Читать книгу The Ocean Inside - Janna McMahan - Страница 12

Emmett had hit his stride, his legs in perfect pace with his heart. The morning sand was hard packed and more responsive than it would be later in the day, after the sun sucked out moisture, and granules crumbled under his steps. He watched his path carefully, always alert to holes where sandcastles were mined. The wind was gentle, and even though he was finishing the seven-mile round-trip from the south end of the island, he had barely broken a sweat. He liked to run on Saturday mornings. He passed friends casting into the ocean. These neighbors usually drove sections of PVC pipe into the beach to hold their rods and reels while they swigged from thermal cups and threw driftwood to their Labs. Occasionally Emmett stopped to check out their coolers of sea bass or pet their dogs, but this morning the beach was empty.

The top of his house came into view ahead. He cut through the dunes on a spongy boardwalk buckled with age and hit the gravel road that ended at home. He ducked under the boom security gate, rounded the crepe myrtles fronting his drive, and sprinted up the two dozen steps to his porch, where he stood panting in front of his wife who was curled up in one of the white rocking chairs sorting mail.

“Hey,” Lauren said without looking up from her task. “Good run?”

He nodded, still catching his breath from his last burst of energy up the stairs. He walked the length of the porch and back, his right knee talking to him. His hands on his hips, he felt his muscles ripple with each exhalation. He had dropped weight the last couple of weeks, as had Lauren. She was looking more like the woman he had married nineteen years ago, her cheekbones becoming more pronounced, her hair growing longer, roots showing through blonde.

Lauren picked through the mail in her lap. She ripped open envelopes, dropping advertisements and solicitations into a sloppy pile at her feet or carefully folding bills into their return envelopes and laying them neatly on the side table. When he had shaken the tension from his legs, Emmett lowered himself into a rocking chair beside her.

She held a slender envelope from Common Good Insurance. Lauren slid the letter opener under the flap, pulled out the contents, and read. Her brow wrinkled and she bit her lower lip.

“Emmett,” she said, handing him the paper. “What does this mean?”

Emmett read.

Dear Mr. Sullivan,

After completing our evaluation of your recent claim number 343345, we regret to inform you there are no benefits payable at the present time for the following reason(s):

Your sickness policy does not provide benefits for preexisting conditions during the first 12 months after the policy’s effective date. Preexisting conditions are diseases or illnesses for which the insured received treatment, advice, or medication within twelve months before the effective date of your policy.

According to our information, your policy was effective 1/15/2008, and your dependent, Ainslie Sullivan, received treatment from Dr. Richard Jessup on 9/9/2007 for stomachache and kidney problems.

We review every claim in a thorough and timely manner because we want our policyholders to receive all the benefits their coverage can provide. You are a valued customer, and we want to ensure you understand your coverage and its benefits.

We hope this letter explains our evaluation of your claim. However, if you believe our understanding of the facts is incorrect, or if you have additional information concerning your claim, please submit information in writing to our office.

The letter was signed The Department of Claims and Customer Affairs, with no particular person taking responsibility for the correspondence.

Emmett read it a second time. He could feel Lauren’s expectant eyes upon him.

“Well?” she said when he had lowered the paper.

“They’re denying the claim.”

“Why?” Lauren said.

Emmett shifted uncomfortably in the rocker. “I think they’re saying the problem is the office had just switched to Common Good Insurance and we knew Ainslie had cancer before we took the policy so they don’t have to pay. I think it’s called a preexisting condition. We’d had another insurance carrier for five years before that and we could have kept that active policy had we known.”

“Why’d you switch?”

“Cost. I thought we needed to switch carriers. Get something more affordable. We’d had Common Good for two months when Ainslie got sick.”

“Is there a waiting period you didn’t know about?”

“According to the insurance broker we used, the minute we wrote the first check and put it in his hand we were covered.”

“But obviously within parameters. Parameters that are no doubt in the fine print of the contract.”

“I guess.”

