“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 nurses’ 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.”