TITLE: Claimed AUTHOR: Satchie E-MAIL ADDRESS: satchie51@hotmail.com CATEGORY: MT/Humor RATING: PG-13 SUMMARY: After Mulder recovers from near fatal injuries, the *real* torture begins. SPOILERS: hehehehehe FEEDBACK: You betcha! ARCHIVE: Ephemeral and Gossamer. THANKS TO: Obfusc8er for nurturing this warped idea and the totally excellent beta read. Also, thanks for allowing me to pick your brains, and for not screaming in pain when I did! DISCLAIMER: Mulder and Scully belong to Chris Carter, Ten-Thirteen Productions and Fox. I'm merely borrowing them because it's cheaper than therapy. * * * * * Mulder opened his desk drawer and removed the economy-sized bottle of Tums. Shaking two pastel tablets into his hand, he contemplated his current predicament. Last October, a friend from his BSU days invited him to the Big Apple. Rudy was reassigned to the New York office over a year ago to investigate high-tech crime and had already made friends in high places. Usually Mulder wasn't a social creature, but the guy had courtside tickets to a Knicks game! This was an opportunity he couldn't resist. Tourists traditionally purchase souvenirs to commemorate their visit to New York. Some buy miniature replicas of the Statue of Liberty, posters of Broadway musicals, "I Love New York" t-shirts or even Knicks paraphernalia. Being unique, Mulder collected injuries when he traveled, instead. While driving back to LaGuardia Airport, a dense fog had suddenly rolled in. He decreased his rate of speed due to the poor visibility and proceeded cautiously. Unfortunately, not everyone altered their behavior during the hazardous road conditions. An eighteen-wheeler struck his rental car with significant force, causing it to roll over before sliding down an embankment and crashing into a ditch. Mulder woke up in a hospital several days later. Scully was at his side when he regained consciousness. She explained to him that because the car's airbag had failed to deploy, Mulder's body absorbed the brunt of the horrific impact. The steering wheel brutally crushed his chest, causing massive internal bleeding. He coded en route to the hospital, and again in the emergency room. It was a miracle he survived. Mulder sustained an aortic tear, a hemothorax, lacerated liver, spleen and ruptured small intestine. A bone fragment from his broken left arm nicked the radial artery, contributing to his already substantial blood loss. His other injuries included a dislocated hip, broken femur, compression fracture of his lower thoracic spine and, of course, a moderate concussion. During the first twenty-four hours, he underwent two surgeries. When Mulder developed pneumonia and peritonitis, he didn't have the strength to combat the infections. To give his battered body a chance to heal, the doctors placed Mulder in a drug-induced coma until his condition improved. Mercifully, he couldn't recall his harrowing experience. His first coherent memory after the accident was a smiling Scully feeding him ice chips to soothe his dry, sore throat. Oh yeah, then he whined about wanting a certain tube removed. Now fully recovered and back at work, Mulder waged war against his health plan like a modern day Don Quixote tilting at imaginary windmills. His medical claim had been denied five times without explanation, and he was incredibly frazzled. Numerous phone calls to the hospital and claims office were less than productive. He was inundated with past due notices and harassing phone calls from the hospital threatening to turn his account over to a collection agency, as well as letters from the health plan stating his claim could not be paid under the terms of the contract. Mulder was convinced his injuries were far less painful than dealing with these ... morons. Scully frequently volunteered to handle this unpleasant task, but his misplaced guilt prevented him from accepting her gracious offer this time. For crying out loud, he nearly died simply because he went to an out-of-town basketball game. It was so senseless and humiliating. No, he would fight this battle alone. Since Scully was attending to an errand this morning, Mulder decided to try using his FBI credentials to penetrate the claims department labyrinth. Surely *someone* was in charge of this so-called organization. Chewing the citrus-flavored antacid tablets, he spread the impressive collection of documentation across his already cluttered desk, took a deep breath and dialed the customer service number. An hour later he had been transferred to thirteen different people, routed to voice-mail purgatory, disconnected five times and listened to music designed to make anyone acutely psychotic. Finally he was referred to Pat, the claims manager. Not surprisingly, she vigorously defended the health plan's decision. "Sir, you're