silence, Mr. Murphy?” Roger demanded. “We have a major problem here. Frankly, we as an institution are finding it very difficult dealing with these short-term insurance policy companies, especially since they have proliferated during this coronavirus pandemic with people losing their employer-based coverage.”
“More than one hundred and sixty thousand dollars is a big bill,” Brian managed to say, thinking out loud as he tried to conceive of such a number.
“It is not an exceptional hospital bill by any stretch of the imagination in this day and age,” Roger said. “Remember, your wife spent several days in the intensive care unit, which, like the Emergency Department, is very expensive to maintain and run. And she has had many tests over the eight days, including several MRIs and a number of electroencephalograms.”
“I suppose,” Brian said distractedly. Once again, his mind was going a mile a minute, trying to put this cost into the perspective of his life experiences. The only time he’d dealt with such a number was when he and Emma had bought their house. But that was an investment, not a one-time expense, and his wife was still ill.
“Mr. Murphy, please,” Roger said. “This is a major problem, and I need your full attention. We have to decide on a course of action.”
“Did Peerless give a reason why they wouldn’t be covering any of the hospital bill?”
“Yes, they did,” Roger said. “I was told it had to do with your deductible, all of which was spelled out clearly in your policy. Did you read your policy, Mr. Murphy?”
“Not carefully,” Brian admitted, fully aware that he was fibbing similar to the way he’d done during his conversation with Ebony Wilson.
“Well, it sounds like that was a big mistake,” Roger said patronizingly.
With some difficulty Brian resisted the temptation to ask Roger how many novel-length, legalese-strewn health insurance policies he’d read in his lifetime.
“I know my policy had a ten-thousand-dollar deductible. Doesn’t that mean the insurance company is then supposed to cover the rest?”
“All policies are different,” Roger said. “It’s up to you to find out. Meanwhile, what do you propose to do about the now $189,375.86 bill that is owed to MMH Inwood? We need to know, or we will have to turn this over to collections.”
“I intend to resolve this situation with Peerless today,” Brian insisted. “And I’m not going to try to do it over the phone. This sort of money calls for an in-person visit.”
“All right, that’s up to you,” Roger said. “But you must get back to me soon. You can’t ignore this situation.”
“I’ll get back to you right away, but before I go, I need to ask something. What came first: the decision to discharge my wife or the hospital getting word from Peerless that they were not going to cover the bill?”
“I don’t think I understand the question.” Roger sat back in his chair, wrinkled his forehead, and stared at Brian through his thick-framed glasses.
“I can’t help but worry that the reason my wife is being suddenly discharged is because of the outstanding ED bill along with the new fear that her hospital bill might not get paid in a timely manner.”
“That is a preposterous accusation,” Roger said, taking immediate offense. He rocked forward, glaring at Brian. “The clinical people, meaning the doctors and nurses, make all the decisions about patient care. We on the business side are not involved, ever! All we do is strive to keep the institution solvent. The two do not mix on any level whatsoever.”
“Really?” Brian questioned. “There had been no talk of her being discharged as far as I know, and I’ve made it a point to talk daily with Dr. Raymond, who’s been in charge of her care. This all seems very quick and out of the blue. And my wife has recently developed a new symptom of spasticity. From my vantage point, she’s no better off now than when she was admitted.”
“Let me tell you something, young man,” Roger said as he used a mildly crooked index finger to point repeatedly at Brian. “This hospital never allows financial concerns to affect patient care decisions. Never! I’m offended you would even suggest such a thing.”
“I wonder,” Brian questioned while provocatively raising his eyebrows. He was getting a smidgen of pleasure from being the cause of Roger’s apparent indignation and discomfort. After a pregnant pause, he added: “Who actually is Dr. Graham, this supposed chief medical officer? I’ve never met her, and I have been coming here every day for more than a week to see my wife. Is she more on the clinical side or the administrative side?”
“What on earth do you mean?”
“What I’m wondering is whether she is more concerned about patient welfare or institutional welfare. It’s as simple as that.”
“Dr. Graham is part of the administration, but she is also a doctor,” Roger sputtered. “Once you are a doctor, you are always a doctor. That should be plenty obvious.”
“I hope you’re right,” Brian said. He stood up, knowing that the chances of getting a straight answer were slim. “Meanwhile, I expect to get a copy of the hospital bill, and I’d like it in English. Even the second ED bill you sent me seemed like it was done on an Enigma machine.”
“I’ll see what I can do,” Roger said. “But let me warn you in advance: The hospital bill will definitely be more complicated than the ED bill, especially the part involving the ICU. And the bill from MMH Inwood is not the only bill you will be getting. You’ll also get bills from individual doctors not employed by MMH who saw your wife during her stay.”
