A fictional monologue.

You’ve reached the prior authorization denial appeal line for insurance CEOs. Case number, please.

I’m sorry you’ve had to hold for over an hour, but we can’t proceed if we don’t have your case number, a copy of your business degree on file, GMAT score, three letters of recommendation, the middle name of your dentist, and your high school transcript.

Yes, I was only joking about the dentist! LOL! We’re all about fun here. Yes, we do understand you have other essential tasks as a CEO. But somebody’s a little full of themselves today …

Of course, we’ve set up this system to maximize inconvenience and interruption to your day, and, no, before you ask, you cannot have an assistant do it for you. Oh, yes, that decision was very much intentional to show we don’t respect your time and to deter the number of appeals.

Oh, you did find your case number and all supporting documents? Even your dentist’s middle name? How about that!

You’re right. We weren’t joking.

I have a feeling this isn’t your first time with us … Good for you!

I’m just going to put you on another short hold—

Fifty-seven minutes later …

Thank you for holding. Are you still there? Oh, you are? Persistent little bugger, aren’t ya?

I found your case and … Oh, dear. That’s too bad. It’s already been closed. It appears it was denied yesterday. You missed the twelve-second window to call us to provide additional information. It was right there in the email we sent at 4:59 p.m.

That was midnight in your time zone?

I think not playing by the rules sounds like a “you” problem …

Next steps? You can request a peer-to-peer review of the denial. Oh, no, we can’t schedule that another time. It’s either now, or your right to a peer-to-peer call is forfeited.

Yes, that does sound like a conflict if you have a meeting with your shareholders in five minutes …

You’ve decided to reschedule your meeting and hold for the peer-to-peer review? Good choice! Look at you, so determined!

OK, let me see who we have available. Yes, here we go. I’m going to transfer you to Linda. Please hold—

Oh, Linda’s credentials? Let’s see here. It looks like she’s a used car insurance junior manager—

What? You want to talk to a CEO, specifically another health insurance CEO? That’s just not possible—

You’re saying Linda wouldn’t be a true peer? Hmmm, I suppose you have a point there. Still, it’s irrelevant because either you talk to Linda or we close the case, and it remains permanently denied for all eternity with no options to appeal again.

Good choice to talk to Linda!

One hour later …

Thank you for calling the prior authorization denial appeal line for health insurance CEOs—

Oh, hi! It’s you! You’re back, and … Ah, that’s too bad. I see Linda denied your appeal. So that’s it then—

No, I’m sorry. You can’t appeal the denial of the appeal of the denial. I was afraid of that …

OK, fine, there is a process. But I’m only allowed to tell you if you specifically ask, so good thing you did! It’s almost like you’ve gotten this far before.

So here’s what’s going to happen. I’ll file a request for one of our specialized health insurance CEO reviewers … Oh, yes. We have a secret holding facility in Idaho where we keep them, but it could take up to 24 hours to call you back.

You know what? Wait.

Let me turn off the recording …

I like you, so I’m going to break protocol here. They’re not going to call you back within 24 hours.

But you knew that, right?

So, let’s cut to the chase, shall we? You’re going to need to use your valuable time to continue to call us back hourly, only to be placed repeatedly on hold, and once you’ve called seventeen times and the moon is waxing crescent and Jupiter is in retrograde and it’s a leap year, then we’ll put your call through. Got it?

OK, have a nice day! Is there anything else I can help you with today? No? What do you mean I haven’t helped you at all? That’s rather rude to say. Buh-bye!

Jennifer Lycette is a novelist, award-winning essayist, rural hematology-oncology physician, wife, and mom. Mid-career, Dr. Lycette discovered the power of narrative medicine on her path back from physician burnout and has been writing ever since. Her essays can be found in The Intima, NEJM, JAMA, and other journals. She can be reached on Instagram, LinkedIn, Facebook, and Mastodon.

Her books explore the overarching theme of humanism in medicine. Her first novel, The Algorithm Will See You Now (Black Rose Writing Press), a near-future medical thriller, is available now. Her second novel, The Committee Will Kill You Now, a prequel in the form of a near-historical medical suspense, is available in paperback and on Kindle.