Adam Matson

This Call May Be Monitored for Quality Assurance

Fresh from the attitudinal jump-start of her 10:15 AM smoke break, nicotine coursing through her veins, her eyeballs pulsing from that tingly little kick, Rebecca Swain sat down at her desk and saw by the blinking light on her computer screen that a customer call was about to be patched through to her. She took a deep breath and donned her headset. The headset pinched her skull, ruined her hair. Her chair was upholstered with cheap fuzz which magnified her own body heat back into. The cubicle was cramped and stifling. Her monitor was tilted at an angle that made her scrunch up her shoulders, causing neck pain after about six minutes. The office around her was abuzz with the false ebullience of customer service chatter.

It was raining outside, and her smoke break had been rushed, offering only physiological, rather than psychological, relief. What Rebecca needed was like a six-month comprehensive mental and emotional smoke break. This was her first day back at work after two Mental Health Days off. She had been ashamed to call in and inform her supervisor, Craig Bortle, that she was taking her two company-allocated Mental Health Days. She should have lied and called in sick. But Sick Days were different from Mental Health Days. The company allowed five Sick Days per year, and Rebecca always saved those for colds and hangovers. Those employees who did take their Mental Health Days usually made a big fuss over them later at work, regaling coworkers with tales of salon appointments, beach trips, nights out with friends, or whatever other fleeting, socially acceptable excused absences the herd would understand. What the company did not allow its employees were Attempted Suicide Days, which is what Rebecca had actually taken. She had used a fresh re-up of the Percocet Dr. Gould had given her for her ulcer, washing down most of the bottle with a handle of watermelon-flavored vodka. She had woken up almost thirty hours later in her bed, vomited several times, and spent the next day crying in the bathroom, wondering how she would explain her actions to anyone who cared. Like her family and friends.

The job was killing her. Every day she rejected dozens of perfectly reasonable health care claims from GreatHealth customers. Her role as an accounts administrator was to gently repeat the word “No” as many times as it took for the customer to admit defeat and hang up the phone. This one word had come to epitomize her life. She woke up with No on her lips, and went to bed with No ringing in her ears.

Another cruel irony: GreatHealth’s health insurance package allowed her a maximum of twenty-five mental health consultations per year, the cost of which was covered at 75% after a $1000 deductible. Who had $1000 dollars to throw away on a shrink? And what happened if twenty-five “consultations” failed to cure your chronic depression and overwhelming sense of self-hatred? Was it suicide at that point? Rebecca had decided to save her $1000, skip the twenty-five sob-a-thons, and jump right to the end game.

She had failed at suicide too. Her two Mental Health/Auto-Euthanasia Days were up, so she returned to work.

The phone beeped in her ear and suddenly she heard the familiar empty vacuum of space where another person seemed to enter her head. “Thank you for calling GreatHealth Health Care,” Rebecca said in the chipper voice she hated like poison. “May I have your first and last name and subscriber number, please?”

“My name is Charles Biederman,” said the youngish-sounding man on the phone. He gave her his subscriber number. She pulled up his customer profile on her computer.

“Thank you for calling us today, Mr. Biederman. My name is Rebecca, your GreatHealth Wellness Facilitator, how may I assist you?”

“I have a question about my coverage.”

“Certainly, Mr. Biederman! I just want to let you know that this call may be monitored or recorded for quality assurance.”


Rebecca glanced at the red phone icon in the top-left corner of her screen to confirm that this call had indeed been randomly selected by the computer for quality assurance recording. It was likely, however, that nobody at GreatHealth would ever specifically listen to this call.

“The long and short of it is this,” Biederman said. “My wife and I are trying to have a baby. We already have a daughter, but we always wanted two, so we want to try again. However, we have to go through a fertility clinic because we are unable to have children by traditional means. We’ve tried in vitro fertilization, but our attempts so far have been unsuccessful. We were gearing up to try again, but then I got a notification from GreatHealth saying that we have… I have the letter here… that we have ‘fulfilled our maximum number of allowances and are ineligible for further coverage.’”

He stopped abruptly.

“Certainly, sir, I understand,” she said. “Let me just verify your information in our system.”

She checked his profile, reading it over carefully as if she might find some little error or exception that would enable him to reach the outcome he obviously wanted, but she knew already that there was nothing she could do. It said so right there on the screen: “Used maximum allowances.”

