“See you after your appointment. I’ve got your grocery list and mine, so I shouldn’t get into too much trouble.”
“See to it.” Garrick waved him away before he checked in to his appointment. Good mood still swirling along with some excess energy from that morning’s outing, he was ready to get to work. But, to his surprise, Stephanie was accompanied by a stuffy-looking dude in a white dress shirt and skinny mustache, and they led him to one of the little private exam rooms in the back of the facility, not the main PT room with all the equipment.
“What’s up?” His stomach churned, already not liking whatever this interruption to his routine was.
“This is Alec. He’s from the billing department,” Stephanie explained.
“Oh, f—crap. Am I behind on copays? Thought I had you guys on autopay.”
“No, you’re largely caught up.” Alec glanced nervously at Stephanie. “That’s not what we need to discuss. It’s more about going forward. That is, looking at both what your personal goals are as well as what the insurance is willing to cover and what your clinical team recommends.”
“I’m afraid I don’t understand,” he admitted. Alec and Stephanie’s uneasy faces were giving him a complex, so he looked away and studied a poster illustrating correct posture for carrying boxes and other bulky loads. “I come. We do the work. I haven’t missed an appointment yet. Goal hasn’t changed. Get me back out there.”
“It’s not that easy.” Stephanie gave a pained sigh. “I wish, I really wish it was. But what Alec is trying to get at is that he’s been fighting the insurance on your behalf several weeks now. They want to stop covering intensive PT. And we’ve been working with your neurologist to try to get them to reconsider, but we keep running into brick walls.”
“What does that mean? They’re not going pay for more PT? Why?”
“The insurance looks at what is medically necessary.” Alec continued to frown, mouth twisted like he’d rather be discussing colonoscopy options than having this conversation with Garrick. “That is, they need the medical team to regularly review your care plan and to state that your condition can be reasonably expected to improve with the current course of physical therapy.”
“But that should be easy, right? I’m still not at one hundred percent. I don’t get why they wouldn’t think it’s necessary.”
“It’s the ‘reasonably expected to improve’ part.” Stephanie’s voice was soft but weary. “The whole care team has been worried for a while that your personal goals may not be realistic. I know the neurologist has explained to you the slim chances for total recovery. And your attitude of wanting to defeat those odds is so, so admirable, but—”
“I’m not here to be inspiring.” Garrick wasn’t sure whether he was madder at her and the rest of his medical team for not believing in him or the insurance company for putting all of them in this position. “If I’m hearing you right, what you’re saying is that the insurance doesn’t think I’m going to have significant improvements from where I am now, so they don’t want to pay for what we’ve been doing. Okay. So I pay out of pocket.”
“It’s a lot of money. A lot. And we can discuss that option, but the insurance is willing to cover some things on an adjusted care plan—for example, more occupational therapy for things like learning to drive with hand controls, counseling to help with your adjustment, and more limited PT to maintain your current level of mobility. Part of why I didn’t want to hit you with this over the phone or let Alec explain this to you alone is that everyone on your team—our head of PT, me, the neurologist, and the orthopedist—want you to take some time to seriously reflect on what your treatment goals are from here on out.”
“You said I was making improvements. As recently as a few weeks ago, you said you’d seen some progress.”
“Yes. Incremental progress. You are way stronger than when you started. Your balance has improved as your hip and ankle strength has improved. Your initial breaks have healed about as well as could be expected. You’re so much better at navigating with the crutches now. The problem is that the spinal injury is going to have a lasting impact, one that all the therapy in the world can’t erase. I wish it could.”
“But it was incomplete. Everyone said it was best-case scenario in a lot of ways.” The urologist’s words about luck rang in his ears, along with that doctor’s skepticism for him giving up the crutches. Fuck luck. Fuck it hard. Did no one believe in him? It’s almost been a year. That was what the neurologist had said at their last appointment, like Garrick didn’t know that, like he could forget, like that mattered when he was willing to work as hard and as long as it took.