“Oh, so we knew she had cancer, but we waited two months before we got her treatment so we could rip them off?”

“I suppose that’s how they’re approaching it.”

“That logic works against itself. If we were that smart, we would have found a policy without an exception for her illness.”

“All we’ve paid are, well now, five months of premiums, and they’re going to have to pay tens of thousands of dollars or maybe even more. They view it as a huge loss.”

“A loss?” Lauren was suddenly animated. “What do they know about loss? What about losing a child? There’s no bigger loss than that!” Bills blew off the table and scattered around the porch, but she didn’t notice.

Emmett chased the blowing papers and gathered them up. “Look, it’s all going to be okay. I’ll take care of it. They have to pay for her treatment. We paid the premiums. It’s all going to work out.”

“What does the policy say about cancer coverage?” she asked.

“I’m not sure.”

“Why don’t you know? You bought the policy.”

“Look, I trusted the agent.”

“You didn’t even read the policy, did you?”

Emmett didn’t answer. He studied his feet, a wad of errant mail clutched in his fist, trying to formulate an answer that didn’t make him sound like an idiot.

“You’re scaring me. You didn’t, did you?” she asked solemnly.

“No,” he mumbled weakly.

“Why’d you buy this policy?”

“Look, Lauren. My company was being eaten alive with insurance premiums. Shit, how was I supposed to know this was going to happen? I’m no insurance expert. The policies are so long and complicated.”

“Have you read it yet? It’s been three months since this all started. Have you even read the policy yet?”

“No. Have you?”

“You know you’re the one supposed to take care of this. Is her surgery covered? Is chemotherapy covered?”

“Nobody ever reads all of those contracts. Look, when you’re in business you make decisions every day based on hunches. This was a reputable company. I bought a name brand with lots of years in business. They don’t stay in business by having their policyholders die on them, so what was I supposed to expect?”

Lauren’s gaze burned a hole in his heart. “I’ll tell you what I expect. I expect you’ll look out for our well-being. This is Ainslie’s life we’re talking about here. I expect…”

“Stop it.” Emmett held up his hand to her. “I may have made a mistake, but blaming me isn’t going to solve this problem.”

Tears simmered in her eyes. “Okay,” she said. “How do you intend to fix this?”

“Larry. I’ll talk to Larry. He’ll know what we should do.”

Eric Clapton was singing about Layla when Larry came into The Pub. Like most of The Pub’s patrons, Larry was a fixture. Emmett and Larry had their usual spot at the bar where they’d been hanging since they became drinking age. Larry was older by a few years and had been friends with Judd and Rick when they were all young. But after his brothers left the island for places north, Larry and Emmett had continued the routines of island males—fishing and crabbing and cracking oysters with pocketknives. They washed the salty critters down with cans of cheap beer fished from filthy coolers. There were a few years when Larry was gone pursuing a law degree, but he came right back home and slid up onto his bar stool without missing a beat.

But things had changed some. Larry had a little more heft after law school and he had continued to gain weight, Emmett suspected, mostly from drinking. His backside spilled over the bar stool and his jowls drooped over the starched collars of his button downs. He’d been married briefly in law school, but this short marriage was something Larry rarely spoke of. Other than a heavier body and a heavier heart, he seemed like the same old Larry—dependable, sarcastic, sharp as a tack.

Larry glanced at the golf game on the wide-screen above the pool table, then he checked their usual spots at the end of the bar only to find their stools empty. Emmett raised his hand to his friend from a booth in the back. Larry squeezed onto the bench opposite Emmett, his belly grazing the edge of the table.

“Hey,” Emmett said.

“Hey, yourself,” Larry said.

“You been lawyering all day?”

“Nah, been sitting at home listening to that damn police scanner. You wouldn’t believe the crazy fool stuff people do.”

“You still have that thing?”

“Free entertainment. Old habits die hard. Still have it from my defense days when I was always looking for my next customer.”

Emmett snorted and slid the insurance letter across the rough tabletop.