“Mr. Biederman, I’m looking over your plan right now, and I see that GreatHealth offers three family planning events for the lifetime of your coverage, and according to our records, you have processed three claims.”

“What does that mean, three family planning events?”

“For example, one cycle of in vitro fertilization would constitute one family planning event. According to our records, you have completed three family planning events.”

“Meaning each of the times my wife and I went through in vitro, that was considered one ‘complete family planning event,’ regardless of whether the process resulted in a pregnancy?”

Rebecca felt the ulcer start to clench its teeth around her abdomen. “That’s correct, sir.”

“So, essentially, three strikes and you’re out.”

Rebecca could not tell if this was a question or a statement. She hated the moments when the customer realized his or her call to GreatHealth was futile.

“I don’t see how an unsuccessful cycle can be considered a family planning event,” said Charles Biederman. “We didn’t get pregnant. It was a non-event.”

Rebecca knew what was coming, and worried she was going to lose it. She had been back to work for less than an hour, and of course she was being hit with a family planning call. These stung her the most. Three years ago she had had a miscarriage, which had ultimately resulted in the dissolution of her marriage (obviously there were mitigating factors, and the divorce was complex and multi-faceted, but the miscarriage had served as the catalyst for she and Lewis growing apart, for her brief period of heavy drinking, for Lewis’ affair, and every family planning call only served to remind her how miserable life could be when things did not work out the way you wanted).

“Sir, I’m sorry to hear that-”

“Whose idea was it to limit medical coverage to three family planning events?” Biederman asked.

They often wanted to know who were the policymakers hiding behind the curtain. “That’s GreatHealth company policy, Mr. Biederman. Our family planning package covers three events over the lifetime of the coverage. However, you are always free to attempt more fertilization procedures. If you have additional coverage with another provider, for example.”

“We don’t. My wife and I share my insurance.”

“It is also possible in certain cases for customers to apply for special financial assistance through local- or state-sponsored programs, depending on their region of residence.”

“What programs are those?”

“I actually don’t have that information, sir. You would have to check with your personal physician, or with the fertilization clinic.”

There was a long pause over the phone.

“Let me ask you something,” Biederman said, his voice louder and closer, like it was burrowing into her head. “Why do you call it ‘family planning?’ Starting a family isn’t just like writing out a grocery list for a trip to the supermarket.”

No kidding. She and Lewis had planned to have three children, before they got derailed.

“I don’t understand why the insurance company has to put a cap on the number of children a family can have,” he continued. “Is GreatHealth promoting eugenics, or something?”

“No, sir, that’s just our company policy.”

“I know, you said that. Here’s the situation, ma’am. What did you say your name was? Rebecca?”

“Rebecca, yes.” It stung her when they used her name.

“Rebecca, I’m a cancer survivor. I had testicular cancer when I was twenty-eight. I was diagnosed the same month I got engaged to my wife. Can you imagine the complications that diagnosis entailed?”

She could indeed. The ulcer was really digging in now. After the first round of rejection they inevitably told her “their story.” She was basically obligated to listen.

“I’m being formal with my language because at this point in my life I’ve had a great deal of practice telling complete strangers about my cancer,” Charles Biederman said. “I lost both of my testicles. I thank God my fiancée still agreed to marry me. At that time we discussed having children, and we agreed we wanted to have two. We accepted the fact that we would have to go to a fertility clinic. See, I banked sperm before I had my operation.”

“I’m glad you were able to do that,” Rebecca said, attempting to keep him happy, hoping to create the impression that she was on his side.

“Yes. Well, I still have the same job I had when I married my wife. My wife still has her same job. When we were first married we kept her on her own health insurance, trying to hedge our bets. We attempted three cycles of in vitro fertilization under her health coverage, and none of those were successful.”

Biederman let this information hang in the air. Rebecca was about to offer an apology, but he continued.

“Then we transferred her to my insurance. So, I’ve actually been through this entire phone call, and this entire process, and this entire cycle of unending, infinitely frustrating bullshit before. I know all about ‘maximum allowances’ and ‘elected procedures’ and ‘coverage life-cycles’ and any other inane, flatulent phraseology you can squeeze out your ass.”

