I owe Akilah a big thank-you for helping with the medical billing stuff. I miss my simple Kaiser HMO. Her expertise is greatly appreciated both here and when I get a dumb explanation of benefits I don’t understand (which is always).

“I don’t understand, though, it’s not like I had a choice about the ambulance service that showed up,” said the man on the phone, frustration evident in his voice. “How am I expected to be on the hook for this? I pay my insurance premiums to you people every month…”
“I hear you, sir,” I said. “The issue here is that the ambulance company charges whatever they want to charge. We pay what’s known as the usual and customary reasonable amount. That’s a cost determined to be what most companies would charge for ambulance transport.”
“Five hundred bucks,” he interrupted.
“In this case,” I said, “Yes, that’s the usual and customary amount.”
“So, what? Was the ambulance made by Rolls Royce? Because otherwise how can they justify charging an order of magnitude more than your usual customary amount? It was…” papers rustle, “$6718.20… minus a paltry $500 and I’m left with an angry bill from this limousine of an ambulance company owing $6218.20.”
“I see here that you already filed an appeal,” I started.
“Which was denied! The last person I talked to said all I had to do was appeal and this would take care of itself. Well, it hasn’t!” he yelled.
“Sir, can you please lower your voice. I need you to calm down if you want to–”
“Calm down?!” He yelled. “My wife of fifty years died two weeks ago and you want me to…” his voice cracked and his volume dropped by half as he tried to continue, “you want me to…” He went silent for a long moment.
“Sir,” I said after a bit without hearing anything. “Are you okay?”
I heard him sobbing quietly.
I let him cry and get himself together on his own time.
Finally, he said, “I’m sorry. This isn’t… this isn’t what I do. This is what Margaret did. Even after she got sick she insisted on making me breakfast. I tried to make breakfast for her but she said, ‘James you’re amazing with computers – always have been – but you can’t make a sunny side egg properly to save your life.’” He sniffled and took a moment. “With her black and white checkered apron with ruffles – the one Susie, our littlest – made for her when she took a sewing class. She’d still have it on and she’d sit right there,” I could practically hear him pointing across the kitchen table, “and she’d go over the budget or she’d call you folks and have it out with you about some charge y’all screwed up.” He laughed, “She had the patience of Job because, I don’t know, it always seemed like she’d out argue you guys. She should be here dealing with this. There wouldn’t be any question. She should be here. She should…” a sob escaped, “She should be here…” He broke down again.
“I’m really sorry for your loss,” I said truly meaning it. “Look, we can file a second appeal…”
“Is that going to do anything?” He said. The hope had gone out of his voice.
“I think so,” I hedged. “You should get some additional information that you didn’t have for your first appeal.”
“Like what?”
“Her doctor told you to call the ambulance, right?”
“Yes,” he said and the tone of that affirmation carried all the dread of the moment he had to call 911 and already knew his wife wasn’t coming back.
“Call their office and get a letter indicating they had you get an ambulance. It’s standard procedure, so it shouldn’t be an issue.”
“And then?”
“The form is online…”
“Another form…”
“I’m afraid so.”
“But I’ve already filled out the first appeal, isn’t that good enough?”
“I wish it were, but you need to…” I stopped because I felt a freezing cold sensation behind my left shoulder. I turned and standing behind me was an elderly woman wearing a black and white checkered apron with ruffles. I could see she was slightly translucent. Her eyes met mine and she gave her head a little shake. “Uh…” I stammered without breaking eye contact, “You know… I think I can use the information in the form and fill in the second appeal,” Margaret smiled. “Can you contact your doctor and get that letter?”
“Yeah, what time is it? One thirty… Okay, I’ll call right now.”
“Great,” I said. “Once you get that, can you scan and email it to me?”
“Yeah, I can. What then?”
Margaret’s smile faded and she arched an eyebrow at me.
“I’ll… I’ll put that with the second appeal form and… I’ll make sure it gets approved.”
“You’ll… what?”
“I’ll walk it through myself and make sure it gets approved.”
“You would do that?”
“Yes, I will.”
Margaret smiled broadly.