“But these guys never approved it,” Jay said. “Are they like this with all your cases?”
“Pretty much,” Donald said. He placed the cell phone back in his breast pocket. “And especially lately. They’ve been denying a lot of things they used to pay for without any question.”
“They have a new CEO or something? New management?”
At this question, Donald’s mind flashed back on something Michelle had told him a few weeks ago… that Red Rose was one of Corporate Financial Consultancy’s clients. “No, but get this.” He quickly told Jay what Michelle mentioned to him. Jay looked grim. “This is just too weird to be a coincidence. I mean… Corporate Financial Consultants begins working with Red Rose and suddenly their whole business structure changes, becomes more bottom-line oriented. More ruthless.”
“Same as what’s been happening with Building Products,” Jay said. “This patient, Michael Brennan. What’s going to happen to him now?”
Donald sighed. “Red Rose will deny payment to his providers and the hospital and Michael will be stuck with the bill.”
“How much?”
Donald shrugged. “Hard to tell. Twenty grand maybe.”
“Shit. No wonder the medical profession is getting a bad rap.”
“I share your concern about the runaway cost of healthcare in this country, but now’s not the time to vent your opinion on what you may feel are the overrated prices of healthcare,” Donald said, struggling to keep the anger out of his voice. “The basic cost for such a procedure is around fifteen thousand dollars, which is a relatively low figure when you compare it with the fees of other surgeries. And if you think Dr. Schellenger received that entire amount for his fee, you’re mistaken. That fee covers those assisting him including the assistant physician, surgical nurses, and the equipment used. There’s also risk involved—there’s always risk involved when you put somebody under general anesthesia and operate on them. Anything can go wrong. Operating on a human being isn’t like fixing the transmission of your car or tinkering with the motherboard of a computer. You screw up, the patient dies. You can replace a car or a computer, you can’t replace a human being.”
“I hear you,” Jay said. He was fidgety. “I didn’t mean to criticize.”
Donald buried his face in his hands. “I’m sorry if I snapped. It’s just… I can’t believe this is happening!”
“Do you know where Michael lives?”
Donald turned to Jay, who looked concerned. “Why?”
Jay’s dark eyes reflected more than a concern for Michael Brennan’s financial ruin. “I think… I can’t really describe it, but… I just have this feeling he might be in danger.”
And when Jay revealed this to him Donald felt a shiver pass through him. First Red Rose’s repeated denials to cover treatment for a potentially life-threatening disease, then their hardball tactics to have Michael’s providers dismissed from their respective medical groups due to their willingness to save his life… and Red Rose’s continued refusal to cover treatment in similar cases the past six months while green-lighting other cases. It didn’t make sense. Donald remembered a case a month ago when Red Rose green-lighted plastic surgery for the patient of a colleague, which was definitely not medically necessary. The patient in question simply didn’t like the way her nose looked. Red Rose paid seven thousand dollars, the total fee, for a relatively minor procedure that shaved tissue off the tip of her nose. Last he heard, the Plastic Surgeon in question was planning further surgeries for the woman—liposuction to remove fatty deposits along the face, belly and thighs, some nips and tucks to smooth the brow. He’d never heard of any HMO approving Plastic Surgery for vanity’s sake. It had been the hot topic of conversation at work when Donald mentioned it in passing to one of the other doctors on staff, Jon Sneller.
Yet other procedures… denying coverage for the sixteen-year-old girl with a clear case of appendicitis and having the appendix burst—the medical group was still fighting with Red Rose for the emergency surgery necessary to save the girl’s life; the forty-four year old woman with pneumonia who was admitted to Lancaster General and was now on life-support after Red Rose initially denied the antibiotics that were recommended in the early stage of the illness that would have staved off the condition; the traffic accident victim who almost lost his leg when a drunk driver crossed the center divider and smashed head on into his car—Red Rose’s claim was that the surgery performed on the patient’s leg in order to save it was denied due to a pre-existing condition, one that existed in the driver that caused the crash. The driver in question was an alcoholic, a medical condition that had been documented in his history before. Never mind that the victim wasn’t an alcoholic and was simply in the wrong place at the wrong time, it didn’t matter to the Red Rose governing board.
Their verdict, when rendered, had caused a ripple of concern among Crossroads and Lancaster General, who had performed three procedures to save the victim’s leg, procedures which had so far amounted to seventy-five thousand dollars in medical expenses. Had they simply amputated the leg, Donald had no doubt Red Rose would have paid for that procedure and the follow-up care since they would have wracked up around twenty-five grand in fees all totaled. But now? With three surgeries already under their belt and with more to follow? The fees would be astronomical. The patient in question was fully covered through his employer, and most HMOs would have been bound to cover the cost of the treatment minus deductibles and co-pays. What Red Rose was doing was not only unprecedented in Health Care but unethical and, in Donald’s opinion, highly illegal.
This all flashed in Donald’s mind quickly as he considered Jay’s concerns. He felt afraid too, and he didn’t know why. Everything was spinning out of control; he didn’t know what to think about the situation. “I know Michael lives somewhere in the Denver area. I don’t remember his address or anything.”
“We need to find him,” Jay said. “I don’t know why, but we have to. I just have this feeling.”
Donald nodded and put the car into reverse and backed up. “So do I,” he said, and they pulled out of the Chevron station and headed out.
VICODIN WAS THE best drug in the world next to morphine. Michael Brennan was sure of this as he lay in the bed he shared with his girlfriend Jenny. It not only completely erased the pain in his lower groin, it produced the same numbness he felt the few seconds before he went under completely yesterday during surgery. He had been lying on the operating table surrounded by doctors and nurses at Lancaster Hospital, feeling very calm and confident that he was going to be well taken care of. There was an IV inserted in the vein of his left hand and the anesthesiologist was at his side, telling him he was going to start administering a drug that would put him to sleep very shortly. “You’re going to feel very calm, very relaxed, and then you won’t feel anything,” the Anesthesiologist said through his surgical mask. Sure enough, Michael felt very relaxed and calm, and then for approximately five seconds he experienced the best high he ever had in his life. It was wonderful, like floating on a cloud and having your body feel… well, so relaxed, so calm, so good. His friend Bobby told him the night before that Anesthesiologists used something morphine-based to put you under. Now Michael knew why people did heroin, which was derived from opiates, same as morphine. He didn’t know if Vicodin was an opiate but it sure felt like it. It wasn’t as strong as the morphine high he’d felt for five seconds before he dropped off like a rock and woke up suddenly in the recovery room, coming awake in a rush, crying in relief that it was over finally, but it was pretty damn close. Vicodin was great. It was so great he was thinking about replacing it with salt and pepper in his meals, maybe replacing it with sugar and cream in his coffee.