“Here, looks like I’m your next customer.”

Larry fiddled with the salt shaker and tapped a smidge into his beer while he read. Vonda walked a second round of beers over and set them down beside the first without her usual banter, respecting the apparently serious nature of the men’s discussion.

“Shit,” Larry said when Vonda walked away. “Looks like it’s time to start appealing.”

“What’s that entail?” Emmett asked.

“They have a process you go through. You have to write a letter appealing their decision, substantiate why the claim should be paid, it goes to a review committee that will stick by the company’s initial decision. Bunch of crap most people give up on. It’s just one more roadblock a certain percentage of people won’t make it past.”

“How can they stay in business if they treat people this way?”

“Insurance companies stay in business by collecting premiums from people who don’t get sick and by denying claims from people who do,” Larry said. “They deny, deny, deny until they wear you down. They make the policies so complicated and boring most people won’t read them. When you call to find out what’s covered you’re almost always told you don’t have coverage for your particular illness. They exclude things. They make you get everything preapproved. You have to use certain providers. They bounce bills back hoping you’ll pay and not question. You have to stay on top of every single bill. It’s a game. A big-dollar game.”

Emmett considered his friend, the lawyer, master game player. “This isn’t a game. This is my daughter’s life. What do I have to do?”

“We have to go through the proper channels first.”

“And what happens to Ainslie while we’re going through channels? What if she dies while we’re going through channels?”

“It’s not dire, is it? She’s pretty stable, isn’t she?”

“Right now she is. She recovered amazingly fast when they removed her kidney, but the radiation is really harsh. I don’t want to even think about how sick she’s going to be if she has to do chemo.”

“What’s the chances?”

“I don’t know. They haven’t told us anything solid yet. I can hardly keep up with all the medicines and procedures and shit. Lauren’s the one who deals with all that. So, what if she does need chemo or something else? We’re talking tens of thousands of dollars, aren’t we?”

“Maybe hundreds of thousands. How have you paid for everything so far?”

“Most of the bills are outstanding. Everybody’s been cool about waiting on claims approval, but now that everything is denied, all the doctors and the hospital will be getting antsy.”

“Don’t pay for anything yourself yet. We’ll write all your healthcare providers that we’re appealing the denial. We’ll guarantee they’ll be paid, one way or another. It’ll buy us some more time. What kind of money do you have if this takes a while?”

“Savings. Kids’ college funds. I can sell my boat.” Emmett suddenly slammed his fist down on the tabletop. “It’s not right.”

“Lack of medical coverage is one of the main reasons people go bankrupt. Even people who have coverage, if they miss enough work they lose their jobs, then they lose their insurance. You’re not the only family this is hitting hard.”

“My father always said most people were only one major illness away from the poorhouse. I should have been more careful. I should have taken insurance more seriously, but I just always viewed it as another annoying expense.”

“Everybody loves insurance that pays, but when it doesn’t, well, now you know. Look, don’t go down the damn pity path and blame yourself. You can’t let this be about emotion. We’ve got to beat them at their game now.”

“You’re right.”

“Don’t think of me as your friend anymore. I’m your lawyer now. It’s my job to be logical. This is business.”

“Okay.”

“This company doesn’t want to get a bad rap for a child’s death, so we can play that card if we have to. Insurance companies hate bad press.”

“How long will it take to get a response to our appeal?”

“It should say in the handbook.”

“The handbook. More shit I don’t understand.”

“Bring it to me. I’ll read it for you.”

“What do you charge for all this?”

“Don’t worry about my bill right now. I’ll get on the appeal letter first thing Monday morning. But if I were you, I’d look into St. Jude Children’s Hospital. Just in case. You know that hospital in Tennessee? They treat kids who don’t have insurance.”

Emmett watched Larry neatly fold the denial letter into a pocket.

“What do people do who don’t have a friend like you?” he asked.

Larry shrugged his massive shoulders and finally took a sip of beer.

“You don’t want to know.”