Saturday, October 10, 2015

Counting with George (Non-Fiction Fantasy)

Not the hospital I visited. VAH at Salem, MA.
This happened. It happened to me, and happens to others too often.

“You’re going to need a pre-op x-ray/MRI,” Dr. Man said, releasing my knee. For an old guy who specialized in joints, he handled mine brutally. I instinctively clutched the knee, which throbbed more from his two-minute examination than in the three weeks since it my fall.

“Pre-op?” I asked. I did not like the sound of that. It sounded like an ‘op’ was inevitable. I couldn’t afford any ops right now.

“Yeah,” he said. He took up a pad and scrawled something out, not looking at me. Apparently there was nothing more to tell me.

It’s difficult for me to ask people questions when they clearly don’t want to talk– I feel guilty for desiring the information. Only as he looked at the door did I squeeze out,

   1. “Do you know how much this is going to cost?”

He asked, “The MRI or the surgery?”

“Either. Both. I’m uninsured.”

“Oh.” He looked at me like I’d farted. “No, I don’t know. It’ll be bad. You can talk to billing.”

I swear to God, those were exact words. Then he looked at his nurse, a plump woman in pink scrubs and beaded hair.

   2. “You don’t know, do you?” Dr. Man asked.

Nurse Woman shook her head. Her lips pressed together like she didn’t want to release a single word. That was odd since she’d chatted with me for ten minutes before Dr. Man arrived, with opinions on immigration (she was from North Africa, and liked immigration), God (also liked), Barack Obama and his government (adored), teachers in American high schools, kids in American colleges, math being for snooty people, and how much she’d like to write essays if essays weren’t horrible.

On the topic of how much knee surgery would cost me, though, she voiced no opinion.

Dr. Man handed me his note, ordered me to get the MRI soon, and left. Nurse Woman handed me my pants and followed the doctor.

I wheeled myself to the checkout counter. Outside Dr. Man’s office was a waiting area with at least three desks at every wall, cramming Blood Work and Urology alongside Orthopedics and Joint Specialists.

As I wrote the check for the office visit, I asked the receptionist,

   3. “The MRI he’s asking me to get. Do you know how much that will be?”

“No. Sorry.” She gave me a toothy smile, like a parent whose child might not realize the band-aid was about to come off. She took my check and wished me a nice day.

A week later, I wheeled into the X-ray center of that same hospital. Two ladies were running three computers behind the counter. I couldn’t see over the counter and so wheeled around the side. The nearer receptionist leaned over to intercept me.

“Can I help you?”

After a brief discussion on how they had X-ray machines here but not MRI machines, and that I needed to go to the basement to get an MRI, and yes I could schedule both an X-ray and MRI from here, but no you didn’t get an X-ray up here if you wanted an MRI, I asked,

   4. “Do you know how much this will be? I’m uninsured and have to know I’ll be able to cover this before I do it.”

The nearer receptionist hissed and arched her back like someone was pulling a band-aid off her spine. Lack of insurance can bring band-aids to mind with uncommon frequency.

   5. “Ross, do you know how much an MRI would be?” she asked her co-receptionist, who was female, plump, decorated in jewelry and altogether unRosslike.

Ross offered, “No, but you could call Nel."

“One second,” said my receptionist. “I’m going to call downstairs to MRI.”

She dialed some numbers and got somebody. It went swiftly.

“Oh, I can’t schedule one through you?” the X-ray receptionist said to an MRI receptionist. She nodded for my benefit, power-talking through the call. “Okay. Okay. Yes, I know. I have a patient who needs an MRI and x-ray, and…”

   6. “…do you how much that is? No? Okay, thank you. Is Nel in? Yes, I just want to check with her.”

And a moment later, she asked a new person over the same phone,

   7. “…and he’d just like to know how much the MRI could be. Oh? Okay. Thanks Nel.”

She hung up, said, “Sorry,” at my general direction, and dialed another number. I just assumed she’d thought of another task that needed doing.

“Hi, is this Billing? Hi, this is George from X-rays,” she said, except she didn't call herself George. You'll know why in a minute. “I have a patient who needs an MRI and X-ray for his left knee. Yes, no, I just called down there. Okay? But before he schedules, he’d like to know…”

   8. “…how much it would cost? Sure. No, they didn’t know either. Thanks!”

After a minute on her computer, George turned to me with a sincerely warm expression.

“I can make your appointment from here, but I’m going to call Billing first to find out how much it will cost for you, okay?”

“Thank you so much,” I said, grinning. I don’t know how long I had been grinning, but I couldn’t stop. We were calling Billing a second time, and now I couldn't stop ticking off numbers of people in my head.

George punched up someone else on her phone.

“Hello, Larry? Hi, this is George in X-rays. I have a patient here who needs an MRI of the left knee. … The left knee and…”

   9. “…he’d like to know how much that would cost? Oh, okay. Can you patch me through to her? Okay great.”

She shrugged at me. I shrugged back as encouragingly as possible.

   10. “Hi Moe, this is George in X-rays. I have a patient who needs an MRI of the left knee. He’s uninsured and needs to know how much it will cost. … Dr. Curly would know? Thank you!”

Her brows arched at me with excitement.

