I always have more ideas than I have time to write. I often get frustrated by this, but I’m trying to reframe this as a good thing. Like it’s a buffet of delicious desserts. And it’s okay that I don’t get to eat them all.

Anyway. With that intro . . . here’s a story fresh from the editor’s desk. The seventh story for the Blessed By the Algorithm collection. Will there be an eighth? Maybe.

One Percent

There are too many kinds of pasta. Linguine, spaghetti, bow tie, rigatoni. The grocery store lights buzzed over Gina’a head. Why did they seem so loud? Gina wanted to press her hands over her ears, shut out the clattering carts and the inane conversations. She wanted to sit down on the grimy floor and hug her knees. Wouldn’t that be just what she needed?

Gina could imagine the headline: Local woman arrested for screaming in grocery store.

Pasta. Dinner. Tomato sauce and ground beef. Anything would work. Literally anything would work. The kids needed dinner.

Gina still couldn’t pick. She should be relieved. The last month of her life had been hospital visits and what-if questions. What if my mom dies today? What if she never wakes up but doesn’t die? What if she wakes up paralyzed on one side?

But, finally, finally, Gina’s mom moved out of the hospital. In a nursing home, sure. But out of the hospital. The nursing home was hopefully temporary, just until her mom got stronger.

What if it’s not temporary? How will I pay for it?

No more what-ifs. Not tonight. Tonight she would make dinner for Jeff and Caprice. Tonight they would sit at the kitchen table instead of in the hospital cafeteria. Gina stepped forward and closed her eyes. She grabbed the first box her hands touched.

At home, she attacked the ground beef square with a spatula while the pan heated. Jeff, ten, grated cheese for the topping. Caprice, fourteen, boiled water for the pasta.

“Mom, what’s a stroke?” Jeff asked.

Gina felt a rush of guilt—she hadn’t explained much to Jeff yet. Caprice was old enough to have figured out some on her own. Gina held up two fingers. “Put your fingers on the side of your neck like this. Do you feel anything?”

“I think so,” Jeff said.

“That’s an artery. When something goes wrong with an artery, sometimes you have a stroke.”

Jeff put down the grater. “Will something like that happen to me?”

“No, no, sweetie.” Gina stabbed at sizzling, pink chunks of meat. “It’s something that happens to older people, like grandmas and grandpas.”

Caprice carried the hot pan to the sink and emptied boiling water into a colander. Steam briefly enveloped Caprice’s hands. It still surprised Gina, seeing Caprice act like an adult. Gina could still vividly remember plugging the outlets, hiding the cleaning supplies.

“Mom?” Caprice asked.

Caprice was standing next to Gina. The meat was burning.

“I’ll take over,” Caprice said. “It’s okay.”

Gina blinked back tears. “Thank you.” She sat down at the table and tried to ignore the shoebox full of hospital bills and insurance paperwork. A phone rang. Her phone?

Yes, her phone.

“This is Vicki with Meadowview Nursing Home. Am I speaking to Gina Cantore?”

Gina lost her appetite. “Yes, I’m Gina.”

“I’m calling to arrange for Bonnie Cantore’s discharge tomorrow.”

Caprice set a plate down in front of Gina.

“What do you mean discharge?” Gina asked. “She can barely lift a glass of water.”

“I’m sorry, ma’am. You said you wanted her to stay only for as long as insurance covered her.”

The smell of parmesan and tomato sauce was making Gina nauseous. She got up and paced the living room. “She’s only been there a week. Insurance can’t have run out already.”

“I’m very sorry, ma’am. We called your insurance company to verify coverage, as you requested. The claim was denied.”

Gina knew the drill. “I’ll call the insurance company. My mother is not being discharged tomorrow.”

Emily knew the drill. Coffee, coffee, coffee. She worked the hours her coworkers didn’t want to work. Six p.m. to two a.m., up five hours later to see her kids off to school, then a nap.

Her official job title was Case Manager, but Punching Bag would have been accurate. She rarely talked to someone who was happy with the insurance company.

Emily closed her office door and opened her laptop. Her headphones were a personal purchase, padded around the ears and on the headband. Comfort mattered when you had to wear them for eight hours a day.

