Good Insurance

The caller spoke with a Hispanic accent, so I assumed he was a travel insurer, and I was right. It was StandbyMD, one of the good insurers. It phones; I make the visit; I fax an invoice; it sends a check. Latin Americans make up most of its clients, but anyone can sign up.

A guest at the Sheraton Four Points had been awake all night with an earache. The call arrived at 4:30 a.m., but that’s almost my time of rising, so I was not unhappy. Freeway traffic was light. I was at his room in half an hour.

One thing seemed strange. His name sounded American. This is not rare in Latin American countries, but he also spoke flawless English. He told me his pain began soon after he boarded a plane in Managua.

“So you live in Nicaragua?” I asked.

“No. Vancouver,” he said.

The light dawned.

“Of course,” I added. “You’re Canadian. No American would have such good insurance.”

American travelers buy American travel insurance. When they fall ill, they obtain care and then submit a claim to the insurer which pays as much as their fee schedule pays. Our insurers take a dim view of housecalls, so their reimbursement is not generous.  I can’t remember caring for an American hotel guest and then billing one of the dozen travel insurers that use me.   

 

More Evidence of America's Leadership

 Opening an envelope from an international travel insurer, I expected a check but found only a form letter containing a dozen boxes, each listing a reason why payment was denied. An “X” through one box revealed that I had not submitted my invoice on an HCFA-1500.

That’s the claim form American doctors send to American health insurers. It’s complex, full of codes, questions, boxes, and charges – far longer than my simple invoice. Despite this, it’s badly organized. One must enter today’s date three times.

I found an HCFA form and filled it out, leaving many cryptic questions blank, guessing answers where I wasn’t certain, and including a fictional breakdown of services because I charge a flat fee. An American insurance clerk would post it on the office bulletin board for general amusement.

Two weeks later, a check arrived. Foreign insurers are not up to speed, but they’re trying.

 

 

Ultimatums Are Risky

 Could I see a gentleman at the Omni with an upset stomach?

The dispatcher for International Assistance was delighted to learn that I could. In most cities, dispatchers work hard to find a doctor willing to make a housecall but not in Los Angeles.

I copied the guest’s name, age, room, and insurance I.D. I quoted a fee. That was acceptable. I said I would arrive within an hour. He was pleased to hear that. Then I dropped the bomb. I would need a credit card number.

I could hear the air go out of his balloon.

“We always send a guarantee of payment.”

“You do. But then you don’t pay.”

Many travel insurers pay promptly. Others require repeated phone calls. Pestering a billing department relentlessly usually works, but sometimes I run out of patience, and many visits for International Assistance remained unpaid after six months.

“I’m not sure we have a credit card.”

“Yes, you do. Ask your supervisor.”

All travel insurers have company credit cards but they vary greatly in their willingness to give them out. Some do it routinely. Others require an ultimatum. I hated hearing from Universal Assistance until they coughed up a credit card number. Now I love it when they phone.

But ultimatums are risky. The dispatcher agreed to consult his supervisor and call me back, but I never heard from him.

 

 

 

 

A Rash During the Rush Hour

 A guest in Long Beach had broken out in red spots.

This looked like a terrific visit; skin problems are easy. A sudden rash is frightening but hardly ever indicates something serious. I have no objection to making a diagnosis over the phone, but guests are terrible at describing a rash’s appearance. In any case, most want the doctor to look at it.

My only problem was that the call arrived at 5 p.m. on a Friday, and Long Beach is thirty miles away. I avoid long drives during the rush hour, so I told him I could come around 9.

That wouldn’t work, he replied. He had a long business engagement that evening. But he’d be happy to see me the following morning.

Saturday morning drives are easy, but a rash that arrives quickly often departs quickly. I wanted this visit, so I told him I would be there in an hour. Or two. 

 

Hitting the Jackpot

A call arrived during breakfast. Half an hour later the phone rang again. I was pleased because it was an ideal time for multiple housecalls.