As she looked up Dr. Curly’s number on her computer, she asked, “What does the doctor think it is?”

“He said it might be torn cartilage. I can’t walk on it at all.”

“Oh, that sounds painful.”

George dialed.

“Dr. Curly? Hi, this is George in X-rays. I have a patient who will probably be seeing you soon for an MRI. No, an M-R-I. On his left knee. He’s uninsured and we’d like to know…”

    11. “…if you know how much it will cost him? Yeah. Yeah. Dr. Moe might? But he’s on vacation? Okay. Okay, thanks!”

She hung up and looked dower.

    12. “Dr. Moe wouldn’t know. He never knows. Doesn’t like to deal with bills.”

Wait, was he 12? We hadn’t technically talked to him. Was it unfair to count him as 12? Was he even a ‘he,’ considering ‘Doctor’ is gender-neutral?

I decided Dr. Moe would be 12. I fought not to sigh, not wanting to discourage this incredibly helpful receptionist. I said, "That’s fine. I can’t make the appointment without knowing if I can afford it, though. Maybe I can…”

“No, no,” said George, wagging her index finger at me. She had a silver ring on that finger. “I’ve got an idea.”

She dialed once more, looking away gravely, as though this particular person could not be contacted while looking into the eyes of another living person. I imagined she was calling not just down to the basement, but the very bowels of Hell.

“Hello, Satan? Hi, this is George! Yes. How are you?” George and Satan gabbed a minute, then got to,

    13. “So I have a patient up here who needs an MRI of his left knee. Do you know how much it will cost him? Okay, can you think who would? Great. Can you patch me to her?”

George threw a thumbs-up without looking at me. She waited, only dropping her thumbs-up when the line beeped. She held the phone in one hand, grabbing paper from the recycling bin with the other.

    14. “Hello! This is the X-ray Department. We have a patient who needs an MRI and X-ray of his left knee. He has no insurance. Can you tell me how much it’s going to cost? … Uh-huh. No, I wouldn’t.”

She scribbled on the paper.

“Right, with contrast is different than without.”

She continued listening and raised the paper. It read:

w/c 1,398

w/o 1,308

“Okay. Yes. You guys are so overworked. Thanks again!”

George hung up and leaned over her keyboard as though to catch her breath. She pushed the paper at me.

“So there you go. The bottom number is without contrast. She said it would probably be without, so that would save you some money, but don’t tell anyone I said that. I don’t want to get in trouble. If anyone asks, I’m George.”

Yes, if I ever told anyone this story, she would be George. I would probably change all the names just to keep the conspiracy safe. Because that's how screwed up U.S. health care is.

She grinned.

I kept grinning. “Thank you very much, George.”

We shook hands over the paper. She frowned down at it.

“I don’t have that kind of money lying around. Can I make your appointment today, or do you want to wait?”

I frowned at the paper, too. Then I frowned at my knee. “Honestly, it’s been three weeks. I think it’s gotten worse since I saw Dr. Man even though I’m off it all the time. I sort of wanted to know if I could afford the MRI at all, but more I wanted to use it as a guess on how much the operation might be if he wants one. I had my gallbladder out in November and it completely wiped me out.”

“Oh, there’s no way.” George didn’t say whether there was no way an uninsured person could afford such an operation, or no way to find out how much it would cost until it happened. Instead of getting clarification, I made an appointment.

Two weeks after the appointment, the bill finally came. I couldn't help thinking of George and all those numbers as I read the cost: $2,400. Without contrast.

I hope you will agree that this is more than the $1,308 that I already couldn't afford. It was money I didn't have and I was still relieved, because the MRI showed no tears. There would be no telling how much surgery would have cost.


  1. Ack.
    Fortunately here they can tell you. And they will tell you. And our Medibank system means that if you need an MRI you will get one. Paid by the Government. Optional MRIs are a different kettle of fish. An expensive kettle of fish.
    And our Government wants us to go down your pathway with healthcare.
    I hope not. I really, really hope not.

  2. Ugh, that is terrible. I also have no health insurance and definitely met with some annoyance at my doctor about it when dealing with my corneal ulcer, but once she understood my situation, she has been really helpful. The office got me some prescription discount cards, they found the best deal at the pharmacy, and they give me discounts on my appointments. My doctor is also pushing a surgery, but is willing to wait until I can get enrolled in a plan for next year and is just checking in on me until then. I agree that US healthcare is totally messed up, but some doctors are more helpful than others. I'm glad your knee ended up better than you expected. And before you pay that bill, you should check to see if they can give you any kind of private pay discount, because a lot of places will do that. At least around here.

  3. That receptionist was really helpful, but it showed just how confusing it is in hospitals. The new day job I've taken involves getting my hands on medical records, images, billing, etc. for attorneys. The amount I get thrown around to different numbers, because no one knows who I need to speak to about this record or that is insane, and makes me wonder how hospitals continue running. Some of the records have fallen into a black pit, because they change billing and record services and no one knows where the old records are. It's crazy, and has made me think perhaps I should be getting copies of my records every once in awhile to keep on hand. You never know when they'll change services and lose everything.

    Also, I agree with Shell. Maybe they'll give a discount if you're uninsured? I had a physical therapist who did that, as well as a hormone specialist. Is your knee still bad or is it getting better?


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