financially responsible for any charges not covered under the contract." "I don't understand. How could they not be covered?" She stated flatly, "You failed to properly notify Utilization Review." "Utilization Review?" "Yes. You're required to contact UR prior to a hospital admission. The number is printed on the back of your identification card. Once your case has been reviewed, usually within 7-10 business days, an authorization number is assigned for that course of treatment. Payment cannot be issued without an authorization number." "You can't be serious!" he sputtered. "I was in an accident!" "In that case, an authorization number can be issued retroactively if you provide notification within 48 hours of the admission." Several seconds elapsed before Pat continued. "Hmm, according to our records, this wasn't done." "How could I do that? I was in ICU in a drug-induced coma!" The manager icily replied, "Then a family member should have contacted Utilization Review right away." Mulder snapped his pencil in two. "What if I'm a pathetic loser and don't have a family?" "Policy dictates..." Pat's resolve wavered. "Let me transfer you to UR. They might be able to assist you. Please hold." "Great." The all too familiar disco era music resumed, to his considerable dismay. Who made the decision to inflict this torture on already agitated people? Massaging his temples, he cringed as the lyrics of a bygone era assaulted his ears. *Well you can tell by the way I use my walk, I'm a woman's man: no time to talk. Music loud and women warm, I've been kicked around since I was born. And now it's all right. It's OK...* "No, it's *not* okay," Mulder groaned. Searching for a distraction, he grabbed a notepad from the corner of his desk and carefully removed a page along the perforated line. Having folded the paper in half lengthwise, he began to fashion a nose cone, wing and tail design. Soon the plane sat on the runway, ready for takeoff. He cleared the coordinates with the control tower and aimed the craft directly toward the trashcan. Oops. *Houston, we have a problem.* Obviously, the design needed to be more aerodynamic if the projectile was to reach its intended destination. A timid voice interrupted his analysis. "Utilization Review. This is Judy." "Yes, this is Fox Mulder. I just spoke with Pat in the claims department. She said you might be able to assign a retroactive authorization number to my case." "I'm afraid our area only approves hospital stays *prior* to admission. I'll transfer to you another unit." "Oh joy, oh thrill, oh rapture," he muttered. Once again, the annoying music started. *Macho, macho man. I've got to be, a macho man. Macho, macho man...* Wasn't this crap supposed to have disappeared from the face of the earth along with white three-pieced suits, platform shoes, mood rings and pet rocks? The sound of fingernails scraping across a blackboard was rapidly becoming an attractive alternative. Mulder produced another paper airplane, this time opting for the sleeker design of an F-16. With a flick of his wrist, he launched his latest creation accompanied by the stirring Air Force song. *Off we go, into the wild blue yonder, climbing high into the sun.* Gently gliding through the air, the avionic masterpiece barely missed its elusive target. A crash site assessment was in progress when Mulder was granted a reprieve from the musical abomination. "Utilization Review. This is Brenda." "Are you the person who issues mystical and magical retroactive authorization numbers?" he asked warily. "Possibly. How can I help you?" Leaning back in his chair, Mulder recited his tale of woe. "Yes, my name is Fox Mulder. I was hospitalized in October, and my bill still hasn't been paid. I've been informed that's because an authorization number wasn't assigned." "That's right," she cheerily agreed. Exercising great restraint, he responded, "I was in an accident, defined as an unplanned, unforeseen event. Thus, I didn't anticipate the necessity of the Pre-Certification process. Although I understand I had a 48-hour grace period to report my admission to your department, I was unconscious during the allotted time. Furthermore, I don't have a family member who could have performed this service." He conveniently neglected to mention Scully was listed as his next-of-kin, but was too distraught to be concerned with such mundane matters while he was fighting for his life. "Aside from promising you my first born, what do you need from me to get a retroactive authorization number issued?" Brenda giggled. "Let's start with your group number and employee ID." The tattered insurance card in his hand was barely legible. Mulder fingered it sadly. They had been through so much together. "Uh, the group number is 0716 and my ID number is 773440." "What is the claim