“I’ve heard that Peerless is doing very well.”
“You heard correctly.”
“So, you think the stock is a good investment?”
“It’s an excellent investment,” Mr. Bennet said. “Especially with the coronavirus pandemic, we’re selling short-term health policies like no tomorrow. I’d certainly advise you to pick up some stock if you are in the market.”
“Maybe I will,” Brian said, nodding his head. “Thanks for the tip.”
“You’re very welcome.”
The elevator came to a stop on the fifty-fourth floor and Mr. Bennet got off. Brian followed right behind. With an entry card, the man unlocked the door into the Peerless suite. A moment later they were standing in front of an empty reception desk in a posh lobby furnished with high-end leather furniture and with a view to the west over Sixth Avenue that included a tiny wedge of the Hudson River. But by far the most dominant object in view was the near life-size painting of Heather Williams dressed in her foxhunting finery.
“Excuse me,” Mr. Bennet said, turning to face Brian. “Who are you here to see, if I may ask?”
“Ebony Wilson,” Brian answered distractedly. It was hard to take his eyes off the painting, especially remembering the security guard’s impression of her personality and narcissism.
“Is she expecting you?”
“Absolutely,” Brian assured him. “Can you tell me where her office is?”
“Of course. Follow me!”
After skirting a number of empty secretarial desks, Mr. Bennet stopped at an open door and leaned in. “Ebony, there’s someone here to see you.”
“Who is it?” Brian could hear her ask.
Mr. Bennet turned to Brian, raising his eyebrows questioningly.
“Brian Murphy,” Brian declared as he advanced to the doorway and looked in. In sharp contrast to Roger Dalton, whose deep baritone voice belied his appearance, Ebony Wilson and her assertive voice were well matched. She was an athletic-looking African American woman with a smattering of freckles over her face. Her dark hair was done in a braid, and she was sitting behind a monitor.
“Nice chatting with you, Mr. Murphy,” Mr. Bennet called out before continuing on to his office down the corridor.
“Likewise,” Brian called after him.
Ebony leaned back in her chair and removed wireless earbuds she used for her phone conversations as a claims adjustment supervisor. She tilted her head to the side as she gave him a studied look. “Brian Murphy?” she questioned. “Do I know you?”
“Somewhat,” Brian said vaguely. He stepped into the small office and sat down uninvited in one of two side chairs. “We spoke on the phone about a week ago.”
“I speak to people all day every day. You’ll have to be more specific. Are you an employee of Peerless?”
Brian laughed mockingly. “No, I’m not an employee of Peerless, and we certainly have never met. We spoke about Peerless denying a claim for an Emergency Department visit at MMH Inwood for my wife. You advised me to request a review, which I did, and which has again been denied. But that’s not why I am here.”
“How on earth did you get in?” she demanded as she straightened up in her chair.
“I walked in,” he said.
“I don’t mean how you physically got in. I mean how did you get past security and into our office suite?”
“Mr. Bennet was nice enough to get me in the office,” Brian said. “As far as building security was concerned, all I did was show the guard my NYPD ID. Would you like to see it?” Brian leaned forward to allow him to get out his wallet.
“No, I suppose not since you are already here. Okay, so you are a Peerless customer. If you are not here about a claim denial, why exactly are you here?”
“I didn’t say it wasn’t about a claim denial,” he corrected her. “In fact, it is. It’s just not about the Emergency Department claim we spoke about. It’s now the inpatient hospital bill that I’m concerned about. I’ve been told today that Peerless will not be covering that either, and I want to know why. This situation is the reason my wife and I made sure we had health insurance: in case one of us had to go to the hospital.”
“Maybe you better show me your NYPD ID,” Ebony said. “None of this makes sense.”
Brian complied, flashing the ID the way he’d done for the security guard, but she wasn’t to be fooled, and she demanded to see it up close.
“I see. So you are retired,” she said, handing it back. “You hardly look old enough to retire.”
‘‘My wife and I started a security company,” Brian explained. “She was also an NYPD officer.”
“Which I assume is the reason you purchased a Peerless policy.”
“That’s correct. We were trying to be responsible because we couldn’t afford the COBRA premiums that would have allowed us to stay covered by the NYPD health insurance.”
“Do you have your Peerless policy number with you?”
“I do,” he said, and he gave it to her. She used her computer to bring up the record. As she read, Brian glanced around at the surroundings. Even this small office was opulently decorated, making him wonder what kind of sumptuous, over-the-top quarters Heather Williams occupied. It also made him wonder how such extravagance could be supported by the mere two-hundred-dollars-a-month premium he and Emma had been paying. But then he remembered that when they had bought the policy in December, they’d been told such policies like theirs were selling like hotcakes because a huge number of self-employed people couldn’t afford standard health policies that commercial businesses were buying for their employees. And that was before some twelve million Americans lost their jobs and their employer-based health insurance during the pandemic. Even if just a million of those people bought Peerless policies, that could mean $200 million a month revenue for the company.
“Okay, I found your case and have read through the latest adjuster’s decision. It’s actually pretty simple. Did you carefully read your policy like I suggested during our phone call about the Emergency Department bill? I remember you said you hadn’t when you purchased it.”
“No, I haven’t,” Brian admitted. “My wife’s illness has taken precedence since we talked.”
“Okay, tell me this. Are you aware your policy has a sizable deductible?”
“Of course,” he said. “The sales agent let us know that it was ten thousand dollars.”
“How about the amount that Peerless would pay per day for hospitalization?”
“I’m not sure I remember that.”
“It clearly states in your policy on page thirteen that Peerless will pay a thousand dollars a day after the deductible is satisfied.”
Brian suddenly felt embarrassed, realizing what fools he and Emma had been. Although a thousand dollars a day had sounded like a lot of money when they bought the policy, Emma’s stay in MMH Inwood had been well over twenty thousand dollars a day.
“So now let’s talk about the deductible,” Ebony continued. “Are you aware how the Peerless deductible works?”
“I assume so,” Brian said. “It means that we are responsible for the first ten thousand dollars. After that, Peerless steps in.”
“No, that’s not how the Peerless short-term policy deductible works. This is why you should have carefully read your policy, Mr. Murphy. With Peerless Health Insurance the deductible relates to Peerless payments, not to the policy holder’s payments.”
“I don’t follow,” he said, confused by all the semantics.
“Peerless doesn’t pay the thousand dollars a day until it would have paid ten thousand if there was no deductible. Essentially that means the hospitalization has to be for more than ten days. Starting on the eleventh day, Peerless pays a thousand dollars a day. It is a permutation of the deductible concept devised by Heather Williams, our esteemed CEO, when she was our chief financial officer.”