I exercise before noon because later the gym becomes crowded. Two morning housecalls makes arriving before noon impossible. This doesn’t happen often, so I reward myself by skipping the gym without feeling the usual guilt. An hour of exercise is as exciting as an hour brushing your teeth, and I’m deeply suspicious of anyone who claims to enjoy it.

Even better, the second patient was at the same hotel, a rare treat! A downside was that both seemed to be suffering my least favorite illness: a viral respiratory infection. You’ve heard plenty about my reluctance to give antibiotics when they won’t help.

My good luck held. The first guest had a cough and high fever, probably pneumonia because listening to her lungs revealed abnormal noises. In an otherwise healthy person, pneumonia is the only common chest infection that medical science can cure. So I cured her.

On another floor, I examined a middle-aged man who explained that he had bronchiectasis. This is an uncommon condition in which a small area of the lung becomes obstructed, causing frequent infections. This was another, so I gave him antibiotics in good conscience.

These were satisfying encounters, but there was a downside. Because both were at the same hotel, I finished before 11 o’clock, too early to skip my workout.

 

 

Broken Glasses

 An elderly lady gestured me to come in. As I followed, she remained silent, a sign that she spoke no English. If someone doesn’t know “hello” comprehension is generally poor. 

“Portuguese.” she said.  “Speak Spanish?”

When I shook my head, she took up her cell phone. The first number didn’t answer. The second, after a short conversation in Portuguese, proved unfruitful. She continued dialing. She was Brazilian, and most South American travelers have travel insurance. If I phone the insurance agency’s 800 number, someone will interpret. Unfortunately, my call hadn’t come from a travel insurer but a national housecall service, Expressdoc.

I could phone Expressdoc and ask for the agency’s number, but that makes them uncomfortable. Housecalls is a viciously competitive business.

The lady finally found a multilingual friend, and we proceeded with the consultation, passing the phone back and forth. As usual, delivering medical care was the easiest part. She had broken her glasses. She complained of a headache, but it was clear that she wanted a doctor’s note so insurance would pay for a replacement.

 

A Prominent Scam

A guest at the Luxe explained that he was in town for six weeks and needed a disabled parking pass. I told him that was not something I handled. He added that he had the Department of Motor Vehicles form. All he needed was a signature.

I offered to come to the hotel, but – even at half my usual fee – he didn’t want to pay. I could have politely withdrawn, but he might then ask the hotel to recommend another doctor, never a good idea. As I do when it’s an easy service, I told him I would sign the form gratis if he came to my house.

After hanging up, I felt uneasy. Eleven percent of Los Angeles drivers have a disabled parking pass; it’s clearly a scam, and I didn’t want to add to it. What if I had to refuse him? When guests complain after I refuse narcotics, hotel management takes this with a grain of salt, but a parking pass….

You can imagine my relief when I answered his knock and saw that he had only one leg.  

 

 

The Year of Viagra

 National FDAs in Europe and Asia approve new drugs after deciding that the benefits outweigh the risks. Aware that bad side-effects produce an avalanche of lawsuits, America’s FDA takes more care. No matter how many lives a new drug will save, it wants the risk to be minuscule. This is hard, so our FDA takes a long time to make up its mind.

As a result, other nations often have access to new treatments years before America. Doctors complain all the time, but no one expects the FDA to change.

There was a delightful exception: Viagra, discovered in Britain but first released in the US. It’s my impression that no foreign businessman in 1998 considered his US trip a success unless he returned home with a bottle. My records show forty hotel guests who summoned me with this in mind.

I love visiting guests who aren’t sick. While I have no objection to filling certain prescriptions over the phone, Viagra is a powerful drug with serious side-effects. Experts advise us to examine and educate everyone who wants it.

No one objected to paying for a visit, so I came and asked about the guest’s medical history, performed an exam, and delivered my Viagra education. It doesn’t enlarge the penis; it’s not an aphrodisiac, it won’t prolong intercourse or delay ejaculation. It only encourages an erection. No one failed my exam. One gentleman from Indonesia asked for 5,000 tablets. Suspecting these were for resale, I worried about the legality, but this was no problem insisted the happy pharmacist who called me to confirm.