Authors: Nancy Jensen
Mr. Radford reached through the window to hand the papers to Alma. “You tell them you’re calling from the doctor’s office, and they’ll listen to you,” he said.
Alma adjusted her glasses and tried to make sense of the claims report. Separated into columns were codes that corresponded on the back to various procedures. In the next column was listed the doctor’s charge, followed by how much of the charge the insurance would pay, followed by the difference owed by the patient. The amount owing after insurance for each procedure seemed awfully high—anywhere from $30 to $150—and Alma started to speak. Seeming to read her thoughts, Mr. Radford said, “It’s not that last bit I’m worried about, where it says I owe the doctor. Dr. Crisp has been awful good to me—to Gladys, too. Well, to all of us down at the center. He’s always said he’ll take only what the insurance pays, never has asked a one of us for a penny. Can’t ask for better than that.”
“Yes,” Alma said. “Milton’s a good and kind boy.”
“It’s all those numbers at the start,” Mr. Radford said. “They make it kind of hard to understand, the way they just use the numbers and put all the words in that doctor’s language on the back page in that ink you can’t hardly see.” Alma turned over the page and saw the details corresponding to the codes written in type so small, in such ghostly gray ink, that even she had trouble reading it.
Mr. Radford went on: “Then Gladys had the idea that I bring in one of my other statements—seems like I get three or four a month—and I read off the numbers while she checked them against what it says on the back the charge is for.”
“It’s always handy to have a second pair of eyes,” said Alma. “What’s the trouble, do you think?”
“It’s the charges,” Mr. Radford said. “I don’t know what those insurance people are up to. Probably just not paying attention.” He shifted from one foot to the other and then back again. “You know I come in here every week so Judy can stick me to make sure my blood’s still red enough.”
“Yes.” Alma nodded. “The hemoglobin count.”
“And then she blows me up with that cuff of hers.”
Alma flipped the paper over again and quickly identified the codes for those two procedures. Each code was listed twice, followed by different dates corresponding to two consecutive weeks in January, before she had come to help. She opened the appointment book and noted that Mr. Radford had been scheduled those days, and had come in. With a pencil, Alma made a light check mark for each code she could identify, but two other codes, also each listed twice, with different dates, remained. She checked these dates in the appointment book and couldn’t find Mr. Radford’s name.
“You always come on Wednesday, Mr. Radford. Isn’t that right?”
“I do. So what I want to know is why they’ve charged me for a couple of Fridays.”
Alma checked the codes again. According to the claims statement, Milton had been paid for two cholesterol screenings and two regular office examinations. “Doesn’t Judy always do your blood tests?” Alma asked.
“She does.”
“Do you remember if you saw Dr. Crisp for anything else last month? I don’t have you in the book, but maybe he worked you in?”
Mr. Radford shook his head. “Last time I was in for anything but the blood was about a week after Thanksgiving,” he said. “My grandson had all the family down—did I tell you I have five great-grandchildren so far? There was a lot of commotion—you can understand—and I ate some things I shouldn’t and didn’t sleep so well, so it wasn’t any wonder I picked up a nasty chest cold from one of the kids. I saw the doctor for that, but nothing else since. My hemoglobin’s been so good, I haven’t had to go for a transfusion since last summer.”
Just to be sure, Alma studied all the codes and dates once more. “I expect they’ve confused your records with someone else’s, or maybe Penny accidentally billed you for another patient’s procedures,” she said. “Having a baby can make a woman’s mind awfully fuzzy.”
Mr. Radford laughed at that and told her a story about how his wife, after their first baby was born, kept putting stamps on letters without ever addressing them.
Alma looked at the statements again, wishing she knew more about how the insurance was filed so she could figure out what had happened. She hated to burden Milton and Penny with it. Last Saturday, when Penny woke up with a headache and told Milton she thought the billing could wait another week, he’d taken her back to the bedroom, where they had argued in loud whispers for nearly an hour. It would help ease so much anxiety for them if Alma could solve this problem.
