Over a decade ago my husband begged me to work in his medical office for a year to help straighten out the past due accounts. The past due accounts were in shambles. Patients were angry, the insurance companies were denying payment on old accounts and the both business partners were getting nervous about the potential losses.
The other physician and the office manager Sherri double-teamed me when I stopped in to the office to get Hubby’s signature on the back of his check for deposit. Sherri asked, “What would it take for you to come work here for just a year to straighten out the accounts while we hunt for a replacement collections specialist?”
I told them that I would have to think about it because the weird dynamics of working with my spouse would cause friction. I had to consider the salary and conditions that would make the situation tolerable for all of us. The last time I worked in the office was as a consultant when they switched from manual bookkeeping and billing to a computerized system. Then, the ladies in billing and accounting kept dropping hints to me that the office really really needed a new facsimile machine and a new copier and would I please pass the word along, maybe whisper it in Hubby’s ear while he’s asleep?
The office manager knew both the business of running a small business and the way to coach the best out of employees so that they worked happily and efficiently alone and in teams. So when she asked me to work for the office I knew she was prepared for the odd dynamics of having the boss’s wife around.
It took me a few days to wrap my future plans around the idea of spending almost every waking and sleeping moment with my spouse. I love my husband but just as absence makes the heart grow fonder, full-time, non-stop twenty-four hour daily togetherness practically guaranteed conflict. I would be subservient in his domain.
I would have to treat him as a boss and not as a lover and husband and father of our child. No hugging, kissing, flirting, or expecting him to open doors. At the office I would have to address him as Doctor Fisher as if we were barely friends. The situation demanded that I become and behave as just another employee. On the totem pole of authority, Hubby and his partner were the top, Sherri supported the top, beneath Sherri came the rest of the employees. In order to avoid even the appearance of favoritism from anyone I would be that part of the totem pole beneath the ground.
In my previous experience working at the office as an outside consultant I had the luxury of treating the business owners and the office manager as equals. We each had our area of expertise and mine was in creating the perfect fusion of computers and processes to maximize profit and minimize overhead. Sherri was the subject matter expert in operating the medical clinic from greeting patients to sending accounts to an outside collection agency. She understood basic business law. She knew business practices and standards. She knew medical billing and file management and equipment repairs and purchases and all the daily bits and pieces that make the whole shebang run smoothly. The other business partner recognized that I did not want to spend eight hours a day in a windowless cubicle chasing numbers around on a page.
I presented my offer with a high hourly rate for the position. I did not need benefits like retirement and health care insurance because I was already in Hubby’s health care plan as a dependent and I had my own retirement account as an independent contractor. In addition to the rate, I wanted a bonus at the end of the year equivalent to the tuition and expenses needed for me to attend the ten-day Writer’s Retreat and Workshop in Maui, Hawaii. I submitted the brochure with my proposal and left the office so the two business partners and the office manager could discuss whether or not it was worth this amount to bring me in for a year. I included the Maui trip as incentive to face cubicle walls day after sunless day. I am a lover of words, not numbers. I can handle working with numbers, but it isn’t pleasant or soul-satisfying for me.
Hubby came home that night and told me that the company had agreed to all my terms. Gulp. I had asked for such a high hourly rate that it amazed me that they accepted it. This told me two things. The first thing it told me was that they believed and trusted that I was up to the task of straightening up a huge stack of past due accounts. The second thing it told me was that they had waited so long that the problem was snowballing on them and they feared monstrous write-offs.
Hubby asked if I could start the next day. I agreed. Every day meant more accounts were passing their deadline for refilling, and once passed, the insurance companies had no obligation to pay or even to negotiate.
I borrowed a pair of scrubs to comply with the employee dress code (that as a contractor I had helped write). Scrubs felt as comfortable as pajamas with pockets and they went well with sneakers. I soon learned that the combination of loose clothing and junk food would conspire to pack twenty unwanted pounds of blubber on my frame. Parts of me jiggled when I walked that had not jiggled since pregnancy.
