The following is based on a true story with an ending yet to occur. Suspense builds as the story unfolds towards its inevitable ending that’s sure to come. It is a struggle between right and wrong, greed and compassion, power and the powerless, David vs Goliath.
THE STAGE IS SET
(Dale Evans softly singing “Home On The Range” in the background)
Two non-profit hospital systems compete for business at a place in Texas you can’t get to from here. There are no other choices but these two. One is a county owned hospital and the other is part of a national chain. Collectively they enjoy an all-inclusive stranglehold over health care in the area.
Both hospitals employ doctors beholden to their puppet master. There are few independent doctors left in town anymore. When a patient sees their primary care physician they are effectively held hostage for all upstream care controlled by their doctor’s slave master. These physician slaves are expected to meet “sales quota” and are often pressured to refer more patients to the Mother Ship.
ACT 1
(Emily enters the classroom and spots a Gift Apple on her desk, she has a worried look on her face. She seems nervous)
Emily is not her real name. She is a young married mother of two, a devoted school teacher loved by all. Her students adore her. Pay is not something to write home about but fortunately her husband works too and together they manage to make ends meet.
Emily has been a cancer survivor, conquering the disease years ago…….until now. She’s just learned it’s back and surgery is needed to stem it’s progression towards death.
Emily keeps a brave face. Her students have no clue of the stress she is undergoing yet they sense something different about her. Her mind is not in the classroom. She has an appointment at the hospital after work.
ACT 2
(Hospital setting – Emily sitting across desk from an intake clerk with an attitude)
Emily is distraught. She wants to live. She beat the disease once before. She is ready to go to the mat again, and win again, by whatever means modern medicine can provide. She has hope. There is no price money can’t buy. She has insurance. Surely the hospital will take it.
But Emily has insurance that neither hospital accepts. Her insurance is a Reference Based plan paying providers much more than both hospitals and their slave doctors earn from Medicare or Medicaid patients. But that doesn’t matter.
“We won’t accept your insurance Emily. We don’t have a contract with your insurance company. We consider you a cash paying patient!” snaps the snarling and cold hospital intake clerk, nurse Ratchet’s twin sister.
Emily is in a fog. She is stunned. Hope fades. Death looms in her mind. She cries.
What Emily didn’t hear was the truth. She was just told the hospital wants a lot more money than they eagerly accept from other patients seeking care there. all day and every day. Little does she know they want five times more than they accept from other patients in the community. The Big Squeeze is in play.
Emily is mad. She is not mad at the hospital. She is mad at the insurance company. She is mad at the system.
ACT 3
In a fog of confusion Emily agrees on a surgical date of November 28, 2024 and prepares to meet for a pre-op appointment. At the same time she appeals to her insurance company for help. “They call me a cash pay patient. I don’t have that kind of cash! They won’t take my insurance! she screams into the phone. “What good is this insurance!”
ACT 4
Emily’s insurance company goes to work. An outreach is made to the hospital. It takes more than one phone call to get to a person of suspected authority. Finally after several days of calling a voice is heard on the other end of the phone tree interrupting soothing elevator music. A dialog begins. “Yes, can I help you? yawns an impatient accented voice on the other end of the line.
“Hi, we represent Emily and it is our understanding you consider her cash pay. She is prepared to pay cash and we will facilitate that for her if we can agree on a price” says the insurance company’s experienced patient advocate.
“I’ll have to get back to you, I don’t have authority to help you. I have to take this to committee” The Voice bellows.
After several days of back and forth, the hospital offers a 20% discount off billed charges in return for cash payment prior to surgery. “That’s our best offer. Emily can always find another doctor and hospital that will accept her insurance, that’s her decision! Otherwise she can write us a deposit check for $40,000 and we will be happy to help her in her time of need!”
ACT 5
Emily’s employer knows the hospital offer is bullshit, the equivalent of +500% of Medicare. Stop loss insurance will not cover any claim based on such an egregious markup over cost. The employer doesn’t know what to do and reaches out to us for advice.
ACT 6
“Which hospital is involved here? we asked. “Did the TPA offer any solutions? Has anyone asked about whether Emily qualifies for hospital financial assistance? Did the hospital bring that up as a potential option when speaking with Emily?
“It’s the county owned hospital. And no, no one including the hospital ever brought up any mention of financial assistance” says Emily’s employer.
ACT 7 (Enter Mr. “Take No Prisoners” G. R. Rumble, Attorney at Law. Perry Mason theme music in the background)
“Based on what you’ve told me, and I will need more facts, and without knowing details of this particular hospital’s financial assistance policy this may have legs. From what you have told me they have already broken the law! They could lose their non-profit status over this! I’ll take the case! Let’s roll!
TO BE CONTINUED……………
Will Emily qualify for financial assistance? If she doesn’t what is she to do? Will her employer roll over and open their checkbook? Will she go home and wait to die? Will the local media play a role by printing a story about the evil greedy non-profit hospital system telling a school teacher to go away, go home and die? Will Emily board a plane to parts unknown to received needed care in a more accepting, loving hospital setting?
Stay tuned…………………….
