Charles Bock - Alice & Oliver

“Bill.” Oliver was with the program, even if he wasn’t happy about it.

“It gets nuts,” the lawyer continued. “Doctor visits get processed in a department specifically for doctor costs. Hospital costs get processed somewhere else. Lab costs, somewhere else. You’re going to get these different statements, all from different areas, sometimes different companies.”

“That’s already happening. Most say we don’t have preapproval, which is just bullshit—”

“Boychick, the only way to handle this is calm. You’ve got at least a month before insurance processes and approves. Until then you’re getting those bills. Don’t overreact. Just confirm: the doctor’s office sent insurance the precert.”

“Got it. Okay. I’ve been trying to read the statement sheets, but there’s no logic. It’s to where I have no clue—”

“That’s what I’m saying. And your doe-eyed case manager?”

“Culpepper.”

“Go over her head. Deal with her supervisor. Soon as you can. Today. You write a letter to the hospital finance office. Let that supervisor know you’re appealing everything with the insurance. Every single out-of-network charge. You request medical notes from the case, the case manager, the doctors. Date and sign that letter. Make copies for your file. You want that hospital financial office helping you. Right up until the second they have to start trying to get the balance of what your insurance didn’t pay.”

Oliver typed. “So pit the hospitals against the insurance companies?”

“Part of the process. You and your wife have to be in this for the long haul.”

“Goddamn long-term ground war in Russia.”

“It’s up to you to use the time. Lengthen out how long it takes to settle each appeal. That’s over, apply for financial aid — see if the hospital reduces the bill. Hospitals are like private schools in Manhattan: they have all kinds of money for aid; only the applications are huge, specifically to discourage people from applying . But, kid, you jump through hoops the right way, there’s aid. Still, even afterward, you want to elongate out the payment period for what’s left. Whitman’s going to be in business, so don’t you worry about them.”

“I know we have enough insurance to get through that consolidation thing — five days of chemo, we stay under the cap. Another induction, though — I mean, if Alice agrees to try….But thanks. What you’re telling me helps.”

“You’ve got to adjust how you deal with these people,” Blauner said. “Every time you call your health insurance company, make sure you get name and number of each operator. Take complete notes. Repeat important info back to them for confirmation. When that phone-automation system tells you they’re monitoring a phone call for quality control? Don’t kid yourself — they’re checking on employees to make sure they follow the company script. They’re also monitoring your response. So no yelling at operators. Ever. Don’t give anybody reason to claim you’re unstable, you’re violent, they can’t work with you.”

“Yeah, well…it may be too late for that, but it’s good you told me.”

“Kid, believe me, I understand. But cut that shit out, pronto. Any rep, you’re as polite as with your sainted granny on her birthday. Soon as you wrap up a conversation, say the rep’s been very helpful. Ask for her name — because you want to tell her supervisor. Then send a thank-you letter for the information you were given. Put that information very specifically in the letter. This way you create a paper trail of what you’ve been told, by whom, and when. Keep your own copy of everything.”

“What’s the worst they’re going to do?” Oliver asked. “It’s not like insurance companies can seize property.”

“You’re funny.”

“What?”

“Boychick, you never heard of a court order to freeze accounts?”

“Fuck.”

“That’s down the road. But still — any way for you to hide assets? Do you have assets?”

“Fawck—”

“I had a client. She had cancer, is in for chemo. While recovering she gets pneumonia. They CAT scan her stomach before letting her come home. This at the start of the Christmas holiday weekend. Short staff, all senior docs away on vacation, residents and interns galore through the ward. Scan shows liquid around the gallbladder. Radiologist reads the pictures, sees the liquid, but also fuzz. He can’t make a firm deduction. He writes the risks are significant and could be examples of serious problems. This is what goes into the official report.”

Oliver started to ask what that meant.

“Attending reads the report, refuses to release the patient, naturally. My client complains to the daily resident. She wants to go home for Christmas.”

“I know that scene.”

“So the resident calls the radiologist. Off the record, the radiologist’s willing to admit the scans don’t look bad, whatever’s happening around the gallbladder isn’t such a kenahora. Besides, CAT scan results can be days behind what’s really happening.”

“So the radiologist’s just covering his ass.”

“Well — he can’t afford to have the patient released, and not have a warning in the paper trail. That happens, the radiologist’s legally liable. Client owns the hospital.”

“Why not fucking unplug the tubes with your hands?” asked Oliver. “Just take yourself out. They can’t keep her against her will.”

Blauner laughed. “Leave a hospital against medical advice? Insurance doesn’t pay for your stay, doesn’t pay for any procedures during that stay.”

A long breath outward.

“Exactly. There’s all kinds of angles.”

Another breath. Oliver said, “I just don’t see how we’re supposed to get through this.”

—

Alice raved about how scrumptious the seared strip steak had been, even if she’d only been able to eat a few bites, it had been no less divine; and she told Monsieur Florent how much she appreciated being in such a welcoming and lovely space, and the restaurant owner responded by kissing Alice’s hand as if the medically necessary rubber gloves were elbow-length silk, and he clasped into her palm a black business card, and told her that any time she needed anything, just call — didn’t matter if it wasn’t on the menu; they would have it for her, they could deliver to the loft. Bread baskets and water glasses were refilled; Florent told the women to take their time and he receded. Alice recounted for Tilda being in the blood cancer waiting room and meeting that man with the hump on his back, just what it had been like staring into his eyes, looking right at someone staring at his own death. Alice said she’d seen his death. She’d traveled into his void. Why should she get to live, she wanted to know, why should she get a chance, have everyone be so kind, all these people with their pity and their good wishes?

But staring at that man also allowed her to realize something. It was up to her to accept the void. She was the one who ultimately had to kill her God, kill her parents, kill herself, kill her identity, kill her personal narrative.

Interrupting, sheepish, apologetic, the creative director at a clothing house where Alice had never once set foot introduced himself, and asked if she needed any clothes, if he could do anything for her, anything at all. Alice thanked him for his kindness and accepted his hand in hers, and once he’d gone, she told Tilda that well before she’d ever fallen sick, she’d known about a form of Buddhism that prepared for death by having its practitioners chant: Every day, I am getting older, my body is decomposing, I am closer to my end. She used this chant while she was doing yoga, or chopping up celery and cleaning the sink.