A Brazilian woman had suffered abdominal pain off and on, but her doctor in Rio had found nothing abnormal, so she flew to the US where the pain returned.
It was significant pain. After examining her, I explained that she needed further evaluation and tests, perhaps an ultrasound, because one possible diagnosis was gallstones.
“You are ordering an ultrasound?” she asked. “Where must I go?”
I explained that I wasn’t ordering an ultrasound but referring her to a doctor who could do whatever would provide more information. I added that 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 in Los Angeles until he found one willing to accept the Brazilian insurance and then call the client. It might take a few hours.
“I can fax. Why not call now?”
I didn’t know the insurer’s fax number. It was at home.
“Then I will call.” Examining her 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.
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 I went to Cedars-Sinai. The ultrasound department needs your license for the test.”
“Don’t do that!” I said. “The ultrasound may not solve your problem. Even if it’s normal, you have to see a specialist. And it’ll 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? I called for a doctor, and you came in an hour. What doctor does that?”
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 extra expense. Unfortunately, the Brazilian office had had an earful from the lady who had emphasized her past suffering. This provided an irresistible excuse to claim a pre-existing condition and deny approval.
After waiting at the hospital for several hours, the lady’s pain vanished, so she went home. I warned that she still needed an evaluation and offered to refer her to a colleague. The Brazilian lady remained polite but informed me that the next doctor she consulted would have to have better credentials.