The good doctor

When the insurance company turned loose the bill collectors, one obstetrician settled for the price of gratitude.


Caroline Leavitt
December 4, 1997 9:49PM (UTC)

I didn't exactly choose my obstetrician for all the right reasons.
I admit there were some: He was tops in his field, he delivered 99 percent of his
own babies, his office stocked all the latest and greatest in magazines and, best of all, you never got a chance to read them because you never had to
wait more than five minutes. The main reason I chose Roy was because of the
way he had delivered my friend Emma's baby -- with so much genuine awe and
wonder and boundless joy that he had actually exclaimed, "Oh my God, she's
beautiful!" and meant it.

I liked going for checkups with Roy. I was so thrilled at being
pregnant in my 40s that everything delighted me -- the dizzying morning
sickness, the varicose veins, the weight gain if I so much as looked at a
cough drop -- and my elation seemed to fuel Roy's. We were a great
partnership, joking, trading stories, both exulting over my swelling belly. My pregnancy was so blissful and uneventful that it seemed clear to both of
us that if pregnancy was a profession, well, I was really good at it,
and my rapid promotion to motherhood seemed in the bag.

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Until, that is, I gave birth.

My son, Max, was born at 3 in the morning, a routine delivery. My
husband, Jeff, beside me in green scrubs, started quietly to cry as Roy held
Max up. Looking at Max, I felt as if a shining constellation had exploded
within me.

Three days later Max came home. Seven weeks, five operations and two near deaths later, I came home to him.

I had a Factor VIII inhibitor, a blood disease caused by the
pregnancy, a condition so rare there had been only four cases like it before
me. It stops your blood from clotting. With this disease, any movement can
cause instantaneous, fatal hemorrhage. The good news? It goes away. The
trick is to make it through the two or three years that might take.

I didn't see my baby for seven weeks. I couldn't remember seeing Jeff.
I swam in a hallucinatory sea of morphine and anesthesia and the drugs they
gave me to make me forget what was happening to me. When I rose finally from
my delirium, it was Jeff who filled in the details: the five operations that
no one thought I would survive, the nurses praying at my bedside, holding my
hand, whispering incantations into my ear. And it was Jeff who told me that
the most terrifying moment of all, the moment when he began to realize just
how grave things had become, had been when he had come across Roy in the
waiting room, silently weeping, my chart in his hand.

Sometimes, with illness, enduring the cure is more devastating than the
disease itself. It was that way with me. I couldn't move. No opening was
left untubed. There was so much blood taken and given that my veins began to
collapse. Everything caused pain. And worst of all, I couldn't see my
baby. The medicine made me so paranoid that I began to imagine a medical
conspiracy. I was sure the doctors were doing experiments on my son. I trusted no one but Jeff -- and Roy, who came every morning at 10, who
patiently told me Max was fine and I was simply too ill to see him, who
explained everything he knew about my disease over and over, as many times as
I needed to hear it. Sometimes, he did nothing more than sit in a chair and
calmly listen to me abuse him, accusing him of orchestrating the disease, of
keeping my son from me, screaming at him to just not bother to come back
anymore, and then waiting anxiously for his next visit to begin the very
second he left.

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Two months after I had been admitted, I got well enough to go home. I
still couldn't walk. I couldn't lift Max. I had to be careful. My hair
fell out. My face swelled like a new moon. Every week, I had to get blood
levels checked. I had to be examined by surgeons and hematologists and
critical care specialists and Roy too. But I was with my baby. I was with
my husband. And I was getting well.

The big joke about being ill for so long is that just as you begin to
feel better, your medical bills start to arrive, making you sicker than ever
before. I had hundreds of bills. $600,000 for two days. $400,000 for blood. The
sheer shock of the numbers made me giddy and I sent the bills off to my insurance, which paid and paid and paid until the bills topped a million
dollars and then the company began to balk. They questioned procedures. They
refused fees. Dealing with insurance became a full-time job, as I contested
decisions and reapplied for benefits three, four, five times, and each and
every time, they were refused.

I owed several doctors thousands of dollars. I owed the hospital even
more. The collection agencies began to call, their voices hypnotic, lulling
me to get that credit card and pay now. "Wouldn't you like this to be over
and done with?" one man said sweetly. But if the collection agencies were
the good cops, the billing department was the bad one, and their calls and
letters were nasty and threatening. "We can't wait much longer," they told
me. "We'll have to take action." They never said exactly what action they
planned to take, but I had visions of our having to sell our house and move
to a trailer park. I'd have to get a job flipping burgers, serving fries,
cleaning washrooms, never mind the layers of gauze about my stomach wounds or
my halting, stumbling walk.

I didn't know what to do. I contacted every doctor I owed money to and
explained that I was battling my insurance company, to hold tight and money
would be forthcoming. Sometimes, when I felt most desperate, I paid a little
bit to the doctors myself, in a kind of ragged act of good faith. The
doctors were pretty nice. One of my surgeons even wrote me a personal
letter, saying what a shame it was that I had these problems with insurance
and that he was sure it would be worked out.

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I owed Roy more than $10,000. My insurance refused to pay because I had been precertified only for a normal delivery, which included
two or three doctor's hospital visits, not the seven weeks' worth it had
been billed for.

"But it wasn't a normal delivery," I kept insisting.

The health plan was immovable.

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The next time I went in for a checkup with Roy, I apologized so
profusely for my mounting debt to him that I got tongue-tied. "Just give me a little
more time," I begged. "I'm getting it worked out."

He was seated at his desk, tapping my chart with the edge of his pen.
He studied me for a second. "You know," he said finally. "I've been
thinking. You should be recovering a bit faster than you are."

"I should?" I said.

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He nodded. "And I bet I know what's the culprit."

"Bad blood counts," I said glumly.

He shook his head. "Medical bills," he said finally. "Not very
conducive to a quick recovery." He doodled something. "So here's what I'm
going to do." I was sure he was figuring out a pay plan, a schedule I could
follow without too much trouble. Two years to pay. Ten years. Thank you, I
thought. Thank you.

He lifted his pen. I looked at his pad, where he had scribbled a series
of circles. "I've been paid enough. As far as I'm concerned you don't have
to ever worry about paying me anything more." He grinned. "Ever."

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I thought he was kidding, just being kind. I laughed. But when I left
his office and went to the desk to pay for my visit, his nurse was on the
phone. She held up one finger and then when she got off, she shook her head
at me and pushed my check away. "He says your dues are paid," she said, and
winked at me. "Now go on home to your son."

I stood there for a moment, confused.

She waved her hand gaily. "Get," she said.

It's a year later and I'm almost well. Medical bills still slap
through our mail slot, but none of them are ever from Roy's office. I still
try to pay him, harassing the insurance company, sending Roy what I can, but
every time I do, my check gets sent back to me and then Roy or his nurse
calls me and reminds me cheerfully that I am paid in full, that my guilt is
misplaced and my money unnecessary.

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And so I send Roy other things. Chocolates on holidays. Funny notes
with photos of my son. Invitations to every family event. He never
responds. He never attends any event. But I'm not surprised or even the
least offended because, really, isn't that just like family?


Caroline Leavitt

Caroline Leavitt is the New York Times Bestselling author of "Pictures of You," "Cruel Beautiful World" and more. Her new book "With or Without You" will be published by Algonquin in Spring/Summer 2020. She can be reached at www.carolineleavitt.com.

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