Vomiters Hate Waiting

A hotel guest phoned to ask when I’d arrive.

“In about fifteen minutes.”

On her initial call, I had told her I would arrive in an hour, and I was on schedule, so the call meant that she was still vomiting. Vomiters are impatient.

My database shows 2,328 entries for “gastroenteritis” (the common stomach flu). It’s my second leading diagnosis and far more satisfying than “upper respiratory infection” (4,584). Both are almost always incurable, but gastroenteritis rarely lasts more than a day; patients give me credit when it goes away.

The guest greeted me at the door, a good sign. A guest in bed is OK, sprawled on the bathroom floor is not good.

I asked the usual questions and did not interrupt as she delivered a precise, item by item, account of dinner. Everyone blames an upset stomach on their last meal, a belief as correct as most popular health beliefs. I gave the usual advice which included telling her to stop what she was doing (putting fluid into her stomach as fast as it came out) and to suck on ice and wait.

I gave the usual antivomiting injection and two packets of pills which I had pocketed before leaving so I wouldn’t have to remember to restock my bag.

When I phoned later, she told me that she had recovered and thanked me for curing her.

 

 

Christmas Day

 A travel insurer reported a sick child at the Anaheim Holiday Inn, near Disneyland forty miles away. Freeway traffic was tolerable, but when I arrived and knocked no one answered. 

I walked around the lobby. With my suit, beard, and black bag, I look like a doctor in an old Hollywood movie, but no one responded. A waitress in the hotel restaurant asked at everyone’s table, but no one admitted calling a doctor. 

I drove away in a good mood. When hotel guests call and then disappear, I’m out of luck, but travel insurers pay for no-show visits.  

I was a mile from home when the insurer called. The mother was on the line, claiming she had been waiting in the hotel. So I drove back to Anaheim. To my everlasting credit, I was entirely pleasant to the mother, waving off her excuses. The child had a cold.

Another Easy Visit

 I drove to Glendale to care for an elderly Argentine lady who had been vomiting. That can be a tricky problem in an old person, but she was recovering, so I felt comfortable leaving her with advice and medication.

During the visit, I had the experience of listening to someone with a thick Spanish accent denounce Mexicans. She had eaten in a Mexican restaurant and was certain the spicy food made her ill. Argentina is a country with extensive cattle ranches and a largely meat and potatoes diet. 

Another Failure of Communication

 “My son with pain in ear. Maybe he need a doctor.”

“I can come to the hotel.”

“Not today. I give medicine. Maybe if he has pain tomorrow.”

“So you’ll call me tomorrow?”

“Yes. Can you come in the morning?”

“Yes.”

 “When.”

 “I can be there between 10 and 1.”  Strictly speaking, I can come at any time, but I like to avoid driving during the rush hour.

 “Three hours is too long. We want to visit the city.”

 “You said you’d call tomorrow. When you call, I’ll tell you exactly when I’ll be there.”

 “OK.”

Most guests who promise to call never call, so I put the matter out of my mind. After noon the following day, the phone rang. It was the concierge at that hotel. “I’m afraid we’ve had a complaint, Doctor Oppenheim,” she said. “Mr. Desai in 403 says he and his family have been waiting over three hours. Are you going to come?....”

 

 

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.