Trapped

Maria had been frustrated, but this was the last straw.

Maria is one of the people who work in Maple City Health Care Center’s billing department.

Maria spends the hours of her work day billing patients and insurance companies and recording payments, but the purpose of her work is to help define aspects of the relationships between Maple City Health Care Center and our patients and, if possible, to improve those relationships.

One aspect of our relationship with patients is the way in which we each contribute to the other’s welfare. In return for health care, patients help the Center by paying what they can afford.

From Maria’s point of view, our relationship with “Sara” was broken.

At first, there was a problem with Medicaid. Sara requested and received the Center’s largest discount (90%). In return, the Center asked Sara to apply for Medicaid for her children. For people who qualify for the 90% discount, applying for Medicaid is one thing they can do to help pay for their health care.

At first, Sara put off applying, saying she was going to move. But months went by and she didn’t move.

Maria explained to Sara that without an application for Medicaid, the Center could no longer offer the 90% discount. To do so would undermine the integrity of our relationship with Sara and with other patients who had done their part by applying.

Without the 90% discount, Sara missed payments and accumulated a large debt.

Not only did Sara miss payments, but she ignored Maria’s calls and letters suggesting the need to communicate and to work out a payment plan.

Then one day, Sara brought in an insurance card. The card indicated that Sara had been employed the entire time and that her insurance could have paid for much of the cost of her care.

To Maria, it looked as if our relationship with Sara was in shambles. But Maria decided to check with Maple City Health Care Center’s administrative team, James and Nayla. The three agreed that the Center no longer had the trust needed for a healthy relationship with Sara. They also decided to give Sara a chance to explain.

Maria and Nayla met with Sara. At first, Sara was quiet and subdued. As Maria and Nayla traced several years’ worth of problems, Sara began to look cornered.

Finally, Sara admitted that she had lied and cheated. Through tears, she told Maria and Nayla how desperate she was for health care for herself and her two children, but how fearful she was that applying for Medicaid would cause legal problems.

Sara explained how numerous people told her that applying for Medicaid would jeopardize the eight years that she had spent working to become a citizen. If the U.S. denied her application, she faced deportation.

So Sara lied. And one lie led to another. Soon, Sara lost track of what was true and what wasn’t. Sara felt trapped. She didn’t know how to escape this web of untruth.

Maria and Nayla asked if there were any reasons that Sara felt she couldn’t trust Maple City Health Care Center enough to talk about her fears and problems. Sara acknowledged that all of her friends and relatives trusted the Center.

With Sara admitting her mistakes and with Maria sensing some of the pressure Sara was under, the air cleared. “She looked as if a weight had been lifted. I felt better about her when I understood the bind she had been in and the reasons for doing what she did.”

Sara helped work out a plan for paying what she owes. Maria, Sara, and Nayla all agreed that the relationship between Sara and the Center was on the way toward restoration.

Afterwards, Maria mused, “We came close to just telling Sara that she needed to find another doctor. I’m glad that we invested the time in working on the relationship. Sara continues as our patient and I don’t have to feel angry and frustrated. I think both of us experienced healing.”