J. Gonzalez - The Corporation

“I’m completely on your side in this, Donald,” Dr. Brown said, his voice apologetic. “The medical board is as well, and so is Isabel Frank and Pete Barker.” Isabel and Pete were the Business Administrators of Crossroads Medical Group. “But Pete says he has no choice—if we don’t let you go, Red Rose will cease doing business with Crossroads, and with their market share as a health insurance provider in Central Pennsylvania, we’ll be out of business very quickly.”

“Jesus Christ.” Donald approached the toll-booth and Jay reached over and handed the ticket and change to him. Donald passed it over to the attendant, who nodded and waved them through. Donald piloted the car down the exit ramp and headed toward a Chevron station. “I can’t believe this.”

“If it makes you feel any better, I’m told Drs. Schellenger and Royer were dismissed from Lancaster Urological Group this morning, too.” Eric paused. “This hasn’t been easy on myself or Dr. Westerman.” Dr. Jerry Westerman was the Medical Director at Lancaster Urological Group.

“Red Rose made the same threat to them?”

“Yes, they did.”

Donald opened his mouth to talk but he was speechless. Somehow he steered the car into the Chevron station and parked next to a Cadillac on the side of the building. Jay O’Rourke was sitting in the front passenger seat, looking concerned. Donald put the car in Park. “Can they really do this?” he asked.

Eric sighed. “I’m afraid they can, Donald. They’re our biggest insurance group, they provide the largest patient pool in the area. If we lose them, our patients will defect to other medical groups. You know that.”

“I had Brennan’s report and our request for approval to cover his treatment already written out,” Donald said, still shocked by this sudden news. “I explained to Michael what we were doing, that we were going to word the request in a manner that the claim would be impossible to deny.”

“You made the mistake in authorizing the procedure to take place prior to Red Rose’s final approval,” Eric said.

“They were denying it on the grounds that they didn’t feel it was medically necessary! They would have kept denying it until Michael’s cancer advanced to third or fourth stage and metastasized!”

“I know. I saw your reports.”

“They wanted Michael to wait until it got worse, until blood work positively ruled in their favor that it was testicular cancer. You know that by the time the T-Cell counts show those kind of numbers it’s usually in the fourth stage by then! Those bastards simply didn’t want to shell out money for the procedure at this early a stage! Had we waited it would have not only jeopardized Michael’s health, Red Rose would have wound up paying a hell of a lot more to cover his treatment.”

“You’re preaching to the choir, Donald,” Eric said, his voice still troubled but trying to be soothing. “Trust me, I’ve been saying the same thing to Pete and he’s been saying the same thing to Red Rose, but they’re adamant. They’re furious that you over-stepped their authority on the manner. Their decision to deny coverage for this procedure, at this particular time, was final.”

“Those bastards.” Donald was furious.

“I’m sorry,” Eric said. “I didn’t want to do this, but I had to.”

The thought of being suddenly unemployed didn’t bother Donald; it was the extreme stupidity of the reason for his dismissal. He had taken the Hippocratic Oath to heal people, to provide the best health care and medical services he was capable of. To have his work overruled by faceless corporate suits who didn’t have medical training and who were motivated more by preserving the corporate bottom-line infuriated him. “My patients,” he said. “I can think of several off the top of my head who will be upset. Some of them might want to go with me to whatever medical group I wind up at.”

“Perfectly understandable,” Eric said. “Come in Monday morning and we’ll talk. I’ll help clear your files out and we’ll have a letter of recommendation ready for you as well.”

After agreeing to be in the office at nine a.m. on Monday to collect his things, sign some paperwork and pick up his final check, Donald pressed disconnect on the cell phone. He was still stunned by the suddenness of the events, so overwhelmed by what happened, that he didn’t notice Jay O’Rourke in the seat beside him.

Jay leaned forward, his features concerned. “What’s going on? You got fired?”

“Yeah,” Donald said, snapping out of his reverie briefly. He quickly recapped his conversation with Dr. Brown. “Those bastards at Red Rose insisted that Crossroads and Lancaster Urological fire me, Pete, and Bill or they’d sever ties with them.”

“Tell me about this guy Michael,” Jay said. “He the guy you told me about last night? The one who had testicular cancer?”

“Yes.” Donald gave Jay a brief synopsis of Michael Brennan’s diagnosis and his struggle to get Red Rose to approve the procedure necessary to properly diagnose and treat Michael’s cancer. “I’ve never run across an HMO who denied this procedure. I’ve had a few approve it and then later question me on it, asking if it was really medically necessary, but the claims adjusters who do that are usually the new guys in the office, the ones eager to look good to their superiors. Even then, the treatment is always approved at some point.”

“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.”