by Robin Cook
“I glanced at it,” he said, embarrassed to admit otherwise.
“Well, you should have read it carefully to know what you were buying,” Ebony said. “I recommend you go back and do so now. You see, to make our short-term policies affordable, we have made it a point to spell out specific limitations and define responsibilities of our members. Within our policy it is very clear what will be covered in the Emergency Department, particularly during normal business hours when urgent-care clinics and doctors’ offices are open. You see, we take our role seriously in trying to do something about the rise of healthcare costs in the United States.”
As Ebony droned on about the overuse of emergency medical facilities and the need to cut down healthcare costs in general, Brian’s mind suddenly harkened back to Roger Dalton and how right he’d been. But then Ebony got Brian’s attention by saying: “. . . but if you disagree with our adjuster’s decision, you have the right to request a review online.”
“I’m thinking I will do more than request a Peerless review,” Brian snapped. “Denying a legitimate claim like this seems criminal. I think this deserves a review by an attorney.”
“Of course, consulting an attorney and even initiating a lawsuit is your right,” Ebony said. “But, let me say this, attorneys are very expensive. And in my experience, which is rather extensive, as I do this day in and day out, you’ll be wasting your time and money. Peerless Health knows the ins and outs of this business extremely well, which is why we are so successful. We also have in-house counsel to deal with lawsuits. My advice, for what it is worth, is for you to request a Peerless review and see if it changes the situation. Occasionally it comes to light that an adjuster has made a mistake and the claim is reversed upon review. Is there anything else I can do for you today?”
Similar to how he’d felt after his conversation with Roger Dalton, it took Brian a few minutes to calm down enough to think clearly after disconnecting with Ebony Wilson. He was in no way a litigious person: far from it. As a committed law enforcement officer, he wasn’t fond of lawyers. And he recognized Ebony was probably right about the futility of hiring an attorney to try to deal with a company that undoubtedly was “lawyered up” and prepared to deal aggressively with any legal action. He was left with no other option than to request a review.
He brought up the Peerless Health Insurance website to log in, but before he did so, he decided to give the website some attention, seeing as it was basically his second time on there. After a quick glance at the section trying to sell policies to new customers, Brian clicked on the investment section. He learned that the company had had a wildly successful IPO two years ago and that the stock price had doubled since then, making it one of the fastest-growing companies on NASDAQ. It was immediately apparent that the entire success of the company was attributed exclusively to its wunderkind CEO, Heather Williams. Brian looked at the woman’s picture. He was impressed with her youth as a CEO of a public company—somewhere around thirty was his guess—and the intensity and imperiousness of her gaze.
Finding himself curious, Brian opened up a new page and looked up Heather Williams. He was surprised by the amount of material available on her and clicked on a recent biographical article. Now he was confronted with a second picture of the CEO that was starkly different from the typical businesslike head-and-shoulder pic on the Peerless website. This was a picture of a painting featuring a haughty Heather Williams in a foxhunting outfit with a horse on one side and a foxhound on the other. Brian’s immediate reaction was shock. In his mind foxhunting, like polo, was something reserved for English royalty or those people who aspired to be demonstratively aristocratic. His second reaction was to acknowledge that she’d probably had a very different and a much more privileged upbringing than he had. Beginning the article, he learned that she was the scion of a west Texas oil family, had gone to boarding school in England, and then graduated from Yale undergraduate and finally Harvard Business School.
“Good grief,” Brian exclaimed as he read on. She’d been hired by Peerless directly out of business school. At the time Peerless was a small company founded by a group of young entrepreneurs trying to break into the health insurance market by taking advantage of the passage of the Affordable Care Act and the subsidies it offered. Heather Williams quickly and cleverly saw a different path, and instead of relying on politically susceptible subsidies, she strenuously pushed the company to embrace the short-term health insurance market. Within just a few years, thanks to her aggressive and creative marketing, she was elevated to chief financial officer, or CFO, and two years later to chief executive officer, or CEO. In recognition of her single-handedly tripling the company’s stock value, she’d become a recognized and applauded darling of Wall Street.
After he finished the article, Brian returned to the picture of Williams in her foxhunting outfit. As he stared at it, he found himself wondering how much her and Peerless’s financial success were dependent on Peerless quickly denying claims, as had just happened to him. After entertaining the thought for a few minutes, Brian decided to move on and return to the Peerless website. He had more immediate concerns, like requesting a review of the claim denial for Emma’s ED visit, which he sincerely hoped would result in a reversal and possibly save his family’s fortune.
With that unpleasantness out of the way, Brian gave Camila a break from being with Juliette by spending almost an hour reading The House at Pooh Corner to his daughter in her bedroom. After finishing the fourth chapter, Brian looked up to discover Juliette had fallen asleep. Being as quiet as possible, he tiptoed out.
“How much information do you want on each of these guests for the potential Foster gig?” Camila asked as Brian came into the office and sat at his desk. She was at her desk on her computer.
