Hope and Other Luxuries (48 page)

So I had to stop it. It was up to me to make sure it didn't happen.

In the morning, while Joe was eating breakfast, I started dialing the phone. While he got ready for work, I dialed the phone. In between washing my face and brushing my teeth, I dialed the phone. And before changing out of my pajamas, I dialed the phone again.

This time, I got an answer.

First, there was the menu, of course. There is always the menu. And the menu has always changed, of course, so I had to pay attention. Then the customer-service representative came on the line. I answered her questions. I bided my time.

Because I knew: You can't rush this. They have to fill in their blanks. Until they've got their blanks filled in, nothing is going to get done.

Then the representative asked, “And how can I help you?”

Now—the moment was now.

“I don't think you can help me,” I said politely. “I think I'll need to speak to your supervisor.”

Because I knew this, too: as upset as I was over this situation, rudeness wouldn't help. Rudeness just keeps a representative from doing her best work. The representative I was talking to didn't mess up this situation. She only wanted to do a good job.

I already understood what she could do. I knew that what I needed was over her head. But I also knew that she had to realize that as well. She wouldn't transfer me until she knew what
I
knew.

This representative wasn't just a pair of hands and eyes responding (too slowly and clumsily) to commands that would come from my brain. This representative was a living human being with her own skill set and a very tough job to do. I knew from bitter experience, from her side of the desk, that many people who called this woman every day treated her like dirt even when she did everything right. And I knew that if those people didn't like the answer they got, they treated her even worse.

Admiration and sympathy: those were my secret weapons. People help out when they can. Everybody wants to be a hero. Everyone likes being liked.

“Here's the situation,” I told the representative. “My daughter just arrived at an eating disorder treatment center, under residential—that is, twenty-four-hour—care. Yesterday, a psychiatrist on your staff ruled that her care there isn't medically necessary. I need to reach someone who can order that psychiatrist's decision to be reviewed. I need an outside review of my daughter's case.”

“Then you need to speak to the insurance specialist in charge of her case,” the representative said. “Would you like me to give you that name and number?”

“No, I don't need it,” I said. “I got that number yesterday, and I called it yesterday—several times. I didn't get past that person's voicemail, and I'm not going to wait for her to return my call. What's going on now is too important to wait. My daughter's covered care ends this afternoon.”

“I'm sorry,” the representative told me. “You'll have to wait for the specialist to call you back. I'm afraid there's nothing I can do.”

“Yes, there is,” I said, and I said it as warmly as possible, as if this woman were gifted with a secret magical power. “I'll be very grateful if you'll do me the favor of transferring me to your supervisor.”

“Just a moment. May I put you on hold?”

“Of course.”

Silence on the line.

“I'm afraid my supervisor is in a meeting,” the representative said. “Can I put you through to his voicemail?”

“No, thank you,” I replied. “I'll be happy to hold.”

Because, as Dr. Harris had told me years ago: Never let them hang up the phone. As long as you're polite, an insurance company call center employee absolutely
must
not hang up on you. And the longer you stay on the line, the more your call skews their numbers for the day. They care about their numbers. They want to show the company that hired them that they're handling calls in a timely fashion. So, the longer you hold and the higher you go in their chain of supervisors, the more leverage you have to get what you need.

“All right,” she said. “I'm just going to put you on hold, then.”

Silence on the line again.

While I waited, I read over a few of the points I had written down. They were the advantages I had in this situation:

• Elena has had this insurance since birth—long history, know the system.
  
• Mental health claims are handled by a third party agency, hired by the insurance company—high expectations, play one agency off the other.
  
• Our policy comes through the federal government—very, very important client with a lot of clout.
  

All in all, I had a lot of advantages here. I was lucky—except, there's no such thing as luck.

The representative broke in on my thoughts. “Are you still there?” she said.

“Yes, I am.”

“Then please hold while I transfer you.”

We're getting somewhere!
I thought as I waited through the clicks. Then I waited through the rings. Then I heard the line go live and opened my mouth to speak to the supervisor.

“Hello, this is George. I'm afraid I'm helping another customer right now. But if you'll leave your name and member number and the reason for your call . . .”

Now, why didn't I see this one coming?

I hung up the phone. Twenty-five minutes, gone. But—an important lesson learned.

Patiently, I dialed the number again. Patiently, I pressed buttons. Patiently and politely, I danced the dance with a new customer-service representative. Getting angry at this man wouldn't do either of us any good. I needed him to be doing his best work. It wasn't his fault that the system had let me down.

“I'm sorry,” he said eventually. “I'm afraid my supervisor is in a meeting.”

Of course he was. The supervisors are always in a meeting. I don't think it's a lie; they're always in meetings because they're spending their days with customers like me. They're meeting with the customers who need the things the regular representatives can't do for them. They can't meet with all of us at once.

“I'll be more than happy to hold,” I said. And I meant it.

Silence again. Another ten minutes. While I waited, I read over my arguments:

• You're getting between the patient and her treatment team. They're the ones who need to determine her care.
  
• You designated this medical facility as a preferred provider. That means you encouraged us to trust their treatment decisions.
  

“Are you still there?”

“Of course I'm still here,” I answered quickly—because I knew how quickly he would hang up if I didn't.

“Then please hold while I transfer you.”

And have we learned our lesson yet?

“Just a minute,” I said, “before you transfer me. I have your name noted down as James and your employee number as 657. Now, I need to tell you something, James 657. If you transfer me and this call goes to voicemail, I will count that as you hanging up on me, and I will duly record that hang-up, along with your name and employee number, in the complaint I file with the company that has hired
your
company to handle their phone support.”

