forty joined in.
“Will. . Will. . Will. . Will.”
“There being no further business,” Lemm shouted out over the din, “I’ll see you all at Faneuil Hall. Nice job, all. Meeting adjourned.”
“Dr. Grant?” a woman’s voice asked.
“Yes.”
“This is Ellie Newell. I work in the comptroller’s office at the hospital. Mr. Davidson is my boss. I called him about this, and he called Mr. Brodsky. Apparently, Mr. Brodsky told him you would want to hear what’s just happened.”
Seth Brodsky was the longtime CFO of Fredrickston General.
“What’s this about?” Will asked.
“It’s about your patient, John Doe, in the ICU.”
“He’s not John Doe anymore. He just woke up and told us his name. It’s Langley, Jack Langley from Des Moines, Iowa.”
“Yes, I know,” Ellie said. “I just spoke to his wife.”
“You did?” Will had called Marybeth Langley just a few hours before.
“I also spoke with an officer at Midwest Industrial Care, the HMO that covers the Langley family.”
“And?”
“Dr. Grant, correct me if I’m wrong, but it seems Mr. Langley is still facing a long hospitalization.”
“If there are no serious setbacks, he is. The man was essentially dead when he was brought in. It’s a miracle he’s alive at all. I would guess ten more days. Maybe even two weeks.”
“His bill already-counting, among other factors, the cost of the ER, the OR, the surgical team, the recovery room, the ICU, and a number of consultants-is in excess of forty-five thousand dollars.”
“I’m not surprised.”
“Well, Midwest Industrial has flatly refused to pay anything and will not pay for any subsequent care.”
“That’s ridiculous. What reason did they give?”
Ellie Newell hesitated.
“Well,” she said, “the insurance company has a strict policy regarding all surgery. No coverage unless the procedure is preapproved by them or approved within twenty-four hours.”
“But the man was in a coma!”
“I know.”
“How can they do this?”
“Mr. Davidson told me that you of all doctors wouldn’t even bother asking that question-that you’d already know the answer.”
Will felt himself deflate.
“You know, Mr. Davidson is absolutely right,” he said. “He’s absolutely right. Thanks for calling me.”
Will ended the call, then called Tom Lemm.
“Tom, it’s Will.”
“Hey, I hope you’re not upset with me for the way I railroaded you back there. Desperate situations call for desperate measures.”
“No problem,” Will replied. “I was just calling to see if we could get together tomorrow. We’ve got a lot to do before next week.”
CHAPTER 6
Marybeth Langley was a petite, energetic woman with a sweet face and manner. For the week since Will’s call, she had been spending nights in a small B amp;B in downtown Fredrickston and days at the bedside of her husband, Jack. Despite the persistent refusal of their HMO to pay for any of Jack’s surgery, consultations, or hospitalization, she and her husband had decided to remain at FGH and under Will’s care until it was medically appropriate for him to return to lowa. Finally, that time had arrived.
It was mid-afternoon on a chilly, gray Thursday, the day of the Faneuil Hall managed-care forum. Will had repaired an electrician’s painful hernia in the morning, then worked his way through a reduced office schedule. He wanted to leave at least an hour for a final review of the mass of notes and articles he had accumulated regarding the shortcomings of managed care-especially Jeremy Purcell’s insights and strategies. Throughout college and medical school, Will never took an exam that he felt truly ready for, but never had he felt as ill-prepared for anything as he did for this debate. Saying yes to Tom Lemm and the Hippocrates Society was certainly noble enough, but it was evolving into one of the dumbest, most impetuous things he had ever done. He reminded himself for the hundredth time that he could only do what he could do, and then turned his attention to discharging his prize patient. The titanic struggle the two of them had endured together had forged a friendship that went well beyond the usual doctor-patient relationship.
“So, Jack,” Will said, “it looks like this is it.”
“Looks like.”
Langley had proven to be a bright, well-read man-a laconic Midwesterner with a subtle sense of humor, who listened to country-western music almost around the clock and loved his job selling heavy machinery, although his life’s dream had once been to become a veterinarian. The pictures of and by Langley’s kids had been taken down and packed. Nurse’s discharge instructions had been checked over by Will, then given. Langley, dressed in chinos and a loose-fitting Kansas City Royals sweatshirt, was seated in a wheelchair, the required mode of transportation for discharge.
For nearly a minute, nothing was spoken. Will, distracted momentarily from the impending forum, was trying to remember when he had ever felt so good about a case. Jack Langley was alternating between projecting what it would be like to hold his kids again and wondering when he would be able to return to work.
Marybeth, deeply religious, was processing her overwhelming gratitude for the droll, soft-spoken, surprisingly unassuming man who had saved her husband’s life, and thanking God that there were men and women in the world who could do what he had done for their family. She knew very little of him except that he was divorced and had two children, and that her husband, in his understated Midwestern way, absolutely adored him. Silently, she prayed that life was treating him well. Earlier in the day Will had quite casually mentioned that he had arranged for himself and all of the consultants to rub their charges off the massive balance sheet she and Jack were facing. She took a wad of tissues from her purse and dabbed at the corners of her eyes.
“So,” Will said finally, “you’ll keep in touch?”
“Of course.”
“And you’ll have your doctor call me straight off if there are any problems?”
“I don’t expect there’ll be any-not any medical ones, anyway.”
Will sensed a fullness building in his throat. He had never had that much reserve about crying in public, but this just wasn’t a time he wanted to.
“I heard some interesting news last night,” Marybeth said, as if sensing Will’s predicament. “I was talking to my cousin Peggy. She lives in a suburb of Des Moines. She was telling her friend Claire about what was happening to us with the HMO refusing to pay and all. Well, it turns out Claire used to work as a claims adjuster for that same HMO. She says that she and the others who worked her job were instructed by the company to reject one out of every ten claims out of hand. Don’t even bother to come up with a reason, just reject it. It seems the company had tried this approach to saving money and found that only thirty percent of the rejected claims were ever contested by the doctors. They just didn’t have the time or resources to battle over such things.”
“Lord. I’d like to say I’m surprised and stunned, but I’m not. In many instances, the cost involved in disputing