He had her cornered there. Rebecca hated the company jargon, hated the dialogue they made her go through. She had received three weeks of training on everything she could and could not say to a customer. She had a sixty-eight page binder of phraseology in her desk, and an electronic pdf version of same on her hard-drive. The words and phrases assaulted her brain, came to her in sleep, harassed her in her waking moments. She thought it was ridiculous and insulting that her own employer did not trust her to communicate openly with customers, as if she might screw up and cost the company money by, for example, approving a claim.

“So now it appears we have reached a point,” said Charles Biederman. “Where my wife and I have exhausted our options with regards to our so-called ‘family planning.’ We have used up all of our fertility events, or whatever you want to call them, from both of our insurance providers. Our only remaining option, it seems, is for one or both of us to quit our jobs and hope to find a new job- in today’s economy- and hope that that new job provides insurance which includes ‘family planning,’ and hope that three more cycles of in vitro are enough for us to have one more child. God forbid we might one day decide we want a third child. Do you know what in vitro fertilization entails, Rebecca?”

“No, Mr. Biederman, I’ve never personally been through in vitro.” This statement was not in the phraseology handbook.

“It’s a rigorous process of hormone injection and constant doctors’ appointments. It’s emotionally, physically, and psychologically exhausting, and the majority of the burden falls on the woman, since she’s the one who has to endure all the needles and the drugs. She’s the one who has to go through the procedure. I have to sit there and watch my wife stick herself with hormones. As if I don’t feel ashamed and emasculated enough. And my wife has been through this six times now, Rebecca. Six times. She’s on anti-depressants from the stress-”

So am I

“-which she has to stop taking when she tries to get pregnant. She feels like her brain is being ripped from her head with all the drugs she’s taking-”

Try Percocet

“-and those are only the physical and psychological costs. Do you know what the financial cost of one cycle of in vitro fertilization is, Rebecca? Twenty thousand dollars, if insurance doesn’t cover it. Six thousand dollars, if it is covered, by your company. Do you have twenty thousand dollars lying around, Rebecca?”

I have sixty dollars in my bank account, which is why I even came to work this morning

“My wife and I certainly do not. So now since we’ve used up our maximum number of allowances, I guess we’re stuck. Certainly stuck financially. Which is only one part of the problem. I’ve used my sperm from my sperm bank six times now, and produced one child. That’s a shitty batting average. And I do not have an unlimited amount of sperm. I’m running out. Do you know how humiliating that is for me to admit to people? My real question here, Rebecca, is how can my insurance company dictate how many children I can have?”

I agree with you

“Does GreatHealth have something against cancer survivors? Do I have to go into detail about how much worse my life has become since I had cancer? The word ‘survivor’ hardly provides any comfort, Rebecca. Sometimes I think it would have been easier if I were dead-”

Definitely on the same page now, Charles

“-then my wife could have married someone with working biology and at least she could have had a shot at happiness.”

Rebecca started crying, silently, covering her mouth so Biederman could not hear.

“Now I know how this process works,” Biederman continued. “I know how GreatHealth works. I know you are just a person with a job, Rebecca, and that it is not your fault my wife and I cannot have as many kids as we want to have. I know you personally do not have any control over your company, or the health coverage my employer chose for me, or the stars in the sky. I’m not trying to be an asshole.”

I know you’re not an asshole

“Mr. Biederman, I sincerely wish there was something I could do to help you-”

“There may actually be something you can do to help me, Rebecca. See I know that my entire health care package is really just a file in a computer somewhere. I know it’s all just some electronic profile which someone at GreatHealth has to update according to my claims and rate adjustments and so forth. It’s just a matter of entering data. What if you could simply go into my profile, Rebecca, and click a little box to approve another in vitro cycle? Or delete certain information to make it look like I’ve only used up two of my family planning events.”

“Sir, under no circumstances would I be able to do anything like that.”

Except that somehow- perhaps he really did know, or perhaps he just got lucky- Charles Biederman had in fact identified how exactly the whole GreatHealth database worked. Every customer did have a profile, and every profile did have a separate page for each individual claim, and at the bottom of each page was a button that said “approve.” Claims could be added or deleted by accounts administrations, and she technically had the ability to do so.

“Just a click of a mouse,” Biederman said. “Who would ever know? So one family gets an extra cycle of in vitro fertilization. The world keeps turning and maybe my wife and I get to have one more child, which I don’t think is too much to ask considering how much the world has taken from us.”

Rebecca stared at her computer screen, her lip quivering, her headset pinching her scalp.

