Shortly after forty-six-year-old Karen Hull had elective disc surgery at one of our hospitals, she used a new Geisinger app to request a refund for $150 of her $2250 financial responsibility. The problem wasn’t with the surgery – that went well. But Karen was unhappy with a phone call she’d received earlier from a hospital representative who had requested a “good faith payment” – making her feel as if we didn’t trust her to show up for her surgery. She was also unhappy that she’d been kept waiting for a meal after surgery when she had not eaten all day. The $150 itself wasn’t especially significant to her, but the request, she explained, was symbolically important; she wanted to be sure we understood what didn’t go so well about the experience.