I handle patients A, B, J, and K. We call insurance companies and find out what their benefits are. Then we code the count for the computer. We type up all the necessary forms. This is called pre-admit. We let you know what your benefits are so you won’t have to worry about your hospital bill. Our rooms are seventy-five dollars a day. If the insurance pays only twenty-five dollars, that man’s going to owe fifty dollars out of his own pocket every day he’s here. I get the money ahead of time. You don’t have insurance, there must be a five-hundred-dollar deposit. You have to come walking in here with five hundred dollars if you’re going to be put to bed.
When you ask for money first thing he comes in, it tends to upset the patient sometimes, unless you put it in a way that they’re most grateful. I find the best way to do that, without myself being yelled at and called names, is to charm the patient and they calm down. “Are you aware what your benefits are? Do you have the means to pay the other fifty dollars a day?” They think you’re informing them rather than demanding money. But you are demanding money.
When I visit you, I’ve warned you and I’ve joked about it. I’ve taken the edge off the whole thing. So it’s not a big shock. I’d rather go up to you and say, “Sir, you owe two hundred dollars,” than not bother you and one day you walk out and you owe fifteen hundred dollars and have to drop your teeth and have another heart attack. Health care is expensive, you know.
I don’t feel I represent the patient. I represent the hospital. I represent the cashiers. I’m the buffer between the patient and the collection department. This job could be done with a little more finesse. There are times when we dun the patient while he’s in bed: “Tomorrow, can you have three hundred dollars paid on this bill?”
I have no problems. A few patients think this is a little crude. Also doctors are very good about warning patients to bring some deposit in the hospital if your insurance is not adequate. If he can’t bring in five hundred dollars, you ask him how much he can raise. We work out weekly, monthly payments. Most patients are very understanding and cooperative.
We’ve had a few we’ve asked to leave. The doctor is the only one can discharge the patient. If he suggested you be in ten days, maybe you could go home in five. This is brought to the doctor’s attention because it affects the bill. Then the doctor decides he can go home. You’re doing the patient a favor. You might be saving him five hundred dollars. The guy’s not kicked out of bed: “Sorry, sir, no more money, no more bed.” It is done with finesse.
We visit our patients as often as we can, so they get to know us as their representative. “Are you comfortable?” “Are you satisfied with your food?” Then, when he gets to know me—“I know your account is going to be a problem . . .” I’m not looking for money, but if the patient doesn’t ask such questions, I mention it. I sort of joke with ‘em and then lay it out and sock it to ’em.
“They want the bill explained. It’s computerized, and it had taken me about three weeks to understand when I started out an this job. The patient’s just looking at all these figures and doesn’t know what’s coming off.
“Computers make it worse than before. You used to have three cashiers. You now have seven. There’s the coding, there’s the sorting, there’s the tearing apart of pieces of paper. At one time all you had to do was write a little figure in the corner and that was it. Something very simple you used to do in five minutes takes you five days. Hospital costs have gone up since computers. The cost of an error is so fantastic. Where if you’ve paid ten dollars and I’ve written down a receipt for a hundred, it’s a simple little mistake. All I had to do was scratch out the hundred and write ten. Now if that kind of error’s made, it ties everything up for five days.”
I really do like to visit patients and chatter. Most of ‘em, they’re laying in bed watching the same old soap operas they’ve been watching all day. I walk in the room. I can walk down the hall with my chin draggin’, I’m tired and hot. The minute I hit that room, shoulders back and a big smile on my face. I go bursting in there like gangbusters. They sit up in bed, straighten their gowns, pull up the sheets, and turn off the TV. They’re really glad I’ve come. One guy turns up the set when I come in. He doesn’t need me and he’s tellin’ me that.
I won’t mention the bill to a dying patient, if I can talk with the family. A relative will be grateful to me because I didn’t pester the patient. There’s no problem here. That’s the worst thing about my job, though. I really hate to say, “Oh, did I mention the four hundred dollars to you?” Sometimes I’ll sit there and chat for fifteen minutes and sort of squeeze that into the conversation. All of a sudden the visit is canceled and the business has begun. I try to avoid it, but sometimes I have no choice.