You’re absolutely right, Mr. Biederman. I could just click a button and give you and your wife another chance. And honestly, as long as I deleted one of your previous claims from your record, nobody in the company would probably ever find out about the subterfuge, because technically it’s nobody’s job specifically to double-check claims against maximum allowances, so long as we loyal fucking Rejection Specialists do our good little jobs by constantly saying No No NO. And you might also find it interesting to know, Mr. Biederman, that there are intra-company contests between all the accounts administrators to see who can tally the most claims rejections over the course of the year, and the winner of the contest in each department gets a nice bundle of blood money, which is actually pretty substantial- my supervisor, for example, Craig Bortle, is pushing everyone in our department super hard so that he can get an even bigger bonus from the regional douchebags above him, which he plans to spend on a Jet Ski, yee-fucking-haw!, which I know because he constantly tells me that’s what he wants to buy and when he gets it he says I should totally go out on the lake for a ride with him. And did you know, Mr. Biederman, Charles, Charlie, that my supervisor spent the first two years of my employment making overt, leering references to my cleavage, finding me at the water cooler whenever I left my desk so he could drool over my tits, which is why I wear turtlenecks to work every day now, even though I HATE things touching my neck because I feel like I’m suffocating. Wish I could just click a button for you, Mr. Biederman, wish I could click a thousand buttons, like the one on Mrs. Andrea Wolcott’s profile, who called me last week to complain that her company just switched health care providers to GreatHealth and that now the follow-up PET scans for her double mastectomy aren’t covered because she has a pre-existing condition (cancer again!), and her scans cost about, oh, twelve grand a pop without insurance coverage, and she has to have them every six months. That’s another button I could have pressed, but didn’t. Or Lucia Franklin, who I spoke to last month, who survived a burning house falling on her with third-degree burns over ninety percent of her body, including her entire face and head, who could not receive coverage for the plastic surgery which would restore her just a modicum of dignity and allow her to, oh, leave her house and go fucking grocery shopping, or God forbid try to date again, since her boyfriend left her when the bandages were removed, but she can’t afford the surgery and GreatHealth won’t cover it because it’s an “elected procedure.” That’s another button I could press. And there are a thousand more, and I wish I could press every button, and click every little box, and say “fuck GreatHealth,” this bastion of rejection, so that maybe I could feel good about what I whore myself out for for a living, and I wouldn’t have an ulcer devouring my abdominal cavity- even as we speak- and I wouldn’t shit blood, or smoke two packs of cigarettes a day, or swallow a bottle of prescription pain killers to end my life, which I also failed at, because I don’t have the simple courage or self-respect to quit this job and look for work which doesn’t make me WANT TO FUCKING DIE

“I’m sorry, Mr. Biederman, I’m afraid there’s nothing I can do.” Silent tears poured down her face. “Is there anything else I can assist you with today?”

“You can talk to me like a simple human being, Rebecca. You are a human being, aren’t you? I just told you I have no fucking balls, for God’s sake. Do you know how humiliating that is to admit to someone? To a complete stranger? And you talk back to me like some automated voice-prompt system. I already went through the fifteen rounds of voice-prompts just to get you on the phone. I don’t see why we can’t just fix this little problem, Rebecca. And life will go on.”

I’m going to kill myself tonight

“Mr. Biederman… let me transfer you to my supervisor.”

“Oh, no, please-”

She cut him off and put him on hold. Her hand trembled, her eyes burning with tears. All around her she heard the beehive of the customer service department, buzzing away. Her stomach felt like a pumpkin being carved out with one of those little jagged knives.

She took a deep breath, dialed Craig Bortle’s extension. Her supervisor picked up on the second ring.

“Rebecca,” he said with that mischievous, conspiratorial tone, like they were in on some secret.

“Craig, can you take line three?” she asked, trying not to sound like she’d been crying. “It’s a family planning request.”

“Not taking no for an answer, eh?”

“I’ll send you his profile.”

“No problem, kid. I got this.”

He hung up. Talking to Craig Bortle made her instinctively cross her arms over her chest. The endowment in her blouse was something she had carried with her her entire adult life, one more thing she could not control that the world seemed determined to make her feel bad about.

