For my Models Monday post last week I wrote about the strategies I have been developing in response to what I consider the bullying practices of the business side of medicine. You might recall the resentment I described feeling when a clerk from the hospital where I was scheduled for an MRI called on Friday to pre-register me for an appointment the following Tuesday and told me about the $479 debt that I would have after having the test. The clerk then pushed me towards answering how I would accept “responsibility” for this anticipated bill. My understanding of the fact that this was a business practice led me to seek out another practice whose policies regarding billing were more flexible and better served me. Yesterday, I went to the appointment for the MRI at the place where I arranged to have it. Do you know how much I paid upfront? N-O-T-H-I-N-G. NOTHING. Not a single dime! I went from being told that I had a “responsibility” to pay $479 by one practice to having it all covered by the insurance company at another.

As I have continued thinking about this, I have decided that all manner of unlikely things benefitted me but they all begin with having “other models” for engaging in and with the world. In my case, not having $479 to spend on an MRI on June 26 was one of the chief motivators in deciding that I needed to go elsewhere, but I never told anyone this because I understood that information was largely what this battle was over. The clerk wanted to know how I would take “responsibility,” she never asked if I had the money. The bullying side of this works because it assumes that you are vulnerable because of the anxiety of illness and you will do anything to get the money to pay to discover the cause of your medical condition. Thus, if I didn’t have the money, I would do anything to get it and I would have told her as much. Too, people are supposed to be ashamed of not having enough money or not being able to pay their debts so it empowers someone else to tell you what to do and how to act. So I didn’t give away any information about myself and what I had; instead, I used what the clerk gave me–a number, the value she seemed to think important,   $479. What that clerk told me was that the hospital wanted $479 and they thought that they could get it from me and they were willing to make me think I owed it to them in order to get it. At that point, it didn’t quite matter if the money was sitting in my account because it was all hypothetical anyway–remember, no tests had been performed so there was no actual bill. So since this was all hypothetical, I decided to imagine that I did have the money on hand. Once I did so, I decided that it was precious, that it was mine, and that I got to decide whether, how, and when it would be exchanged. Imagining that I had that money empowered me to act on my own behalf towards where it would go and how it should be paid out. What was interesting, though, was that once I did that the general response to me was one of anger and frustration.

The clerk at my doctor’s office was unhappy with my decision to alter the original plans that had been established for the MRI. She learned of the change after the new place called asking for Orders. The doctor’s office then called me to ask what had happened. The clerk was clearly angry with me. She told me that $479 was probably my deductible and so that is what I owed. It most likely was, I told her, but I decided that I should have some measure of control over how I pay it, I explained. Given that the first place was inflexible over their billing policy, I continued, I sought out a place that had a more flexible one. The clerk wasn’t too impressed by my rationale. What mattered most to her, it seemed, was that my decision meant that the doctor would have to revise my Orders. She told me this twice. I think she expected me to apologize. Though I think I have very good manners, I decided not to apologize as a matter of principle. No one felt that I deserved an apology as they negotiated my debt and constructed a vision of my moral order. Too, I felt, once again, that I was being bullied. At the same time, I did consider the possibility that what I had done might have been unfair to the clerk at my doctor’s office because it ended up increasing her workload. I thought about my responsibility to her and whether or not I owed her an apology for making her work overtime when she might already be receiving inadequate wages. Given my refusal to apologize when she was clearly trying to make me, I also wondered whether or not I was using a flawed business model in determining my own model for responding and this limiting how I might live in the world? These are very valuable concerns and by way of answering them, I have decided that while “I’m sorry” is the phrase that much of my concern turns on, “thank you” will be the one that I go with. To that end, I don’t plan on mentioning any of this when I visit my doctor on Friday but if he mentions it to me or if the clerk does, I will say, “thank you so much for revising those Orders because it paid off for me.”

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