A Letter to the UMMC

This isn't an ordinary MC post, but I couldn't resist sharing it out of vanity.

This past April I was obliged to visit the emergency room. A month later, I received a bill for somewhat less than $700; naturally, since I haven't yet taken up hustling, I applied for financial aid. I have since received a letter in reply, and penned a reply in turn, which I haven't yet decided whether I will actually send.

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To the financial offices of the University of Maryland Medical Center:

I filled out an application for financial assistance on account of the $675.07 bill I received for my emergency room visit back in April. Today, I received a letter saying ‘Insufficient documentation—get real and try again,’ or words to that effect. While admitting that more time to either amass the sum or get it reduced is very welcome to me, since the aforesaid bill is nearly as much as I make in a month, I pray you will indulge me in a review of the process to date.

First, with respect to the billing itself. The engagingly mysterious summary of costs includes the items ‘Laboratory,’ ‘ER/EMTALA,’ ‘ER/Beyond EMTALA,’ and ‘Pharmacy.’ I gather that the first of these charges indicates the two blood tests and one urine test, all inconclusive, that were done on the night of the 24th; but, since those tests cost approximately $12 apiece (including the cost of the work itself and a profit margin of about a fifth for the hospital), I am intrigued—not to say disconcerted—that they sum up at $478.89.

Having, to a very limited extent, familiarized myself with EMTALA, ie. the Emergency Medical Treatment and Labor Act, I remain mildly uncertain about its presence on my bill. I can only assume that ‘EMTALA’ and ‘Beyond EMTALA’ are cryptic allusions to the two saline drips that I received, couched no doubt in the language of medical ritual. This, however, again results in a puzzle, since a saline drip costs something like a dollar, whereas the EMTALA-related charges come out to $1,371.39, which strikes me as rather a lavish (not to say intemperate) expense for a bag of water, even when divided in half in justice to the fact that there were two; although, if the UMMC is experiencing difficulty in acquiring water, I would be happy to donate almost any amount of it from my own home, since I receive it gratis through the taps.

Of the semi-anonymous billing under ‘Pharmacy,’ it may well be for all I know that the medicine to treat a patient for four hours costs $69.05. Given the previous items, I must confess to skepticism on that point; but perhaps I am only cynical.

How I digress. In any case, taking together the tests, the two (2) bags of water, the medicines, and the payment of the salaried professionals who in fact cared for me, I am finding it difficult to make the cost of service come out to more than about $300 at the absolute outside; and while I am perfectly happy to pay $300 to be well, I would venture to point out that the bill before the insurance contribution came out to $1,919.33—an arresting sum for most persons to consider even before choosing to be sick—and that the insurance company obligingly sent UMMC $1,244.26, thus apparently recouping your actual expenses, vis à vis materials and work, four times over with room to spare.

I understand, from the most elementary reading on the subject, that the standard practice of hospitals is to bill not so much for services actually rendered, as for whatever figure can be put to paper without provoking laughter, on the grounds that this must be the starting point for any discussion with insurance companies (who evidently do not mind provoking laughter). That of course is not my business in itself; but it does seem a little squalid and ridiculous to make it my business when the insurance company stops coughing up, given that the vast majority of these values are produced only for haggling and are, accordingly, entirely imaginary.

Nevertheless, perhaps you need $675.07 on some other grounds, and are too shy to say so; a beloved cat, doubtless, is suffering from ennui, and requires intensive aromatherapy and stress counseling. Let us, then, turn to the application you have provided for financial assistance.

My mother is far more devoted to mystery novels than I, but I dare say I derived as much pleasure from the obscurities of this document as she does from a delicious murder. Beginning at the beginning, as the custom is, the instructions say: ‘Return this application with the following required documentation: Income (including all of the following documents you currently receive): Copy of last 2 pay stubs or copy of W-2 form for most recent tax year. … If you are unable to supply any of the required documents above, please complete Form FAF 116 attached.’

Now, I hasten to admit in simple truthfulness that it was my own carelessness that destroyed my copy of my most recent W-2. Further, I do not ordinarily receive pay stubs, my paychecks being routed to my account via direct deposit. Accordingly, since the instructions directed those who lacked these documents to fill out FAF 116, I ventured to fill out FAF 116, on the grounds that I lacked those documents. Judging from the underlinings and highlightings of the letter that I received in reply to my application, this was the wrong thing to do. I trust you will not take a piece of stylistic advice amiss? If your intention was to require these documents from anyone who is employed, it would be as well to say so. The literal-minded like myself are apt to assume that, if they do not possess some document X, and are told to fill out form Y in consequence, they will not then be met with a reply that they failed to send document X—since their intimate knowledge of this fact was the reason for their earlier decision to fill out and mail form Y. But if applications for financial aid (when made by the employed) will certainly be refused when made without document X, it would again be as well to say so, and thus to save much paper, ink, and aspirin.

Turning to the aforesaid Form FAF 116, how wonderful is life! But that aside: FAF 116 requests only the patient’s signature; the letter I received in reply to my application requests ‘a letter of explanation of your housing situation, stating the amount paid each month, to whom, and have all parties sign as verification.’ Here again, the inveterate habit of the student of the Classics prompts a teacherly thought in me: surely it would be as well to require this at the beginning of the process, rather than while it is underway? It would admittedly be curious (even a kind of solecism) not to request such information and attestation at all, but I can testify from experience that life displays many curious tendencies, and as a rather scrupulous person I usually do not hand out personal information (my own or others’) when it has not been asked for.

Nevertheless, in response to that query which has now been made plain, this: I make somewhat more than $14k per year. I live in a house attached to my parish church, along with a few other impoverished parishioners. In an act of great generosity, my parish charges me very little in rent (while I provide board on my own initiative). My monthly rent consists in $100 cash, plus five hours of manual labor, principally janitorial, per week; ergo, about twenty hours or so per month (reaching an estimated $200 in labor); hence my estimate of $300 per month. Fr Albert Scharbach as head of the parish is my de facto landlord, while Michael Byrd, the church’s sexton and general factotum, usually receives and deposits the payment. You may find their signatures below as requested.

The letter’s final highlighted portion, seeking a proof of additional income, was in its way a welcome moment of levity. I do have one: namely, sponsorship on my blog, which comes out to a little more than $5o extra per month. Thus, even if you should elect to ruin me financially in pursuit of your ostensible $675.07, representing $1,619.26 of fees that remain sacrally veiled from the debtor, you need not trouble your consciences, since I will be able to sustain myself with a bag of water every day of the month and, two days out of three, a nutritious nut bar.

Wishing you a pleasant summer, I beg to remain

Your obedient servant,

Gabriel Ian Matthew Blanchard