After more than a half hour, Ebony Wilson came on the line using her signature pleasant voice with its mildly southern accent.
“It’s Brian Murphy again,” he said in response to her initial scripted introduction. He then immediately rattled off his policy number without being asked and said he was again calling about a claim denial and wanted yet another explanation.
“Let me check for you,” she said cheerfully. If she’d been offended by his abrupt disconnect the day before or his current supercilious attitude, she didn’t let on. Brian assumed that she probably had to deal with a lot of angry people in her role as a claims adjustment supervisor of a company that made it a point to deny claims.
After less than five minutes of additional Muzak punishment she came back. “I see the latest claim was for Juliette Murphy at the MMH Inwood ED. Is this the claim you are inquiring about?”
“Yes,” he said. “Why was this one rejected, or are all claims automatically rejected?”
“Our adjusters are experienced, hardworking, and very qualified professionals,” Ebony said by rote, seemingly immune to Brian’s brashness. She then went on to say: “This claim was denied for two reasons. The first was because of a preexisting condition, which your policy does not cover.”
“What kind of preexisting condition?” he interjected with surprise.
“Serious prematurity,” she said. “The attending physician had noted that the child had been born at thirty weeks, weighing only two-and-a-half pounds, which required more than a month in the neonatal intensive care unit.”
“But that was four years ago,” Brian sputtered. “After the first year she caught up size-wise, and she’s been fine ever since.”
“Prematurity has lots of potential complications down the road, or so I’ve been told,” Ebony said. “Do you want to hear the second reason?”
“I’m not so sure...”
“The visit was in the middle of the day at a Trauma 1 Emergency Department,” she continued. “Your daughter should have been seen by her pediatrician or an urgent-care center.”
“I called the pediatrician’s office and was advised to take my daughter to the MMH Inwood ED,” Brian argued. “I was following doctor’s orders.”
“We here at Peerless take our responsibility of reducing healthcare costs very seriously,” Ebony said. “That means encouraging people to use lower-cost alternatives.”
“I’ve heard this argument from you already,” he snapped. He could feel his pulse pounding in his ears.
“Again, if you don’t like our adjusters’ decisions you have the right to resubmit the claim and request a review or...”
“Or I can sue,” Brian said, filling in the rest.
“That is correct, and thank you for being a Peerless Health Insurance customer,” Ebony finished, again by rote.
Without another word and infuriated by the call, he disconnected and, like yesterday, immediately charged down the cellar steps and hurried into the small basement workout room. Using the same forty-five-pound weights, he quickly exhausted himself. Brian had always been a physical and mildly self-righteous person whose first instinct when attacked or wronged was to strike out. With his size, strength, and agility, he’d had to learn to suppress such urges, using sports as a release. When competitive athletics wasn’t available, barbells or strenuous cardio activity would suffice.
Ten minutes later and feeling moderately under control, he returned upstairs and sat back down at his desk. Looking at the phone lying on the blotter, he again debated getting in touch with Aimée. He knew he should, but when he picked up the phone, he still didn’t call his mother. Instead, he called Jeanne, more for moral support than anything else, although he planned on using the Grady material as an excuse.
Again the phone rang more times than he would have liked, and he felt guilty about calling her so much. As he was thinking about what voice message to leave and whether to leave any, she answered. It was clear she was out of breath.
“Am I catching you out on your bike again?” he asked, hearing what he thought was the sound of wind in the background.
“You are,” Jeanne admitted. “Sorry. I had to get the phone out, this time from my backpack.”
“No reason to apologize,” Brian said. “I should be the one apologizing for interrupting your ride again. Are you back in the park?”
“I am, but now I’m riding along the Hudson River, and it’s beautiful. I wanted to get out and get some exercise. What about Juliette? How is she? What did the doctor find this morning?”
“Once again they found nothing, and she’s remarkably improved despite the 102.2 fever and multiple complaints when she woke up. And once again, they did absolutely nothing despite us again waiting more than three hours. I can’t help but feel it was a deliberate slight, same as I did yesterday. Anyway, by the time she was seen, her fever was gone, same with her sore throat. I don’t know about the headache. They said she was fine, thought her complaints were all psychosomatic, and recommended a social worker should her symptoms come back.”
“Did they run any tests this time to be sure?”
“None, even though I made a big stink,” Brian said. “No matter what I said, the doctor refused. I know you might think I’m being paranoid, but I really do think it is all about the money. I’m sorry, but having to wait more than three hours two days in a row and refusing to do any tests, even a simple blood test, has to be deliberate. It can’t be a coincidence.”
“There’s no way to know,” Jeanne said.
“True, but it’s my gut feeling,” Brian insisted. “The doctor tried to tell me some bull about him not knowing anything about the business side of the hospital, but he has to know. They all have to know. I wouldn’t be surprised if the chief medical officer was on their backs all the time with the way that my hospital account manager carries on about the cost of running the Emergency Department. My guess is that Kelley is watching every penny they spend in the ED to make sure it’s a money-making venture.”
“You’re probably right.”
“Speaking of my hospital account manager, I had to have yet another phone conversation with him a little while ago that was as maddening as ever,” Brian said. “Then of course I had to talk again to the Peerless claims adjustment supervisor, which was equally as infuriating. It never ends, but I’ll tell you the gory details later.”
“Oh, my,” Jeanne said with sympathy. “What a day you are having.”
“Well, at least Juliette’s feeling better than when she awoke,” Brian said. “She even said she was hungry when we got home.”
“That’s good to hear,” she said. “I hate to ask, but what about the funeral services for your wife? Were they postponed?”
“I wish,” he responded. “I’m afraid Juliette and I missed both the mass and the burial. We went to the hospital early enough that I thought we’d be back in plenty of time. It’s unfortunate that didn’t happen thanks to the damn ED, but what could I do? Juliette’s fever of over 102 had to take precedence even though it spontaneously resolved. I know my mother will understand, and I just hope Emma’s mother does, too.”
“I’m so sorry,” Jeanne said. “You poor man. You have so much on your plate.”
“There is a bit of good news,” Brian interjected to change the subject. “Grady delivered, as I was confident he would. I have his service list, and it’s going to make our investigation easy now that we have hundreds of Inwood names and addresses.”