By Mike Oppenheim, M.D.
An elderly lady opened the door, smiled in welcome, and gestured me to come in and sit. As I followed, she remained silent, so I knew immediately that she spoke no English. If someone doesn’t know “hello” comprehension is generally zero. Although half my patients are foreign, almost all know enough English to deal with a simple problem. The rest have a companion to interpret, but now and then this problem arises.
“Portuguese.” she said. “Speak Spanish?”
When I shook my head, she took up her cell phone. The first number she dialed didn’t answer. The second, after a short conversation in Portuguese, proved unfruitful. She continued dialing. She was undoubtedly Brazilian, and almost every South American I see has travel insurance; if I phone the insurance agency’s 800 number, someone will interpret. Unfortunately, her travel insurer hadn’t called me but a national housecall service, Expressdoc. When Expressdoc needs a housecall in Los Angeles, it calls me. Since I collect the same fee, I don’t care where the call originates, but it’s a mystery why some insurers don’t call me directly and save money. I could phone Expressdoc and ask for the agency’s number, but that makes them uncomfortable. They also know the insurer could bypass them, so they’d rather not make them aware of who’s doing the visits. I sympathize; housecalls is a dog-eat-dog business. The lady finally reached a friend, and we proceeded with the consultation, passing the phone back and forth. As usual, delivering medical care was the easiest part of the housecall. She had broken her glasses a few days earlier and complained of headaches, but I suspected she wanted a doctor’s note so insurance would pay for replacement glasses.
Before driving home, I answered a message from the Embassy Suites at the airport. The previous evening, a Canadair stewardess had phoned, confined to bed with a backache. Many foreign airlines call me to see sick crew members; I bill their central office. Sadly, American air crew with their American insurance are out of luck. Billing an American insurance carrier – and for a housecall! – guarantees torment and aggravation, and I’ve long since given it up. Billing a foreign airline is no simple matter (“my manager says send your bill to the main office” never works), but once we’ve agreed on a formal arrangement, matters work smoothly. Sadly, I have no arrangement with Canadair. I explained this to the flight attendant, and she agreed to consult her supervisor. When I answered my message, I was delighted to hear her explain that Canadair had faxed an approval for my visit and its credit card number. Her backache had improved, and all she needed was a doctor’s note approving travel home as a passenger. I expected an easy visit.
After a short consultation and the note, I presented myself to the front desk where I discovered my optimism was premature. The number on the Canadair fax belonged to an American Express card. American Express charges more, so many credit card services, including mine, don’t cover them. I explained this to the desk clerk who summoned her manager who apologized, phoned Canadair, and learned that the airline did not have a Visa or Master card, a situation I’ve never encountered. No problem, the manager assured me. The hotel would mail me a check and bill Canadair. This seemed a bad idea because hotels don’t normally do that, and long experience has taught that expecting a hotel to do something it doesn’t normally do leads to frustration. But my rule is to never hassle a hotel, so I smiled and agreed. An hour later, the manager phoned to say that, rather than mail a check, the hotel would pay cash on my next visit. Naturally, I agreed.
Two days later, picking up my wife at the airport, I stopped by the Embassy Suites. I wouldn’t be writing this if matters went smoothly, but the desk clerks looked mystified when I explained my purpose. They phoned the manager who was tied up in an important meeting. I waited half an hour, but when my wife called. I departed after leaving a polite message on his cell phone. He was off duty when I returned the next day, and the desk clerks remained puzzled at my request. There is no great lesson here, and I’m sure I’ll eventually collect, although I suspect I’ll have to phone Canadair a few times, fax a few forms to Canada, and wait a few months.
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