The caller queue was, as it always was, stacked with waiting customers. The call center software showed the queue as a line of cheerful person icons. Emily knew that behind most of those blue icons was an anxious patient or family member.

She took a deep breath and hit the Ready for Calls button.

“Hello, I’m Emily, a case manager with Corinth Health Insurance. How can I help you today?”

“My name is Gina, I’m calling regarding my mom, Bonnie Cantore.” The woman sounded calm, at least.

“I’ll need to verify birth date and insurance information, please.”

Emily heard a fork clink against a plate before Gina answered, partially muffled by a mouthful of food.

“I’m pulling up her account,” Emily said. “One minute please.” It took Emily nearly two minutes to scroll through Bonnie’s recent records. A stroke, a long hospital day, then a doctor’s recommendation for nursing home care while Bonnie completed physical therapy. And one last record—a denial for the second week of nursing home care. The third hcompanionAI case Emily had seen this week.

Emily reminded herself her managers could hear everything she said on this call. “I see Bonnie was transferred to a nursing home after a hospital stay.”

“Yes, that’s correct,” Gina said. “I’m calling about her nursing home care. Our latest claim was denied.”

“Our estimated nursing home stay for a patient with Bonnie’s condition is about a week.” Emily hated that explaining this had gotten easier over time. Like a part of her shut off while she was at work.

“The doctor said she would need at least three weeks,” Gina said. “It’s there in her hospital records.”

“We have internal doctors who review claim coverage,” Emily said. “Ultimately, all coverage estimations are reviewed by those doctors.”

A breadcrumb. If Gina could follow it. Emily had to be careful how many clues she gave.

“Ultimately.” Gina’s tone sharpened. “Do you mean that your estimations—your recommendations—don’t come from doctors?”

This much was public already. If you had read the right news articles. Emily couldn’t get in trouble for saying this. If she toed the company line. “Corinth Health Insurance is committed to keeping nursing home stays to the minimum necessary for the patient. This is for the patient’s sake as much as our own—most people would prefer to be at home if they can be. We have a long history of caring for people, and we use that history to estimate how long someone needs to be in a nursing home.”

“Who comes up with those estimations?” Gina asked.

“As I said, we use the data we’ve collected from caring for thousands of patients to inform our care decisions.”

“She can’t get to the bathroom on her own. The attendants at the nursing home still have to help her get out of bed. This is all documented in her health records.”

“May I put you on hold for a minute while I review—”

“No, don’t—”

Emily couldn’t hear the on-hold music she knew Gina was listening to. Don’t think about how frustrated she must feel, Emily told herself. Emily knew she had to be quick. If she hit the right sequence of buttons . . .

“Ms. Cantore,” Emily said. “Sorry about that. I—”

“You can’t deny this claim. You know my mother needs this—”

“We only have a few minutes before the system realizes this call isn’t being recorded,” Emily said. “Please listen.” Emily hoped Gina’s silence meant she understood.

“Your mother’s claim was based on a recommendation by hcompanionAI,” Emily said. “The tool reviews patient records and estimates what the nursing home stay should be.”

“It’s bullshit,” Gina said.

Emily couldn’t get distracted by the unfairness of it. “Case managers pass on the tool’s recommendations to our physical medical reviewers but they’re under the same pressures we are.”

“I’ve never heard of this tool. I don’t understand.”

“Corinth Health Insurance Healing Days. Write this down.”

“I still don’t—”

“I don’t have time to explain everything. I can approve your mom’s claim for now.”

“For now?! What the hell does that mean?”

“The denials are automated. Don’t be surprised if the claim is denied again in a few days.”

“You’re telling me I’ll have to do this again.” Gina sighed.

Emily could hear the fatigue in Gina’s voice. No time to be kind, time was almost up.

“Listen. Write this down. Daren Price. Corinth Health Insurance Healing Days.”

A warning popped up on Emily’s screen. “Calling error. Call recording failed.”

Emily kicked Gina’s call back to on hold, then answered it as she usually did. Gina would be hearing the automated message right now that played for most calls.

 “Your call will be recorded for call quality assurance and compliance needs.”

