Hold Music

Hold Music

A story about the space between needing help and receiving it.

The call connected at 8:04 in the morning. Margaret already knew what would happen — she had been doing this for eleven months — but she had learned to make herself believe, at the start of each call, that today would be different. It was the only way to make herself dial.

"Thank you for calling Sentinel Health Solutions. Your call is very important to us. Current wait time is approximately" — a pause, a digital breath — "forty-five minutes."

♩ ♪ PLEASE CONTINUE TO HOLD ♪ ♩

She set the phone on the kitchen table and made coffee. She fed the cat. She stood at the window and watched a man across the street shovel snow from his walk, each heave practiced and easy, and she felt something that wasn't quite envy but lived in the same neighborhood.

Her son's medication costs four hundred and twelve dollars a month without coverage. With coverage — the coverage she had been paying into for seven years — it should have cost twenty-two. But coverage had been denied on a technicality she did not understand, involving a form that had been filed on a date that was correct but formatted incorrectly. The date she submitted it was the same as the system required. The problem was a slash where a dash should have been.

CLAIM NO.:88291-B / AUTH. PENDING

DATE OF SERVICE:10/14/2024 [FORMAT ERROR — expected 10-14-2024]

REASON CODE:109 — Documentation Incomplete

APPEAL STATUS: Under Review (Est. 90 business days)

ASSIGNED REP.:

She had filed an appeal. The appeal took six weeks to acknowledge. The acknowledgment told her the appeal would take ninety business days to process. She had filed the appeal in February. It was now, factoring in business days only, somewhere around the middle of the following year, in the language the system used, though in the language the rest of the world used, it was November.

Her son, Daniel, was fifteen. He slept in the room at the end of the hall. Without his medication, he did not sleep at all.

* * *

A representative answered at 8:51.

"Thank you for your patience," the voice said. It was warm and scripted, and Margaret had stopped being angry at the voices. The voices were doing their jobs. The voices were, she suspected, also trapped in the machine, answering calls in a room somewhere, following a flowchart on a screen that told them what they were allowed to say and what paths were available to them and what paths were not.

She explained her situation. She had gotten good at this. She had learned to use precise words — prior authorization, formulary exception, medical necessity, supervising physician attestation — because she had learned that imprecise words triggered a different branch of the flowchart, one that ended in a gentle referral back to the website, where the same imprecise language appeared in an FAQ that did not answer her question.

"I can see your case here," the representative said. "It looks like the appeal is still under review."

"I know it's under review. I'm calling because Daniel has been off his medication for three weeks. I need to know if there's an expedited pathway."

A pause. The sound of typing. Margaret watched the snow outside. The man with the shovel had finished and gone inside.

"So there is an expedited review process, but it requires a letter of medical necessity from your son's prescribing physician, submitted via fax to the Appeals and Grievances department, along with a completed Form CX-7 and a copy of the original denial notice."

"I submitted all of that in September."

Another pause. More typing. "I'm showing a Form CX-7 received September 19th, but I don't see the letter of medical necessity."

"His doctor faxed it. We have the confirmation."

"I believe you," the representative said, and Margaret believed that she did. "But if it's not showing in our system, we'd need it resubmitted. Sometimes documents get lost in transit."

In transit. As if her son's paperwork were a ship at sea. As if it had encountered weather.

* * *

She called the doctor's office. The doctor's office had a new receptionist who did not know what Form CX-7 was. She was transferred to a billing specialist who knew what Form CX-7 was but did not know where the original fax confirmation was stored. The billing specialist put her on hold, and the hold music was the same melody, she was almost certain, as Sentinel's hold music — some licensing arrangement, she imagined, a package deal, a subscription to tranquility sold in bulk to companies whose business it was to make people wait.

♩ ♪ YOUR CALL IS IMPORTANT TO US ♪ ♩

The billing specialist returned. The fax confirmation had been found. The letter would be resent today.

"Can you make sure it goes to the Appeals and Grievances fax number, not the general submissions fax?" Margaret asked. She had learned this, too — the two numbers existed, and one of them was a void.

"Of course," the billing specialist said.

* * *

That evening, Daniel came into the kitchen while she was making dinner. He was tall now, surprising her still with how much of the doorframe he occupied. He stood in the way teenagers stand when they want to say something but haven't decided yet whether to say it.

"Any news?" he asked.

She thought about what to tell him. She thought about the flowchart, the fax machine, the slash versus the dash, the ninety business days, the letter lost in transit, the hold music that played for no one in particular. She thought about how a system had been built — by people, each making individual decisions that probably seemed reasonable at the time — and how the sum of those decisions was a structure that worked beautifully for the people who never really needed it and failed, reliably and mechanically, at the exact moment someone did.

"Not yet," she said. "But we're getting there."

He nodded and went back to his room. She turned back to the stove. Outside, it had started to snow again, covering the walk the man had shoveled clean that morning, and she thought that there was something in that — in the way effort disappears, in the way you have to keep doing a thing the system requires of you, endlessly, just to stay in the same place — but she was too tired to finish the thought, so she let it go, and stirred the soup, and waited.

Case Pending -