People see hospitals as money first and health second. On our admitting forms we ask all these questions—next of kin, who’s gonna pay the bill?—and fill out all these blank squares. The last question is: “What is wrong with you, sir?” I’d rather see patient care first and your financial problems second.
Not all my visits are for collection. A guy just had his leg amputated, doesn’t have anybody. I go visit, then shoot the breeze with him. Is he going to be able to take care of himself once he gets home? If he’s going to live in a third-floor flat and he doesn’t have anybody home, this bothers me. He’s my patient because he’s my letter in the alphabet. When the account’s taken care of, I become his friend.
Isolated patients are on my mind. I had one little girl who had rheumatic fever. She was very ill. Spanish. They had very limited insurance and her bills were just soaring. I talked to the oldest son who was seventeen. I took their application to public aid. It was denied because both parents were working. I got her transferred to La Rabida.
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They still owe us fifteen hundred dollars. They’ve made arrangements to pay forty dollars a month. Sad. But this is an eight-hour-day thing. I can walk away from the job and not worry about it.
I used to work at Wieboldt’s.
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In head cash. Counting all the money taken in the day before, getting it ready for the bank. I never saw the customer, I only saw his money. I’ve worked in drugstores managing a cash register. Everything I’ve done is money, some way or another. It’s hard for me to deal with the emotional factors.
When people ask me, I don’t like to say I’m in collections. If I’m gonna work in collections, I’d rather say I work at Wieboldt’s. It seems strange that you should have a collection department in a hospital. Patient repersentative has a better sound. Nobody knows what it’s all about. It’s like any organized business. They give people such titles that nobody knows what it’s all about.
I’d like to see one insurance for all people, one plan—socialized. Free medical care would be wonderful, but I don’t know how it would be supported. We’d only end up paying for it through taxes. That would tend to irritate people. Intelligent people realize health care is expensive. They realize hospitals don’t make profits. Hospitals misuse money badly. But that’s poor management.
That’s what I was in at the other hospital. We were on a cash basis. If you didn’t have insurance, you paid cash. It hurt those other girls to sit there and ask for money. It didn’t bother me. I wasn’t out there doing it. I’d say, “If he doesn’t have the money, he can come back tomorrow. He’s not gonna die.” It was easy to have an attitude like that. But I’m the other end of the stick now.
I don’t get into many arguments with patients. They’re more or less at my mercy. They can’t say too much. Once you’re in the hospital and you owe me money, if I talk to you in a sympathetic way, you’re not gonna get too sarcastic about it. If you owe me money, I can’t ignore that fact. You may be sick and dying and I like you a lot and you make me cry and all that, I still got to go in and talk to you about your bill. That’s what’s hard.
POSTSCRIPT:
She has since been transferred to the accounting department. She is in charge. She has—and this occupies most of her leisure time—joined Jehovah’s Witnesses.
CARMELITA LESTER
She arrived from the West Indies in 1962. She has been a practical nurse for the past five years. “You study everything about humanity, the human body, all the way through. How to give the patient cares, how to make comfortable . . . Most of the time I work seven days.”
We’re in a private room at a nursing home for the elderly. “Most of them are upper, above middle class. I only work for private patients. Some may have a stroke, some are maybe confused. Some patients have nothing wrong with them, but relatives just bring them and leave them here.”
As she knits, she glances tenderly at the old, old woman lying in the bed. “My baby here has cerebral thrombosis. She is ninety-three years old.”
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I get in this morning about eight-thirty. I shake her, make sure that she was okay. I took her tray, wipe her face, and give her cereal and a cup of orange juice and an egg. She’s unable to chew hard foods. You have to give her liquids through a syringe. She’s supposed to get two thousand cc per day. If not, it would get dry and she would get a small rash and things like those.
The first thing in the morning, after breakfast, I sponge her and I give her a back rub. And I keep her clean. She’s supposed to be turned every two hours. If we don’t turn her every two hours, she will have sores. Even though she’s asleep, she’s got to be turned.