Be businesslike, Emily told herself. Cold. You’ve risked enough today. “Ms. Cantore, looks like there was a technical issue with our call. My apologies.”

Was Gina crying? Emily could hear Gina sniffle or maybe just clear her throat.

“We were discussing my mother’s nursing home care,” Gina said.

“Based on her medical records, I’m recommending your mother’s claim be approved. Is there anything else I can do for you?”

“No.” Another sniffle. “Thank you.”

“Excellent,” Emily said. “You may be asked to complete a survey about your—”

Gina ended the call.

Emily felt a flash of anger. If Corinth knew that Emily was telling patients about Daren’s lawsuit she would be fired. Just reversing a coverage denial was a risk for her.

A few months ago, she’d been sitting in a webinar with a bunch of other case managers during Healing Days. An executive from Corinth had announced new targets for her department. Nursing home stays should be within 1 percent of hcompanionAI’s recommendations.

“What if the recommendation looks like an error?” someone had asked.

Emily still remembered the executive’s greasy, charismatic smile.

“Well, of course, we should take care of our customers,” the executive said.

“Are we allowed to overrule hcompanionAI if we feel like coverage was wrongly denied?” someone else had asked.

“As I said, we should take care of our customers. Our goal is to improve hcompanionAI until its predictions are within 1 percent of actual nursing home stays.”

“So are our decisions feeding back into hcompanionAI’s decisions?” a third person asked. Emily had been thinking the same thing, but she hadn’t been brave enough to ask.

“I think that’s enough questions on that for now,” the executive said. “We need to reserve some time for our bonus program. When Corinth Health does well, we want all employees to share in that success.”

Emily looked at the note she’d made that day. A note she’d never dare leave on her desk if she worked in an office.

A list of Corinth Health executives and their pay. All in the top 1 percent.

Behind the office door she could hear a game of Minecraft. “Get the torches out!” her daughter said. “Quick!”

A bad job was better than no job. Emily needed a paycheck. She needed health insurance too.

All the ice had melted in Daren Price’s drink. He sipped the warm pop, grimaced, sipped again. Lawyers weren’t supposed to end up on stakeouts. But lawyers on shoestring budgets sometimes did.

Meadowview Nursing Home’s parking lot was helpfully hidden from the front entrance. Daren could only see the end of a walking path that led to the door. He couldn’t see when people left the building, but they also couldn’t see him parked here. For hours.

A woman entered the parking lot. Rainbow paracord bracelet. Dark brown hair streaked with gray. Red oversized purse. Finally, the woman Gina had told Daren about. The woman who had comforted Bonnie Cantore the most before she died.

Daren got out of his car. “Ms. Morel?”

Amanda Morel, nursing home attendant, eyed Daren suspiciously. “Yes?”

“I’m a lawyer. I’m working on a case against Corinth Health.”

“I’m afraid I can’t . . .”

“You can remain anonymous,” Daren said. For now, anyway. He just needed someone to establish a pattern. “I know you care about your patients.”

Daren had talked to several families from Meadowview Nursing Home who were on Corinth Health insurance. They all said Amanda Morel was the most caring nurse on staff.

“I told you, I can’t.” Amanda had her hand on her car door.

If Daren pressed too hard, he would lose her. He slowly approached and tucked a business card into her purse. “I get it. You’re worried about being fired.”

Amanda didn’t answer. But she hadn’t opened the car door yet either.

“I can protect you. You have my card now. Just think about it. Let me know if you change your mind.”

People would be surprised at how mind-numbing the most important cases could be. A woman died on a bus stop near Meadowview Nursing Home last year. She’d been left there after her health insurance stopped paying out.

Last year. Daren was still collecting data, looking for witnesses, building a case. Scrutinizing every detail, trying to anticipate any weakness in his arguments or documentation. Even if he won, it would be years before the families he represented saw any relief. He spent his days documenting tragedy and pain and heartbreak. He spent his nights worrying it wouldn’t be enough.

p.s. If you’d like to get more frequent updates, you can find me on Bluesky, Instagram, or Mastodon. And, of course, all book details are at https://www.megancarney.com