number?" He despondently shuffled through the avalanche of forms. So many trees had valiantly given their lives for this ignoble cause. "Where would I find it?" "It would appear on any Explanation of Benefits." A "Non-Explanation of Benefits" would be a more accurate description. Mulder scanned a blue and white form. "Okay, I see it. The claim number is 3-731-1121-1013." She dutifully entered the information into the computer. "Fox William Mulder? Date of birth 10-31-61?" "That's me." "I can have the medical director review your file. Under the circumstances, I'm sure Dr. Cheatham will approve your request." "How long will that take?" "About 7-10..." "Business days," Mulder finished tiredly. "But," Brenda cautioned, "Even with the appropriate authorization, you'll be penalized for going outside the network. You didn't seek services from a participating provider, so your benefits will be reduced." His patience was wearing thin. "I wasn't exactly in a position to consult my directory." "Oh, you can call 800-555-0517 from 7:00 a.m. to 7:00 p.m. Central Standard Time. A representative from Provider Relations can refer you to a participating provider in your service area." "What the hell did you expect me to do?" Mulder exclaimed incredulously. "Call your 800 number for a referral before I lost consciousness and stick a Post-it note on me informing the paramedics which hospital to take me to? Wait a minute; I was supposed to contact Utilization Review first. I'll make sure I program these numbers into my speed dial, as soon as I buy a crystal ball and tarot cards so I can predict any future accidents or illnesses. Or perhaps I should have them tattooed on my chest, next to the indelible bull's eye that makes me an easy target for these unfortunate situations." There was an awkward pause, followed by the frenetic clicking of a computer keyboard. "I'll send an e-mail to Dr. Cheatham requesting he waive this requirement." Enthusiastically clasping his hands together, Mulder positively beamed. "Terrific! While I have you on the line, I have some questions about some of the charges." "That's not my area of expertise," Brenda apologized. "You'll need to speak to the claims department about those. Please hold and I'll connect you." Arrggghhh! The aural punishment recommenced. *Sittin' here eatin' my heart out waitin.' Waitin' for some lover to call. Dialed about a thousand numbers lately. Almost rang the phone off the wall. Lookin' for some hot stuff baby this evenin'...* Mulder had visions of appearing on the evening news as another crazed federal employee who inexplicably went on a shooting rampage. Closing his eyes, he contemplated his next aviation project. A Stealth Bomber would probably achieve his desired objective. He folded a sheet of paper according to specifications and drew a menacing face on the nose cone. With great pride, Mulder watched the craft effortlessly slip the surly bonds of earth and land in the wastebasket. Yesssss! GPS technology couldn't have accomplished a mission with greater precision. Before he dislocated his shoulder from patting himself on the back, fate intervened in the form of a customer service representative. "Claims Department. This is Trish," she answered almost mechanically. Confidently clutching the cryptic hospital bill, Mulder resolved to unravel its hidden mysteries. "Yes, may I please speak with Pat?" "I'm sorry. She's out to lunch." "No kidding," he mumbled. Trish quickly regretted her choice of words. "May I help you?" "My name is Fox Mulder. I've reviewed my itemized hospital bill from my last admission, and I'm kind of fuzzy about some of the charges." "All right, I'll need some information..." "My group number is 0716, my ID number is 773440, the claim number in question is 3-731-1121-1013 and my date of birth is 10-13-61. Does that about cover it?" "My goodness," she laughed. "Sounds like you've done this before." "You have absolutely no idea." The constriction around Mulder's neck was becoming unbearable. After vainly tugging at his shirt collar, he loosed his tie and unbuttoned the top button. "Fox William Mulder?" "The one and only," he confirmed. "Oh, my! Give me a couple of minutes to scroll down to the right screen. Looks like you've had a few hospitalizations." Upon inputing the voluminous data into the system, Trish eventually retrieved his recent claim. "Okay, how can I be of service?" Adjusting his glasses, Mulder began, "There must be a zillion charges for dispensing fees. What are those?" "A dispensing fee is charged when a nurse delivers medication to you." "Then there must be duplicate charges. Once I was out of ICU, I received my meds about four times a day." "No, sir," she hastened to explain. "The fee is for delivering each individual pill." "So if I got a bunch of pills in