She dropped her headset and left her cubicle. Took the elevator down to the lobby. Pushed through the glass doors and strode fifty paces through the drizzle to the designated smoking area located safely away from the oxygen sphere of the building. Fingers trembling, she fumbled her Camels out of her purse, stuck one in her mouth, lit up and inhaled. Her whole body seemed to hurt. Across the parking lot she could see her car. She wanted to walk over to it, get in, drive away, maybe floor the accelerator and drive herself into the highway abutment. Right now she knew Craig Bortle was sending Charles Biederman back into his misery with a little serpentine company jargon. Rebecca tried to picture Charles Biederman in her head. She saw a tallish man, thin, with brown hair, neatly combed, smart glasses. A gentle but tired smile. She imagined him undressing for bed in front of his wife, self-consciously pulling pajamas over his boxer shorts. She wondered if they ever had sex, if they even could. If they talked about it at all. She and Lewis had stopped talking about it. Why had they stopped talking about it? Why had they let one miscarriage defeat them?

Rebecca watched another group of smokers shuffling in the cold, cackling at the same old jokes and stories they told each other every thirty or forty minutes all day every day. These men and women were twice her age, their faces lined like old leather shoes, clouds of smoke wafting from their heads. One of them hawked and spat a grey tobacco globule onto the wet pavement, and Rebecca wanted to throw up. That would be her, she realized, one day, thirty years on.

Tonight I will finish the Percocet, finish the job

She returned to her desk, stared at her monitor. Charles Biederman’s profile was still open on her screen.

Suddenly Craig Bortle appeared at her cubicle, sending a shockwave of adrenaline through her veins.

“Rebecca,” said the cleavage peeper. “I got him for ya.”

He made a pistol with his fingers and fired an imaginary shot. “Gave him the elected procedure spiel. Dude was pretty adamant. Said what did we have against cancer survivors? Nothing, guy, it’s not personal, for Christ’s sake. Plus, it’s like, so what if you can’t have another kid? The planet has too many goddamn people as it is.”

I’m going to be sick

“I went ahead and entered the rejection under your name,” he said. “That’s another one for our team. We need all we can get, Bill Pooley’s team is creeping up. His target call durations are a hundred and fifty seconds. Good luck, Pooley. Check this out, Rebecca.”

He leaned across her, thrusting his body into her space, clicking away Charles Biederman’s profile to open up Google images on her computer. He typed in “Yamaha FX Cruiser,” and a hundred pictures of the Jet Ski appeared on Rebecca’s screen.

“That’s it,” he said, turning to her, his face inches from hers. “What do you think? That’s some serious throttle.”

I don’t give a screaming shit

“I hope you get it, Craig.”

“Oh, I’m getting it. I’ll totally take you for a ride too. Break out that bikini, kid.”

I will douse you with gasoline and set you on fire

Craig Bortle winked at her and sauntered away from her desk.

Rebecca stared at her computer screen. Stared at the fucking Jet Skis. Some man-child’s little toy purchased from the fruits of a nation’s misery.

She banished Google images, opened up her customer profile database and started typing. Clicking buttons and checking boxes. Approving all kinds of previously rejected claims. Charles Biederman’s in vitro cycle, Andrea Walcott’s PET scans, Lucia Franklin’s plastic surgery. Hundreds of others. With each little click of the mouse she felt the pain in her stomach transform into the giddy, butterfly flutter of a first kiss.

I will not kill myself tonight

For each “approve” she clicked the company would generate an automated letter to the customer informing them that GreatHealth would cover their medical claim. The letters went out as routine as clockwork.

Ladies and gentlemen, I quit!

By the time anybody noticed Rebecca’s sabotage, if anyone ever did, months would have passed, and the treatments and procedures she had approved would likely already have happened. The company would have to eat its losses. They could not retract or recall a cancer treatment, or a nose job, or a baby.

If it’s a girl, Charles Biederman, Rebecca might be a good name

As her final act of employment as an accounts administrator at GreatHealth Health Care, Rebecca typed a short email to her supervisor, Craig Bortle. She pasted a picture of a Jet Ski into the email and typed: “No, Craig, I will not ‘go for a ride’ with you.”

She cc’d every email address in the GreatHealth corporate directory, starting with Human Resources, then clicked Send.


Adam Matson is originally a native of Acton, MA, and now resides in Malibu, CA. His short fiction has appeared in numerous publications including The Berkeley Fiction Review, The Indiana Voice Journal, The Broadkill Review, Happy Magazine, and The Cynic Online Magazine. He has also published a collection of short stories called “Sometimes Things Go Horribly Wrong” (Outskirts Press).