The worst part was that when we were at work we talked about work. When we got home at the end of long tediously repetitive work, we talked about work. I wanted to read a book to empty the numbers from my brain. I started dreaming of numbers, account numbers, ICD-9 codes, insurance company codes, referral codes, supply codes and all the various information translated into codes that simplified billing into what would fit on the forms. I researched the accounts and rebilled the past dues that had been rejected for lack of a secondary form or code or proof of a procedure, such as a copy of the dictation or the operative report. I rebilled insurance claims that were on the care of children because the original claim failed to include the name or policy information on the guarantor or parent. I rebilled claims that showed no proof of having been billed.
I argued with insurance companies day after bloody day until I wanted to reach through the phone line to slap a few offensively ignorant clerks who failed to follow their own company policies and the law. The game playing of the insurance companies drove me to drinking. Coca cola all day and wine at night kept me buzzed with caffeine and crashing at night. Sleep happened occasionally but it wasn’t restful because I spent my dreams on the hunt for numbers.
My eyes were sore at the end of the day from staring into computers and struggling to read blurry, poorly photocopied documents and crappy handwriting so it wasn’t fun to read a novel at night. I watched the most vacuous television shows just to crowd numbers out of my consciousness before I went to bed.
After a few months, I had memorized the voice mail menus of Medicare. I knew that Blue Cross Blue Shield’s voice mail purgatory system never ever allowed access to a live human and that rebilling with a letter of explanation only meant that the claim and the letter would be separated at the Blue Cross Blue Shield billing office no matter how many staples were used to secure the two papers.
Sherri taught me how to process insurance checks so I could read them well enough to find underpayments and rebill the claims based on the explanation of benefits form that arrived with the checks. I learned how to handle all the tasks in recovering past due accounts from the various screw ups that caused them to be rejected by their insurance companies.
To my shame, I never learned how to transfer a call on the office’s new telephone system. The problem wasn’t in my brain. I understood the procedure. The problem was that each employee’s phone required a transfer code. To forward a caller to Doctor Fisher I was supposed to press the key labeled TRANSFER and then press the 1 key on the phone because doctor Fisher’s phone was phone number one. Well, days before I arrived at the office to work, the phones had been upgraded.
The codes posted on the cubicle wall over my phone were the OLD codes. Every phone had been issued a new different number and the list of new codes had been typed up and posted in every cubicle but mine. I wasn’t hired to answer the phones, so it was expected that calls would be transferred to me not from me.
Patients expect that one call to an office should be enough to connect them to anyone in the office and that that one call could be transferred to another employee within that same office without an ordeal or a disconnection. So here I was telling people to pay up on their copays and deductibles and when they asked to schedule their next appointment I was accidentally disconnecting them. Not great customer service if you know what I mean.
I became known among the veteran patients as that new kid in collections, the one who could not handle the phone equipment. I was the new kid for twelve miserable months.
In late August, at the end of my one year sentence in the four by four by five foot cubicle, I was released to my own recognizance. Freed at last, amen and amen. I packed my novel manuscript, pens and steno pads with a laptop and printer. There was a little room left for clothes and toiletries. I flew to Hawaii for the second time in my life and this time I was on my own for ten glorious days.
I was so hungry for the world of writing, the world of words and story that I ached for it. It took three connecting flights from Orlando to reach Maui and each served breakfast. I read a book on each flight.
In Maui I shared a cab with man who said he was going to the conference. We struck up conversation. He was one of the instructors for the workshop, he said. He would run the daily workshop for a class of screenwriters and was I a screenwriter? No, I admitted that I had signed up for the fiction workshop class for help on my first novel. I handed him my business card. Under my name was “writer, pilot” and my website listing.
He handed me his card. Jeff Arch. The Jeff Arch who wrote the screenplay for Sleepless In Seattle. He admitted he was very excited to be at the conference as an instructor not just because it was a paid trip to Maui, but because the solitary of life of writing wore him down. He said he gets renewed at conferences, where people speak his language and share his love of the craft of storytelling.
His confession nearly brought me to tears. It was exactly how I felt. That is the reason I chased numbers on a paper for a year, to be with my writing tribe, that peculiar group of people who love words and stories. The retreat and workshops fed my writer’s soul. After ten days among my tribe, the numbers left my head.