SUMMARY: After Mulder recovers from near fatal
injuries, the *real* torture begins.
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
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
"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
"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
"How could I do that? I was in ICU in a drug-induced
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.
"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
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
"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
"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
Brenda giggled. "Let's start with your group number and
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
"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?"
"I can have the medical director review your file. Under
the circumstances, I'm sure Dr. Cheatham will approve your
"How long will that take?"
"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
"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
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
"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
"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?"
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?"
"Then why would I require a pelvic exam, let alone eight of
She stammered. "Oooh. I see your point. I'll mark
as ineligible charges. I don't know how that could have
"At least they didn't start me on hormone therapy," Mulder
added dryly. "I'd hate to start shaving my legs."
"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
"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."
"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
"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
"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,
"Mr. Mulder, are you there?"
He frantically repositioned the phone. "Sorry. There's a
problem with my phone. It keeps making a weird buzzing
"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
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
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
"Are you still working on that? Why don't you let me
"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."
Lyrics quoted from:
"Stayin' Alive," written and recorded by The Bee Gees
"Macho Man," written by Victor Willis, recorded by The
"Hot Stuff," written by Pete Bellotte, Harold Faltermeyer
and Keith, recorded by Donna Summer
"Disco Duck," written and recorded by Rick Dees