After I left Da City, I worked as a ED nurse. Eventually, I took a job up north, at Erewhon Memorial Hospital. (“Both Nowhere, and Backwards!”) In due course at work I met The Woman Who Would Become The Plaintiff, after she had been She Who Must Be Obeyed. (another story, for another time).
This woman, let us call her Annie (because “The Woman Who Would Become The Plaintiff” is simply too complex to type repeatedly!), and I began to see each other, dating and, eventually, moving in together. Annie had two children already, Brenda (age 3) and her older brother Adam (age 7). Unsurprisingly, they accompanied her.
Well. Love bloomed, and Annie and I got married. I worked, she went to school, the kids attended school, and all seemed well.
One night Annie and I were asleep. I awakened to hear wheezing from down the hall, in the direction of Brenda’s room. Being the inquisitive sort, I followed the sounds, arriving in Brenda’s room, where she was sitting upright in bed, wheezing and terrified. Annie had awakened when I left the bed, and soon joined us. I listened to Brenda’s lungs with my stethoscope, hearing wheezes. I noted her rate of respirations (42 breaths per minute. Yes, 30 some years later, I remember it), and her pulse rate (162. Yep, I remember.) I got dressed, and Annie stayed home to watch over Adam. Off we went to the ED where I was employed as an Emergency Department RN.
Once we entered the door, well, I was not alone in my assessment that This Was Not Good. Brenda was whisked into a bed, gowned, x rayed, breathing treatment-ed, had blood drawn, and an IV started, and generally auscultated/poked/prodded/imaged very thoroughly.
A couple of hours later, Brenda’s breathing MUCH improved, we were discharged with antibiotics and an inhaler, and instructions to return IMMEDIATELY if her breathing worsened. It did not.
So, several weeks later I received a letter from Erewhon Memorial Hospital, informing me that our insurance company had determined that this was not an emergency, and that therefore the insurance company would not be paying anything on the emergency department visit we recently had.
I called Erewhon’s billing department, and asked them what was up? They informed me that I had to speak to the insurance company, in order to determine what they were thinking.
I did so. It develops that our insurance company hires people who are, in short, stupid. I (finally) spoke to a representative who told me that the claim was not going to be paid, “because that visit was not an emergency.”
I asked her on what basis she had made that determination.
“It simply was not an emergency”.
I observed that, where I came from, answering a question seeking an explanation, was not adequately answered by repeating the previous, unsatisfactory, answer. Then, I asked her, “Ma’am? In which corner of the resuscitation room were you standing? I work there, I know everybody-EVERYBODY!- who works there, and I do not recall you standing there, taking notes on the non emergency nature of my child’s acute respiratory distress.”
“Oh, I wasn’t there!”
“Then, how did you determine that my child, in respiratory distress, was not emergent? The leading etiology of cardiac arrest in the pediatric population is respiratory distress, and my child was in respiratory distress, wheezing, tachypneic, tachycardic. Being just older than a toddler, she does not have much in the way of respiratory reserves, and that which she did have, was being expended rapidly. Please, explain that to me, and show your work!”
After a spell of stuttering, she told me that the charting did not support the insurance company’s criteria for an emergency, and I would have to have further conversations with the hospital.
I did so. I walked my happy ass into the billing department, and asked about my daughter’s bill.
The charming soul I spoke with told me that “It wasn’t an emergency, the insurance company would not pay for it, so the entire bill was my responsibility!”
I told her, “Uh, no. My child was an emergency. She was in respiratory distress, wheezing at a rate of 40 times a minute, and tachycardic at a rate of 160 a minute. The leading etiology of cardiac arrest in the pediatric population is respiratory distress, and my child was in respiratory distress, wheezing, tachypneic, tachycardic. Being just older than a toddler, she does not have much in the way of respiratory reserves, and that which she did have, was being expended rapidly. So, I will pay the co-pay, and the deductible, for which I am liable, but you can collect the rest of the bill from the insurance company, which owes you that money, not me.”
She puffed up. “Well, if you do not pay that bill, we will have to send you to collections!”
She saw all of my teeth, in the grin that was my response. “Ma’am, if you do that, you will libel me, and slander me, and impugn my character and reputation. You will get the opportunity to explain yourself, under oath, at trial, when I sue for damages occasioned by the torts I just enumerated that you will have performed.”
She puffed up, more. “You can’t sue me!”
I chuckled. “Ma’am, I can sue you for damages because you are ugly, and your ugliness causes me harm. Count on it. If you send me to collections, I will sue you, personally, and do everything I can to impoverish you. After I am done with you, I will sue your supervisor, personally, for failing to supervise you, and allowing you to perpetrate these offenses. Once I am done with her, I’ll sue HER supervisor, personally, and so on up the chain of command, until I’ve sued every son of a bitch here, and then I’ll go after the hospital as a corporation, and individual members of the board of directors, for breaching their duty to ensure that the hospital is not run in a fraudulent manner, which your plan is. Fraudulent, that is.”
She huffed, and puffed for a while, and then deliver what she evidently thought was her clincher. “You cannot sue me! You simply cannot!”
More wolf grin on my part. “Oh, really? Is that what your attorney told you?”
“I do not have an attorney!”
I smiled, a smile that in no way reached my eyes. “Really? You know, I will fix that. I’m pretty sure that, once you get served by my attorney, you will find an attorney of your own, right damned quick!”
She gaped at me for a moment. “You know, you are an asshole!”
“Yep! Sure am! For most folks I try very hard to conceal the fact that I am an asshole. For you, and everybody working at this shithole hospital, well, I will make an exception! I’ll be in touch! Have a nice day!”
So time passed, Annie and our children moved a couple of times (she is part Gypsy).
A couple of years later, around the middle of December, I received an Explanation of Benefits from the insurance company. I found this odd, since I hadn’t been insured by this company for a couple of years. It appeared that they had paid a claim for emergency services at Erewhon Memorial Hospital, the very claim that I had shown my ass to the billing department about.
It was as if it was our own little Christmas Miracle!