“I thought about showing these to my grandson,” Mr. Radford said, “but I don’t like him thinking I can’t handle my own business. Peter has his own trucking company. He’s used to dealing with papers and red tape and such.”
“Oh, I don’t think we need to bother him just yet,” she said. “You leave this with me.” Alma refolded the pages and tucked them into her purse. “I’ll get to the bottom of it.”
Later that afternoon, after Judy had left and Milton was pulling on his overcoat, Alma said, “I have a few things to finish up, dear—four or five reminder calls to people scheduled for tomorrow. And then I have some errands to run.”
Milton stared at her.
“Don’t worry,” Alma teased. “Dinner’s all ready. There’s beef stew in the Crock-Pot, so all you have to do is heat up some rolls if you want them. They’re in the freezer. Penny can manage those.”
“It’s getting dark out,” Milton said. “I’ll wait for you.”
Alma blushed at his concern. She squeezed his hand. “Really, dear, it’s all right. I’m a big girl.” When her son hesitated, she added, “Yes, I know how to reset the alarm when I leave.” She bumped his shoulder playfully. “You go on. I know you’re tired.”
Milton stood in his place for another moment, his fingers clutching a button of his coat, but at last, without another word, he left, pulling the outside door hard behind him.
Alma took Mr. Radford’s statements from her purse and opened the appointment book to the first date when he was mistakenly charged for the cholesterol screening. It took a few minutes to pull the patient files for the people listed that day, but now they all lay before her. One by one, she opened the folders, looking for some evidence that someone else on the same day had come in to have a cholesterol check. This was more difficult than she had expected, because, in spite of Milton’s notes having been transcribed to typed pages, the procedures were shortened to four-digit billing codes—in most cases, three, four, or five codes for each patient. Several of the records showed the code for cholesterol tests, but there was no surprise in that. Old people had to watch their cholesterol.
Alma took Mr. Radford’s folder from the bottom of the pile and opened it. The only way to do this, she decided, was to be methodical and look at least briefly at every sheet of paper. The first several sheets, which she laid aside one by one, were Penny’s typed notes. Then came a photocopy of Mr. Radford’s insurance card—he was one of the lucky ones from the Senior Center who didn’t have to rely on Medicare. He’d worked for the railroad for nearly fifty years, and they still paid for his coverage. Behind that was his original patient record, filled out during his first visit. Alma noticed the date, just a few weeks after Milton had opened the practice.
Next, gathered with a binder clip, were the forms Judy and Milton used for their notes during the patient’s visit. At the top of each, Mr. Radford’s name was scribbled in Judy’s handwriting. Most of the notes were Judy’s, but Alma did find Milton’s notes from the early-December visit Mr. Radford had mentioned. They were hard to read, but when Alma got the hang of it, nothing seemed amiss. She wasn’t going to find the answer this way, she decided, so she carefully tapped the pages back in place and fastened the clip.
Alma gathered the loose sheets she’d set aside and was just about to place them back in the folder when she caught a glimpse of writing in the lower left corner of a notes page. She pulled the stack out again to look—a pair of four-digit numbers written in fine black ink, followed by a plus sign and another single digit. She lifted the first page to see the second, and there was one number marked in the same space. On the next there were three, and on the one after that, two again, then one. Every page of notes had codes listed in the lower corners.
Surely they were the codes for the procedures listed in the notes. Of course they were—to make things quicker for Penny in transcribing and billing. To prove it to herself, Alma reached for Mr. Radford’s claims statement. By now, she knew the dates by heart, so she found the pages of notes for Mr. Radford’s January visits. Just one for each of the weeks, as she expected. On the claims statement, she had checked off the code for hemoglobin testing—7418, and the one for the pressure check—6100. The numbers in the lower left were 8146 +2 and 2002 +2. She didn’t understand the +2, but the four-digit numbers were the codes for a cholesterol check and a regular office exam. Alma looked again at Penny’s transcriptions. For the January dates, all four codes appeared in the narratives as services performed.
