“Yes, that’s it,” Brian said. In contrast to the elevator music, Ebony’s voice had a welcome and distinctive soothing quality. “Out of curiosity, are you in the Peerless Midtown office or are you working from home?”
“I’m in the office,” Ebony said. “As a supervisor, it works better for me to be here, same with senior management. Most of the secretaries work from home. Why do you ask?”
“No real reason, just curious. It’s such a crazy time, what with most people working from home if they can. I was wondering how the health insurance world was faring.”
“Okay, I have read through the adjuster’s report,” Ebony said, ignoring Brian’s comment. “Everything seems to be in order here. Why do you think there was a misunderstanding?”
“My wife had a grand mal seizure on the Henry Hudson Parkway after feeling ill all day,” Brian told her. “As soon as the seizure was over, we drove directly to the MMH Inwood Emergency Department.”
“Yes, that is documented here in the claim,” Ebony agreed. “But it also says that Emma Murphy walked into the ED without assistance at four-thirty and waited in line to be helped.”
“That may be true, but she was disoriented. I could have called for an ambulance, but that would have taken longer. When she had her seizure, we were in our car fifteen minutes away from the hospital.”
“I agree perfectly with your assessment, Mr. Murphy. An ambulance surely wasn’t needed and would have been an unnecessary expense. But so is the kneejerk reaction to go to a Trauma 1 Emergency Department when your wife should have been seen by her general practitioner, or perhaps an urgent-care center.”
“We don’t have a general practitioner,” Brian interjected. “My wife and I have been in perfect health. We work out every day. For our four-year-old we have a pediatrician, but we haven’t needed a GP.”
“Doesn’t your wife have a gynecologist?”
“Yes, of course she does, for her yearly checkup.”
“GYNs frequently function as general practitioners for young women. Your wife could have gone to her GYN, who could have seen her and admitted her to the hospital if necessary.”
“That’s absurd,” Brian practically shouted.
“Calm down, Mr. Murphy. Anger will get you nowhere. Let me explain something to you. Peerless Health Insurance and our CEO, Heather Williams, are responsible members of our community, our city, and our country. We provide health insurance coverage with the lowest-priced premiums possible, but it comes with responsibility on the part of our members. Let me ask you something, Mr. Murphy. Did you read your Peerless policy as carefully as was recommended by our agent?”
Brian glanced down at the thick stack of papers on his desk. The truth was that he had not read the policy at all and didn’t know if Emma had, either. He’d never read any of the health insurance policies he’d been given, even while an NYPD officer.
“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.