Tuesday, July 9, 2013

Having the Proper Credentials

A Brazilian woman had suffered abdominal pain off and on for weeks. Her doctor had found nothing abnormal. It resolved, so she flew to the US, but the pain had come back, explained the travel insurer who phoned to request a housecall.

Her host lived in the Hollywood Hills and spoke excellent English. She may have been a show business personality because the walls were covered with celebrity photographs and posters. After examining the guest, I explained that she needed further evaluation and tests, perhaps an ultrasound because one possible diagnosis was gallstones.

Her host spoke up. “You are ordering an ultrasound? Where must we go?”

I explained that I wasn’t ordering an ultrasound but referring her to a doctor who could do whatever tests would provide more information. My next step would be to go home, fax my report to the insurer’s American office in Miami, and follow it up with a call to alert the dispatcher. He would phone facilities until he found one willing to accept the Brazilian insurance and then call the client. It might take a few hours.

“I have a fax machine. Why not call now?”

I didn’t know the fax number. It was at home.

“Then I will call.” Examining her guest’s insurance papers, she found a fax and phone number, but they looked foreign. As she dialed, I warned that the Brazilian office probably didn’t handle policyholder medical problems, but she waved me off. 

The followed a long conversation in Portuguese. Afterward, she explained that she had laid out the problem. They promised to get back to her.

I returned home, faxed my report, and called the Miami office. Before I could report back to the Brazilian lady, she called me.

“What is your license number?” she asked.

“Why do you want that?”

“Brazil never called, so we went to Cedars-Sinai. The ultrasound department needs your license for the test.”

“Don’t do that!” I said. “The ultrasound will not solve her problem. Even if it’s normal, she has to see a doctor. And it’ll be very expensive unless the insurance approves.”

I phoned the Miami office to urge them to deal with Cedars-Sinai. Within minutes my phone rang. It was the Brazilian lady again.

“There is something serious…. Cedars-Sinai has no record of you.”

“Probably because I’m not on their staff.”

“They check everywhere. They cannot find your name. I am very disturbed.”

I assured her I was a real doctor.

“How do I know that? When I called for a doctor, you came to the house in an hour. That is suspicious.”

She could Google me, I suggested.

The dispatcher called with equally unsettling news. He had phoned Brazil to obtain approval for the extra expense. This is never a problem because I phrase my medical reports so they are undeniable. Unfortunately, the Brazilian office had an earful from the Brazilian host who had emphasized her friend’s past suffering. This provided an irresistible excuse to claim a pre-existing condition and deny approval.  

After waiting for several hours, the patient felt better, so everyone went home. I warned that she still needed an evaluation and offered to refer her to a colleague’s office. Her host remained polite but informed me that the next doctor she consulted would have to have better credentials.   

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