“What kinds of doctors?” Brian demanded as he sat back down. This sounded like insult added to injury or, more accurately, like a kind of extortion.
“Specialists of various kinds,” Roger answered vaguely. “Some of the consults are independent practitioners.”
“Is this the surprise medical billing I’ve vaguely heard about?”
“It is,” Roger admitted.
“Well, get me what you can,” Brian said while regaining his feet in preparation of leaving. “Meanwhile, I’ll be back to you after I have a face-to-face visit with Peerless Health, which will hopefully be today.”
As he rode up in the elevator, he couldn’t get the concern out of his mind that Emma was being discharged on account of economics, which was an infuriating thought. When he walked into Emma’s room, he found her asleep, which was happening more frequently of late. Instead of waking her, he let her be and returned to the nu
rses’ station. Over the preceding week he’d gotten to know many of the day-shift nurses, including the charge nurse, Maureen O’Hara, whose brother Brian knew well. They’d shared a class in grammar school and had attended the NYPD Academy together.
“So, Emma is being discharged,” Brian said when he managed to get Maureen’s attention. She was a no-nonsense, squat, and powerfully built woman just like her brother, and she ran the fourth floor with an iron fist. She, like most of the floor nurses, was wearing a plastic face shield as well as a mask.
“That’s what I’ve been told,” Maureen said. “To tell you the truth, it took me by surprise.”
“Do you think it’s appropriate?”
Maureen shrugged. “We’re not doing all that much for her. In fact, you are doing more than we are, even more than physical therapy. The thing that I am most concerned about is the seizure monitoring.”
“Me, too,” he said. “What’s the story with this Dr. Kathrine Graham?”
“What exactly do you mean?”
“I’m not sure. I was just told she was the one who wrote the discharge order.”
“That’s not surprising,” Maureen said. “She does that a lot.”
“What kind of doctor is she?” Brian asked. “I’ve never met her.”
“She doesn’t often come to the floor. She has an office in admin. My understanding is that she was an internist before becoming the Chief Medical Officer.”
“What about Dr. Raymond? Where is she today?”
“She’s back in the chart room. I saw her go in there not five minutes ago.”
Knowing full well he was overstepping his bounds to a degree, Brian went to the door to the chart room and pushed it open. Instead of being full of charts as he was expecting, the room was made up of countertops and computer monitors. Dr. Raymond and several other people were busy entering data. The only noise was coming from the keypads.
“Excuse me, Dr. Raymond,” he called out self-consciously. “Could I please have a word?”
To Brian’s relief, she immediately stood up and came to the door. Speaking in a whisper, she asked what he needed.
“I’ve just heard my wife is being discharged,” Brian whispered back.
Dr. Raymond graciously stepped out of the chart room, allowing the door to close.
In contrast to Maureen, Dr. Shirley Raymond was rail thin and imbued with a nervous energy. “Yes,” she said. “I was informed of the discharge plans this morning.”
“So, this wasn’t your decision?” Brian was surprised to learn that she hadn’t been involved in the order.
“No, it wasn’t. It’s apparent to me that Emma still has an active viral infection. She also seems to be somewhat drowsier and more confused. And, as far as I know, neurology hasn’t finished evaluating the spasticity that’s emerged.”
“The current plan is to send her to Hudson Valley Rehabilitation Hospital.”
“Oh, I didn’t hear that,” Dr. Raymond said. She shrugged. “That will work, I guess. She should be under a seizure watch since the encephalitis is still obviously active, and they’re capable of doing that at Hudson Valley. Although, if it were up to me, I’d keep her here in an acute care facility.”
“I was told she was discharged by a Dr. Graham. Do you know her?”
“Of course. She’s one of the kingpins around here.”
“Is she a good doctor?”
Dr. Raymond laughed nervously. “That’s a strange question. Yes, I guess she is a good doctor.”
“To be frank, I’m a little worried. Do you think there is any chance that finances influenced the decision to discharge my wife?”
She shook her head. “No. That’s not how we practice medicine. There must be a valid reason Dr. Graham gave the discharge order. Perhaps it’s to free up beds for the expected Covid-19 surge.”
“That’s reassuring coming from you. Well, thank you for talking with me and thank you for taking care of Emma.”
“You’re very welcome. And good luck. I’m afraid you are in for a long haul with Emma. EEE is a persistent illness.”
“Yes, I’ve gotten that impression,” Brian muttered and turned to return to Emma’s room, significantly more confused and daunted by these conversations than he was expecting.
CHAPTER 9
August 27
It was just after two in the afternoon when Brian walked out of the Hudson Valley Rehabilitation Hospital and paused on the steps to regroup. He was feeling out of sorts. It had been a stressful morning. Emma had resisted the idea of leaving MMH Inwood, but there had been little he could do, and it was true to an extent that MMH wasn’t doing very much in terms of therapy. It was also true that Emma had not had another seizure since the one in the Emergency Department, so maybe the need for seizure monitoring was less important. Plus, the term “rehabilitation” had a nice ring to it as far as Brian was concerned, and he hoped that there would be more opportunity for Emma’s walking difficulties to be addressed. But that was before he had seen the hospital.