the same paper cup, the hospital charged $6 per pill, even though the nurse only made one trip?" "That's correct." Armed with a handheld calculator, Mulder attempted to compute an average day's dispensing fees. Four pages later, he concluded this daunting task would have to wait until his blood pressure was lower. It would be a terrible irony to survive a near-fatal car accident, only to stroke out over a trivial charge. Selecting another highlighted item, he asked, "What is a mucous retrieval system? Does that have anything to do with respiratory therapy?" "Uh, it's a box of Kleenex," Trish sheepishly admitted. "And they charged you $42 per unit?" "That's industry standard, sir." Mulder was completely aghast. No wonder the cost of health care was escalating! What other pseudomedical terms were bestowed on ordinary items to justify charging exorbitant fees? Was his water pitcher coded as a "water delivery system" or his toothbrush an "oral plaque removal system?" What about the standard issue comb included in the new patient kit? Was it now a "follicular maintenance device?" In a futile effort to relieve the building tension in his neck, Mulder rolled his head back and forth. Somewhat reinvigorated, he awkwardly posed his next query. "I'm truly confused about this one. Do I understand correctly I was charged for eight pelvic exams?" "That's odd," Trish mused. "The $302 charge indicates the exams were performed under anesthesia. A Well Woman Exam for a new patient should only be $170." "You're missing the *broad* picture," he grumbled. "Do your records indicate I'm a male of the species?" "Yes, sir." "Then why would I require a pelvic exam, let alone eight of them?" She stammered. "Oooh. I see your point. I'll mark these as ineligible charges. I don't know how that could have happened." "At least they didn't start me on hormone therapy," Mulder added dryly. "I'd hate to start shaving my legs." "Huh?" "Never mind. Speaking of anesthesia, why is there a discrepancy in the anesthesia charges?" "Practices vary by area, but it's common to bill a flat rate for the first hour. Additional anesthesia time is charged in fifteen-minute increments." Clumsily reaching for his coffee cup, Mulder said, "Let me get this straight. You mean the anesthesiologist gets paid one fee for knocking me out and another one for making sure I stay asleep? Does he earn a bonus when I wake up? And what if I don't regain consciousness when I'm supposed to? Does the health plan delay payment of the claim?" Trish chose to tactfully overlook her client's outburst. "Do you have any other questions?" "Um, yeah." Tapping a highlighted item with an unmarred pencil, Mulder hesitated. "There's a $23,242 charge for T&A. At the risk of demonstrating my ignorance, what is that for?" Even in his most inebriated state, he was not capable of spending this amount of money on adult entertainment. "That would be a tonsillectomy and adenoidectomy. Oh dear, something is obviously wrong. The code the hospital submitted indicates the procedure was performed on a patient under 12 years of age. The pricing is also incorrect. According to our database, a T&A performed at this POS is about $2,630." "POS?" "Yes, our system indicates New York Hospital Medical Center of Queens was the POS." "Wait a minute," he protested. "The hospital may not have been a five star hotel, but my stay wasn't *that* bad." "POS is an acronym for 'Point of Service,'" Trish replied distractedly. "This doesn't make any sense though. The ICD-9 codes don't correspond to the CPT codes." The Rosetta Stone would be beneficial about now, anything to translate this gibberish into a comprehensible language. He rested his head on a stack of papers, firmly cradling the receiver against his shoulder. For one of the few times in his life, he felt utterly clueless. "Mr. Mulder, are you still there?" No, Elvis left the building a loooOOOooong time ago. "Yeah, I'm here." "I'm going to refer your claim to the audit department," Trish assured him. "Clearly there are a number of irregularities. You've already pointed out two questionable charges. Also, physicians, surgeons, radiologists, anesthesiologists and pathologists tend to submit their claims via HCFA forms or electronic filing. It's highly unlikely these charges would appear on a hospital bill. Furthermore, a diagnosis code has to be consistent with the procedure code for the claim to be considered valid. For example, a provider can't bill for an MRI of your left foot if the diagnosis is chicken pox. It's possible your record got intermingled with someone else's, transposition errors could have occurred or this could be a potential case of fraud. We won't know until the auditor has reviewed your file. Therefore, we'll assume the responsibility of determining which charges