I give her lunch. The trays come up at twelve thirty. I feed her just the same as what I feed her in the morning. In the evening I go to the kitchen and pick up her tray at four ’ and I do the same thing again. About five thirty I leave here and go home. She stays here from five thirty until eleven at night as floor care, until the night nurse come.
You have to be very, very used to her to detect it that she’s having an attack. I go notify that she’s having a convulsion, so the nurse come and give her two grains of sodium amytal in her hips. When she gets the needle it will bring down her blood pressure. Because she has these convulsions, her breathing stops, trying to choke. If there’s nobody around, she would stifle.
Some days she’s awake. Some days she just sleeps. When she’s awake she’s very alert. Some people believe she isn’t, but she knows what’s going on. You will hear her voice say something very simple. Other than that, she doesn’t say a word. Not since she had that last heavy stroke last year. Before that, she would converse. Now she doesn’t converse any more. Oh, she knows what’s going on. She’s aware. She knows people by the voices. If a man comes in this room, once she hears that voice, I just cannot undress her. (Laughs.)
She knows when I’m not here. If I’m away too long, she gets worried, sick. But she got used to it that I have to go out sometimes. She knows I’ll be back, so she’s more relaxed now. Oh, sometimes I sit here and get drowsy. I think of the past and the future. Sometime I think when I was a little girl in Cuba and the things I used to do.
If I’m not doing nothing after I get through with her, it’s a drag day. I laugh and I keep myself busy doing something. I may make pillows. I sell ’em. Sometimes I’ll be writing up my bills. That’s my only time I have, here. If I don’t feel like doing that, well, I’ll make sure she’s okay, I’ll go down into the street and take a walk.
The work don’t leave my mind. I have been so long with her that it became part of me. In my mind it’s always working: “How’s she getting along?” I worry what happened to her between those hours before the night nurse report. If I go off on a trip, I’ll be talking about her. I’ll say, “I wonder what happened to my baby.” My girl friend will say, “Which baby are you talking about?” I’ll say, “My patient.” (Laughs.) I went to Las Vegas. I spent a week there. Every night I called. Because if she has these convulsions . . .
My baby, is not everyone can take of her through this illness. Anybody will be sittin’ here and she will begin to talk and you don’t know it. So you have to be a person that can detect this thing coming along. I called every night to find out how she was doin’. My bill was seventy-eight dollars. (Laughs.) If she’s sick, I have to fly back. She stays on my mind, but I don’t know why. (Laughs.)
She works through a nurses’ registry. “You go where they send you. Maybe you get a little baby.” She had worked at a general hospital before. “I used to float around, I worked with geriatric, I worked with pediatric, I worked with teen-agers, I worked with them all. Medical-surgical. I’ve been with her two years. As long as she’s still going.” (Laughs.)
In America, people doesn’t keep their old people at home. At a certain age they put them away in America. In my country, the old people stay in the home until they die. But here, not like that. It’s surprising to me. They put them away. The first thing they think of is a nursing home. Some of these people don’t need a nursing home. If they have their own bedroom at home, look at television or listen to the radio or they have themselves busy knitting . . . We all, us foreigners, think about it.
Right now there’s a lady here, nothing wrong with her, but they put her away. They don’t come to see her. The only time they see her is when she say, “I can’t breathe.” She wants some attention. And that way she’s just aging. When I come here, she was a beautiful woman. She was looking very nice. Now she is going down. If they would come and take her out sometimes . . .
We had one lady here about two years ago, she has two sons. She fell and had a broken hip. They called the eldest son. He said, “Why call on me? Call the little one. She gave all the money to that little one.” That was bad. I was right there.
All these people here are not helpless. But just the family get rid of them. There is a lady here, her children took her for a ride one day and push her out of the car. Let her walk and wander. She couldn’t find her way home. They come and brought her here. And they try to take away all that she has. They’re tryin’ to make her sign papers and things like those. There’s nothing wrong with her. She can dress herself, comb her hair, take a walk . . . They sign her in here, made the lawyers sign her in. They’re just in for the money. She will tell you, “There’s nothin’ wrong with me.”