“The more the merrier,” he said as he booted up his machine. He hoped that the Foster affair would take place despite the growing concern over a second wave of Covid. With that thought in mind, he went online to look at the Personal Protection LLC bank balances to figure out if there were adequate funds to somehow at least appease the hospital while Emma was an inpatient, especially in case Peerless wasn’t going to participate. As he expected, the balances weren’t encouraging, and they were going to be hard put to cover basic expenses and put food on the table if some significant business didn’t materialize during the next month.
“Our cash flow is a bad joke,” Brian voiced out loud. It was depressing, and for many reasons he wished he and Emma had not decided to take the vacation on Cape Cod even though they had gotten the cottage for a steal. Continuing in that trend of thought, he wished they had at least avoided the beach barbecue. Things could have been so different.
“As if I didn’t know,” Camila said. “We’re in dire need of some luck. Fingers crossed for this Foster event. One thing I’m going to insist on: Stop paying my salary until things turn around.”
“Camila, we couldn’t,” Brian countered and meant it.
“I know that neither you nor Emma have taken any salary for months. It’s only fair, especially since you’re giving me room and board.”
“At this point you are more like family,” Brian said. “How about we defer your salary? I’m willing to consider that under the circumstances.”
“That’s fine, if that’s what you want to call it,” Camila said.
With Camila’s suggestion of deferring, he looked back at the numbers. From that perspective it seemed possible that Brian could manage five to ten thousand dollars to placate the hospital, provided the bank was willing to continue deferring the mortgage payment on the house. With the mortgage question in mind, Brian decided to put in a call to their banker, Marvin Freeman. As the call went through, Brian thanked his lucky stars that he and Emma had not taken a business loan to start their security company and instead renegotiated the mortgage on their house. After the usual superficial pleasantries, Brian got right down to the reason for the call.
“You and a thousand other businesses.”
“What do you think the chances are that we could renegotiate our mortgage yet again to give us some operating cash to carry us through?”
“We just renegotiated your mortgage not even a year ago, Brian,” Marvin said. His voice lost some of its friendliness, becoming significantly more businesslike.
“I was afraid you’d say that,” Brian said. “What about a business line of credit? Something to get us cash if we get desperate.”
“What kind of collateral are you thinking of offering for a credit line?” Marvin asked. “Do you have any stocks and bonds?”
“No, we don’t have any collateral. The house is our only asset.”
“Having no collateral ties my hands, my friend. There’s no way I could get a line of credit for you without it. Plus, the bank is already allowing you to defer your mortgage payments for the immediate future.”
“Yes, and I appreciate that, Marvin. I suppose in a way that is already a line of credit.”
“You could look at it that way, but I should warn you that it is not going to last.”
“I understand, but thanks, Marvin.”
“Sorry I can’t be of more help.”
Disconnecting from the call, Brian went back to staring at the meager bank balances. After hearing the bank’s position, he really didn’t think he could pay MMH very much without putting himself, Emma and Juliette, and his fledgling business in jeopardy. Now more than ever, it seemed tragic to live in a wealthy country where basic emergency healthcare could put a decent, hardworking family like his at risk.
CHAPTER 8
August 27
Brian stepped out of his front door a little after eight in the morning, and as he put on his face mask, he surveyed the street in front of his house. The roadway was in the process of being repaved but so far had only been ground down and striated. It was a mess, dangerous to walk on, and he had no idea when it was going to be put back together. In many ways it seemed symbolic of his life in the past week.
Emma was still hospitalized after a week and not doing as well as Brian hoped. During her first twenty-four to forty-eight hours in the ICU, he had been told she’d improved and had regained a reasonable degree of orientation. But then when she was transferred into a normal hospital room and he was able to see her, he found her mental state varied from day to day. Sometimes she didn’t even seem to recognize him, and she spent most of her time sleeping. She had continued to run a fever, suggesting that the EEE virus was still active despite whatever antibodies her immune system was making.
But at least being in a normal hospital room made it possible for Brian to see her, and thanks to Camila, his mother, and Emma’s mother, he’d been able to spend considerable time doing so while the women took turns taking care of Juliette. His poor daughter missed her mother and was sulky, irritable, and withdrawn despite a lot of effort on the part of all three extra caretakers. To everyone’s concern, Juliette wasn’t even eating properly. Brian was enormously thankful that taking care of her wasn’t on his shoulders alone, as he wondered if he would find the patience it required. Just being with her during the night could be trying enough when she’d wake up crying.
Although he had taken one entire afternoon to run out to Southampton to check out the Fosters’ palatial summer home and meet the bride-to-be so that Camila could come up with a budget for the wedding, he spent every other day with Emma. It was his feeling that the nursing staff wasn’t spending the time necessary to make sure his wife was being appropriately mobilized. From his EMT training, Brian knew how important it was for a patient not to remain in bed continuously.
Multiple times every day, Brian forced her to get up and walk up and down the hallway despite her constant complaining. While walking with her two days before, he’d noticed a change in her stride. It was a kind of clumsiness that was almost imperceptible at first, but slowly progressed over the next twenty-four hours. Yesterday morning when he got her out of bed, it was definitely more apparent, and he brought it to the attention of Dr. Shirley Raymond, the hospitalist responsible for Emma’s care. She in turn alerted the neurology consult who had been following Emma. This new symptom, labeled by the doctors as spasticity, had raised Brian’s concerns, and as he started out toward MMH Inwood, he wondered if he would find Emma even worse today.