are legitimate." "So that's it?" Mulder asked hopefully. "Well, first the audit department will have to subpoena your records from the hospital. That process takes about 7-10 business days." "Yeah, yeah, okay," Mulder snickered. Scully once said time was a universal invariant. Apparently that natural law applied to health plans as well. "Do you have a direct phone number I can call if I want to check on my claim's progress?" "Sure. I'll put you on hold while I make a call to the appropriate unit. I'll be right back," Trish promised. Before Mulder realized what she said, the vicious auditory attack began anew. *All of a sudden I began to change, I was on the dance floor actin' strange. Quack, quack! Flappin' my arms I began to cluck. Go, do! Quack! Look at me, I'm the Disco Duck! Ah! Let's go Mama!* Refusing to go down without a fight, Mulder rolled his hospital bill into a cylindrical shape. He held the telephone receiver at arm's length and brandished his newly acquired light saber toward the source of his irritation. In a deep, authoritative voice Mulder proclaimed, "I feel a great disturbance in the Force." The only logical action was to obliterate the evil with his Jedi light saber. Touching the phone's mouthpiece, he provided the chilling sound effect: *zzzzzzzzzzttttt zzzzzzzzzzttttt, zzzzzzzzzzttttt.* "Mr. Mulder, are you there?" He frantically repositioned the phone. "Sorry. There's a problem with my phone. It keeps making a weird buzzing sound." "I have great news," Trish gushed. "Vince, the senior auditor, has agreed to handle your case. Due to the complexity of your claim, it might take him several weeks to get everything straightened out. But you can contact him periodically to get an update. His direct number is 800-555-0925. And by the way, when you call, tell him your reference number is 4710111. That's an internal code that identifies your audit file." "Do I just sit back and let you do all the work now?" "Yes sir. We'll notify the hospital's business department to immediately cease billing you until further notice. If they've already turned your account over to a collection agency, we'll explain the situation to them as well. I sincerely apologize for any inconvenience and distress this matter may have caused." Mulder could barely contain his excitement. "I can't tell you how much I appreciate your help, Trish. I've spent months trying to get this claim paid. It's really been stressing me out." Trish understood wholeheartedly. "I'm glad we made progress today. Give me a call if you need anything else. I don't have a direct number, but I'm the only Trish Cauthen in the department." "Bless you, my child. Thanks again." Intoxicated by his success, he was performing a victory dance when Scully opened the door. "I thought you vowed to cut back on the caffeine," she teased. Undeterred by his partner's arrival, Mulder strutted around his desk, imitating dance moves John Travolta made famous in the movie "Saturday Night Fever." For the grand finale, he sank to his knees and slid about two feet before coming to a screeching halt. "Hey!" he gasped. "How did your date with Mr. Goodwrench go?" Scully wasn't going to ask what brought about this display of youthful exuberance. Instead, she exhaustedly sank into her chair. "I can't believe an oil change and lube job took all morning. Why doesn't the Bureau contract with vendors that guarantee thirty minute service?" "I'm still wondering why it takes so long to get a hospital bill settled." "Are you still working on that? Why don't you let me handle everything?" "Nah, I think I have it under control. But it's so damn frustrating. What kind of idiot do they think I am?" She smiled. "Is this a multiple choice question?" Ignoring her remark, he complained, "I had the dubious honor of speaking to some of the most exasperating people on the face of the planet this morning. I was almost tempted to barge into the claims office and pull out my weapon." Noting her bemused smirk, he clarified, "My gun, Scully, my gun." The persistent heartburn gnawed at him, and he automatically reached for the bottle of antacids. "Mulder," she admonished, "you can't keep eating those like candy. You should be evaluated by a gastroenterologist." He stared at his hospital related paperwork and nodded in resignation. "I guess it wouldn't hurt to make an appointment. I'll call Utilization Review and Provider Relations too. After all this aggravation, I may need to be hospitalized for an ulcer in about 7-10 business days." Finis Lyrics quoted from: "Stayin' Alive," written and recorded by The Bee Gees "Macho Man," written by Victor Willis, recorded by The Village People "Hot Stuff," written by Pete Bellotte, Harold Faltermeyer and Keith, recorded by Donna Summer "Disco Duck," written and recorded by Rick Dees