Sweat beaded along Alma’s nose and at the nape of her neck. She closed Mr. Radford’s folder and chose another randomly from the pile she had made. The papers were in the same order, multiple codes listed in every transcription. And in the lower left corner of every page of working notes, more black ink codes, followed by a +2 or +4, sometimes even a +7, were jotted in a small but legible hand. Judy’s numbers were large, sloppy, with twos that looked like sevens and fours that might be nines. Always in bright blue ink.
Alma pulled another file, then another.
It couldn’t be.
There had to be some terrible mistake, some reason other than the one that was in her mind.
Patient after patient, page after page, codes for every test that could be performed in the office, ordinary procedures that were common for elderly people—flu shots, pneumonia vaccines, allergy treatments, stress tests, EKGs, X-rays, heart monitors, and every possible blood test—tortured Alma from those lower left corners.
The plus signs added days—days between the patient’s actual appointment and the invented ones. She saw that now. Code upon code upon code for procedures never performed, visits never made.
Every one of them written in fine black ink by her son’s hand.
Alma slapped the folder shut and pushed it away from her. Her face burned, as if she’d been struck. A great pain pounded in her chest and poured out as she wept.
“Sarah … oh,
Sarah,
” she cried.
At the sound of her granddaughter’s name, Alma quieted. She saw exactly what she must do.
First, she dried her eyes. Then, she took Mr. Radford’s insurance statements and folded them again inside her purse. Tomorrow, she would give them back to him, saying how sorry she was that she couldn’t help him.
Penny will have to see to them
, she would tell him.
But in the meantime, perhaps you would feel better letting your grandson have a look
?
Next, Alma restored the pages in the files to perfect order and returned the folders to the cabinet, making sure each settled in again as if it had never been removed.
She would drive back to Milton’s house, and, after dinner, after putting Sarah to bed, Alma would find a moment to speak with Penny. She would remark, casually, that Penny seemed bored at home—and no doubt Penny would confirm this, so Alma would quickly suggest that, in a few days perhaps, she and Penny could begin to split hours at the office, and by the middle of next week, Penny could take over again and Alma could stay home with the baby. If Penny balked at all, Alma would mention Mr. Radford, describing his concerns in a clumsy but pleasant way.
Then, if she had to, she would go further and show Penny the statements, remarking on how she had tried her best to help Mr. Radford but had quickly discovered the problem was well beyond her. “I’m afraid it’s up to the young people now,” she would say, mentioning Mr. Radford’s grandson. If necessary.
It might take ten days, perhaps two weeks, before she could muse aloud about taking Sarah back with her to McAllister—just for a little while. Just until Milton and Penny were settled again in their routine—that’s what she would say. Gordon would be so glad to go home he wouldn’t argue about taking the baby.
Milton and Penny wouldn’t protest at all—they wouldn’t even pretend. Though it froze Alma’s blood to think of it, this was the one thing she was surest of.
Only two weeks of careful stepping—three at the most. What was that after a lifetime of practice?
Let come whatever end must come for the wrongs Milton and Penny had done. Nothing mattered but Sarah. Nothing. Not Milton or his practice. Not Gordon. Not anyone here or in McAllister. No one but Sarah—her Sarah, whom Alma would keep safe, bound forever in her arms.
T
WENTY-ONE
Armorer
April 1995
Pilgrim’s End, Indiana
GRACE
“W
HERE DO YOU BUY ALL
these tiny links?”
It was the question Grace got most often at art fairs, and, when answered, was usually followed with an incredulous “You
make
them?”
The woman asking the question now was a type Grace recognized, an expensively dressed weekend crafter up from Greenwood who trolled all the booths at fairs, looking for ideas she could knock off and sell in some little shop her husband had set up for her in the children’s abandoned playhouse.