During the admission process, Brian again had to sign papers giving the name of their insurance carrier and committing to being responsible for all charges. Knowing what he did about Peerless, it was obvious he was accepting even more debt despite having no possible way to come up with the money he already owed.
And if all this wasn’t bad enough, Hudson Valley Rehabilitation Hospital had been a disappointment. In sharp contrast to the renovated MMH Inwood, the building was aged and shabby, especially Emma’s room. And worse still, the number of patients per nurse was significantly higher than at MMH, meaning Emma probably wasn’t going to be receiving a lot of seizure monitoring or monitoring in general. Luckily she seemed oblivious to the nature of the hospital surroundings and had fallen into a deep sleep almost immediately after she’d been put in her bed and her vital signs were taken. The transfer procedure had been stressful for her even though MMH had arranged an ambulance service, and she had been moved in and out of both institutions on a gurney. The ambulance ride itself had been only fifteen or twenty minutes, and Brian had been able to ride with her.
From his perspective, this whole experience of Emma contracting a disease that he had never heard of from an innocent barbecue had been a rude awakening. As a conscientious hard worker who followed the rules, he’d always felt reasonably in control. Now it was the exact opposite. It was as if he and Emma had been poised on a precipice and didn’t know it, and now that Emma had slipped off, Brian and his family were only holding on by their fingertips. To make matters worse, he’d never had any inkling that the cost of a week’s stay in a hospital could potentially upend his life thanks to an unscrupulous health insurance company. It seemed criminal that he was now almost two hundred thousand dollars in debt and counting.
Pulling his phone out of his pocket, Brian made a quick call to Aimée to let her know that Emma had been moved and to ask her to let Emma’s mother know as well. He then passed along the current visiting restrictions and requirements. Toward the end of the call, he experienced a sudden and unexpected surge of emotion, bringing him almost to tears.
“Are you okay, Brian?” Aimée asked, detecting a catch in his voice.
“This is all more stressful than I could have imagined,” Brian managed after a pause. He’d not shared any of the financial problems with his mother, nor his worry that Emma might have been discharged from MMH because of the bill. “I hope this Hudson Valley Rehab Hospital works out.”
“I’m sure it will,” Aimée assured him. “I’ve had a number of friends who have been hospitalized at HVR, and they did well. It’s not the Ritz or even MMH, but the staff is friendly and caring.”
“They better be, or there’s going to be hell to pay.” As quickly as his surge of emotion had appeared, it metamorphosed into anger, and he was reminded of his planned visit to the Peerless Health Insurance offices. “Mom, I’m so
rry, I’ve got to go.”
“Okay, dear,” Aimée said. “I’ll let Hannah know that Emma is situated at HVR, and we’ll plan out a visiting schedule. You get home and take care of that darling daughter of yours. She needs your attention, too.”
Brian disconnected the call, eager to make the visit to Peerless. The question was: How to get there? With his anger ramped up and wanting to get it over with quickly, he decided on the subway. From Inwood it was by far the fastest way to get to Midtown Manhattan.
Ten minutes later he was on the A train thundering south, and as he rode, he thought about the hospital bill that Roger Dalton had emailed to him and that he’d glanced at briefly on his phone while waiting for Emma to be discharged. As Roger had suggested, it was mostly incomprehensible and in code similar to the ED bill, but there were some bits of it that were perfectly understandable and that riled Brian to no end. One of those was an outlandish charge of $970 for a supposed “physical therapy evaluation session.”
From the date of the service, Brian distinctly remembered the episode. A young, bouncy, and very friendly woman had appeared at Emma’s bedside, gotten her out of bed, and proceeded to merely walk her up the corridor exactly as he had done fifteen minutes earlier. Another was a thirty-dollar charge for a single ibuprofen tablet that Brian had requested for Emma on that same day when she complained of a headache. From Brian’s perspective, if such charges were representative of the entire bill, the whole thing bordered on being absurd, if not out-and-out fraud.
From the Columbus Circle express stop it was a relatively short walk to the building on Sixth Avenue where Peerless Health Insurance had their home office. He found it strange to be walking the streets of Midtown Manhattan and seeing so few people. Like on the subway, most of the few people he encountered were masked. Reaching the proper building, Brian thought it a coincidence that it happened to be a few doors down from where Priority Capital was located. Thinking about Priority Capital and Calvin Foster made Brian hope that his proposed budget for the fancy Southampton wedding was being well received, and that he could be on the verge of securing some income.