Feeling the need for exercise, which Brian wasn’t getting, he literally ran to the hospital. The face mask made it a bit more difficult, but he was willing to put up with it. As he entered through the front entrance into the marbled lobby, one of the women behind the information desk called his name. With as much time as he’d been spending at the hospital on a daily basis, he was becoming a known commodity.
“Mr. Murphy! Harriet Berenson would like to see you,” one of the pink-smocked ladies said.
“Who is Harriet Berenson?” he questioned. He was moderately out of breath, even though it had only been a little more than a week since he and Emma had done their daily mini-triathlons.
“She’s one of our discharge planners. Her office is on the second floor.”
Brian was taken aback. He never even knew there was such a position as a discharge planner. And why would a discharge planner want to talk with him—unless they were thinking of discharging Emma? But how could that be, particularly with her developing a new, alarming symptom? After hesitating for a moment to decide whether to go up to Emma’s floor first or visit Harriet Berenson, the latter won out. He needed to know sooner rather than later if there was even talk of Emma being discharged. The idea of having to take care of her at home terrified him.
“Ah, yes,” Harriet said once he had made it to her office. She picked up one of the folders on her desk and opened it. “Emma Murphy is to be discharged today. I want to arrange for post-hospital services.”
“My wife cannot be discharged,” Brian stated simply. As far as he was concerned, she was hardly capable of even basic functions. “That’s not going to work. Our house is ill-equipped to handle her needs. I’m not even sure she can climb a flight of stairs in her condition and the bedrooms are upstairs.”
“That’s good to know,” Harriet said. “That’s what I am here for: to make sure your wife gets the care she requires. We can certainly arrange for extended care in a nursing home.”
“But she’s developed some difficulty walking,” he argued. “And it’s getting worse.”
“Do you think a rehabilitation hospital would be a better solution?”
“I don’t know,” Brian stammered. “I hadn’t given it any thought. I certainly didn’t think she was ready to be discharged. She’s still symptomatic from the EEE virus. In fact, she still has a fever as far as I know.”
“That’s not what Dr. Kathrine Graham thinks,” Harriet countered. “She wrote the discharge order this morning.”
“Who is Dr. Graham?” Brian asked. He’d never heard the name.
“She is our Chief Medical Officer here.”
“Does Dr. Shirley Raymond know that my wife is to be discharged?” He had briefly seen Dr. Raymond around noon the day before, and she’d not mentioned anything.
“I’m sure she does,” Harriet said. “As I said, Dr. Graham is our CMO. If your wife needs help regaining strength for things like walking, a rehabilitation hospital would be the proper choice, no doubt. How does the Hudson Valley Rehabilitation Hospital sound to you? It’s in Hudson Heights, so it’s close by, and it is an excellent facility. We send a lot of our patients there.”
“I guess it sounds better than a nursing home,” Brian assented. A rehabilitation hospital sounded decent, but he was hardly enthusiastic.
“Okay, then I’ll get right on it,” Harriet said. “I know Hudson Valley has room because I placed someone there just yesterday. Now, I was told that you
must see Roger Dalton right after talking with me. Do you know where his office is located?”
“I do.” He didn’t like the idea of seeing Roger Dalton again. He’d not spoken to the man since their less than personable visit a week ago and, from Brian’s perspective, it was better to let sleeping dogs lie in regard to the outstanding, humongous ED bill. Yet now that there was a possibility of Emma being discharged, it probably wasn’t avoidable.
Leaving Harriet’s office, he briefly debated whether to see Dalton first or check in on Emma. Reluctantly, he decided it best to get the Dalton meeting out of the way, as he might find it difficult to leave Emma if she became upset about being discharged. Using the stairs, Brian descended to the first floor and entered the administration area.
With Roger Dalton, Brian wasn’t so lucky as he’d been with Miss Berenson. Not only was there someone in the man’s office, but there was another individual waiting to see him, too. At least the wait gave him a chance to think about Emma’s discharge. He still did not like the idea, but he admitted he knew nothing about the Hudson Valley Rehab Hospital other than approximately where it was. Being that it was rehab hospital, maybe Emma would get more attention, but the uncertainty bothered him, as he didn’t know what to expect going forward.
When Brian finally walked into Dalton’s office and sat, he thought he was prepared for whatever the man was going to say, but he wasn’t, especially since the meeting started out on the wrong foot.
“I thought you were going to get back to me about the outstanding Emergency Department bill?” Roger said with a definite accusatory tone.
“I was planning on it,” Brian said in his defense. “I have applied for a review of the decision to deny the claim, and I’ve been waiting for a response.”
“You got your response,” Roger spat. “You were informed the claim again had been denied by email yesterday. I know because I’d resubmitted the claim when I hadn’t heard from you.”