“Oh!” said James 657. And his tone of voice indicated that he was learning something, too.

“Now,” I said, “if you'd like to check first to make sure there's a live person at the end of that line, I'll be happy to hold while you do that.”

“Oh. Yes, please hold.”

A much
longer
hold this time.

Then James's supervisor came on the line. A live supervisor! This was progress.

It had taken forty-five minutes. But it was progress.

Again, I explained the situation—to Stacy 112 this time. “You're getting between my daughter and the care her medical team recommends,” I concluded. “So I'm going to stay on the line with you until you see to it that her case receives outside review.”

“I can't do that,” Stacy 112 said.

“Then I need to speak to your supervisor.”

“She can't do that, either.”

“Then I'll need to hear her explain that to me herself. And then she can transfer me to
her
supervisor.”

“HIPAA privacy laws forbid me from discussing your daughter's case with you.”

Ah! Well played, Supervisor Stacy 112
.

“I'm not asking you to discuss her case with me,” I replied calmly. “I'm discussing it with
you
, but I'm asking for no information in return. All I need is a guarantee that my daughter's case will receive an outside review. Since that review isn't medical, but insurance-related, telling me about it gives out no HIPAA-protected information. But I need that review, and I'm not going to hang up until I get it. I need a psychiatrist who
doesn't
work for you to decide whether her care team is right in recommending residential treatment.”

“I can't do that. We can't do that.”

“Then please transfer me to your supervisor. We'll see what she's able to do.”

Very slowly, link by link, I worked my way up the chain. One of the supervisors tried to argue with me, but I declined to argue. Another one
kept me on hold for an hour. I plugged the phone charger in, kept the phone to my ear, worked crossword puzzles, and answered promptly and cheerfully each time she broke in to see if I'd given up yet and hung up the phone.

Off and on, Clove House called me on my cell phone. They were working to try to get Elena's care extended, too. They weren't having much luck on their end, but they cheered me on.

“We can put together our best arguments,” their staff member told me, “but nothing can replace the client calling. You're the one who pays their premiums. You're the one who can submit complaints to your employer and persuade your fellow employees to switch to another insurance plan. We don't have that kind of pull.”

“I don't mind doing it,” I said. “It's the least I can do. I have to admit, I get chills at the thought of Elena coming back home.”

“It's extremely important that she stay here,” the staff member said. “It took a lot of courage for your daughter to seek the help she needs. I'll be honest with you. Her physical health is very fragile. Her EKG and blood values are not normal. She could be days away from a heart attack. If she doesn't get this turned around, it's likely that she won't survive another month.”

In a dream, I heard myself thank the woman and say good-bye. My hand shook as I set down the cell phone. So I had been right when I had roamed my dim house and it had seemed that dawn would never come. All my fears were coming true. This
was
a matter of life and death.

In my other ear, a voice broke in on the flowery hold music. “Are you still there?”

“Yes, I'm here.”

“The supervisors are all in a strategic meeting. I don't know when they'll be out. Can I—
please
—have my supervisor call you back?”

“No,” I said. “I'm very sorry, but no. I'll be happy to hold for as long as that meeting lasts.”

“But this is keeping me from doing my work!” she said.

“My daughter
is
your work,” I answered. “My daughter's survival is at stake. I'll hold on your line until this time tomorrow to get my daughter the care she needs.”

One hour melted into another. The day crept slowly by, and still I was sitting on the floor in my pajamas with the phone held up to my ear. “My daughter's heart was damaged the last time her weight was this low,” I told the next supervisor. “Her care team says that her heart rhythm is abnormal. Do you want to be the person whose name and employee number goes down in the letter I submit to Washington, DC, when I tell them that the insurance company they chose for their employees caused my daughter to die?”

“Her case was reviewed,” the woman told me. “You have the name of the specialist in charge. There's nothing I or anybody else can do to change that decision.”

“I don't know about anybody else,” I said. “But I know what you can do. You can transfer me to your supervisor. Please.”

“Well . . . Can you please hold?”

“Yes, I'll be happy to.”

And flowery music played in my ear again.

A woman's voice came on the line. There was nothing new about that. But this voice sounded different. It sounded like it was used to giving orders.

“This is Clare Dunkle,” I began, “calling for patient Elena Dunkle, insurance card number 509 . . .”

“Mrs. Dunkle,” the voice interrupted, not unkindly. “I know who you are.”

The woman proceeded to explain that she was authorizing Elena to stay at Clove House for seven full days, during which time the staff there could collect the data they needed to justify a longer stay. Then the insurance company would okay further residential care from week to week.

“Because your daughter went straight from no care to almost the highest, most expensive level of care,” she said, “that put us in a predicament. No one had put together the paperwork to justify this level of care. No one had said, ‘We tried to treat her with day therapy'—for example—‘and that treatment failed.'”

“That makes sense,” I said. “But we couldn't persuade Elena to seek treatment until she hit bottom. And now that she's hit bottom, there's no time to lose on care that isn't going to work.”

“Yes, I understand,” the woman said. “In fact, it isn't all that unusual with this kind of illness. Now, I'm going to make arrangements to have your daughter's case flagged so that I can keep track of it personally, and we need to get in touch with her facility to give them the authorization codes they need. I have to let you go now, but I promise that someone will call you within half an hour and let you know when our work is completed.”

Hang up? Now? After all this effort?