A Brazilian woman suffered abdominal pain, but
her doctor in Rio found nothing wrong. It went away, so she flew to the US
where it recurred.
Her host lived in the Hollywood Hills and spoke
excellent English. She may have been a show business personality because her
walls were covered with celebrity photographs and posters. After examining the
guest, I explained that she needed a further evaluation, perhaps including 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 were necessary. I
added that my next step was 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 doctors in Los Angeles, preferably the ones I recommended, until he found
one willing to accept the Brazilian insurance and then call her. It might take
a few hours.
“I have a fax machine. Why not do it now?”
I didn’t know the insurer’s fax number. It was at
home.
“Then I will call.” Examining her guest’s
insurance papers, she found a phone number, but it looked foreign. As she
dialed, I warned that the Brazilian office probably didn’t handle referrals,
but she waved me off.
There 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 came to Cedars-Sinai.
The ultrasound department needs your license for the test.”
“Don’t do that!” I said. “The first step is to
see a specialist. And the test will be very expensive unless the insurance
approves.”
I phoned the Miami office to urge them to settle
matters 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.”
“I’m not on their staff.”
“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 in an hour.”
She could Google me, I suggested.
I phoned Miami to warn that the patient had gone
to Cedars. The dispatcher delivered equally bad news. He had phoned Brazil to
obtain approval for the expense. Unfortunately, the Brazilian office had had an
earful from the Brazilian host who emphasized her friend’s past suffering. This
provided an irresistible excuse to claim a pre-existing condition and deny
approval.
After hearing this news, the patient and her host
went home. I warned that she still needed an evaluation and offered to refer
her to a colleague. The Brazilian host remained polite but informed me that the
next doctor she consulted would have to have better credentials.
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