I woke up in a rented room in London in the middle of the night, feeling like my eyes had been packed with hot sand and the lids were somehow glued together. When I pried them apart, the whites of my eyes were an angry crimson.
Maybe it was nothing. I’d been told that the pollen counts in the UK this summer are sky high. A raging heat wave in a city that doesn’t really do air-conditioning (like my gloriously fogbound town of San Francisco) didn’t seem to be helping. But when I squinted in the bathroom mirror, I saw a greenish-white discharge collecting around my tear ducts. This looked like more than a bad case of hay fever.
Then I remembered that one of the cognitive psychologists I’d come to London to interview mentioned that she’d recently had a bad eye infection. I Googled “conjunctivitis.” It dawned on me that the bottle of water I drank in her office may have been a mixed blessing.
But what to do? I was far from home with lots of work to do and no idea how to see a doctor locally. Thankfully, I didn’t have any appointments for a couple of days, and have health insurance from Kaiser-Permanente through my spouse’s employer. But I knew that getting reimbursed for treatment by a doctor outside the Kaiser network can be complex; what about an out-of-country doctor?
When I dialed the 800 number on my Kaiser card to find out what to do, an automated voice from AT&T informed me that I would be billed at the standard international calling rate of $1 a minute. After navigating a maze of call-center prompts, I sat on hold for 15 minutes.
The first Kaiser rep who took my call fired off a barrage of questions. Was I experiencing “blind spots, double vision, floaters, hallucinations, or any other problems” with my vision? Yes — the goopy discharge from my tear ducts was making it hard to see, and I said so. But that turned out to be the wrong answer. The Kaiser rep simply repeated her question in a more brittle tone of voice and added, “Just answer yes or no.”
Yes, I was having problem with my vision, but not “double vision, floaters, or hallucinations.” Judging by the structure of the question, I suspected that it was designed to fish for a different sort of problem than the one I had, such as evidence of entopic phenomena that might indicate something awry inside the eyeball, or even in the brain. I didn’t want to end up shunted onto the wrong track in the voicemail maze. “Floaters, hallucinations, and double-vision, no,” I explained, “but problems with my vision yes, because the discharge from my tear ducts…”
“Sir,” she cut me off sternly. “These are yes or no questions. Answer either yes or no or I will not be able to help you.” I furiously tried to calculate which falsely binary oversimplifications were the right ones.
Then back to limbo at $1 a minute. Finally an advice nurse picked up. She ran me through a nearly identical gantlet of questions — hadn’t my previous answers been logged into the database? — but unlike the previous insurance rep, the advice nurse could handle nuance. Given the severity of my symptoms, she told me, I should certainly certainly see a doctor right away — as soon as I had secured permission for an out-of-network exam with someone at the member-services line on the other side of my Kaiser card.
It was 2 in the morning in a strange country and my eyes were oozing green goo, but at least I was getting somewhere. I called the other number, navigated another maze of prompts, and waited. Tick, tick, tick.
Thankfully, the member-services rep was both efficient and sympathetic. Of course, she said, it must be upsetting to be having eye problems far from home. I should definitely go to a local clinic. But before she could give me permission to do that, she would have to talk to her supervisor, because she’d never dealt with someone having a medical problem outside the country before. Several minutes passed.
Then, good news from the supervisor — with one caveat. Yes, I should go see a doctor at a local clinic. But because this was all happening out-of-network, I would have to pay out of pocket. As long as I made sure to obtain all the necessary receipts and forms, however, I could submit them when I got home, and Kaiser would “open a case file” on me so I could be reimbursed.
I wondered how much the visit would cost me up front — $200, $500, $1000? The unfavorable exchange rate had already vacuumed out my wallet, just picking up Chunky Hummus Salad wraps and “flat white” coffees at Pret A Manger. But it didn’t matter. My eyes needed help now, and I was almost certainly highly contagious; I didn’t want to pass this mess on to anyone else.
The member-services rep then explained that a Kaiser doctor would be calling me within the next four hours to give me additional information. I asked her gently if the doctor could possibly call in the morning London time, because I was already sleep-deprived and had a lot of work to do the following day. Sorry, she replied, that was just not possible. The doctor would have to call within the four-hour window allotted for my case — even if that meant the phone ringing at 5 in the morning.
Still, I was grateful to finally have permission to seek the care that I desperately needed. I called a number I found on the Web for urgent care in Marylebone, the central London neighborhood where I’d found a semi-affordable place to stay for three weeks. Amazingly, a human being picked up the phone right away — an affable guy with a disarmingly chummy accent and an empathic manner. Yes, yes, of course I should see a doctor right away. Where should they send him?
What? This guy was offering to dispatch someone to examine my eyes immediately in my apartment in the middle of the night?
I couldn’t even remember the last time I’d gotten a house call from a doctor — was it when I had chicken pox in 3rd grade? I expressed my astonishment. The chap on the other end of the line just laughed: I assure you, it’s no problem.
Alas, there turned out to be a hitch after all. One of the amenities I’d traded away for affordable lodgings in Marylebone was a landline. The guy explained that the National Health Service couldn’t send out a doctor to see a patient who only had a mobile number. But he took my name and gave me the address of an urgent-care center in a hospital near the Latimer Road Tube that I could visit at 9 in the morning. I thanked him profusely and went to bed.
The physician from Kaiser who called half an hour later was brusque and reassuring as he told me everything I already knew. I almost certainly had conjunctivitis. I should go to an urgent-care center in the morning, get an examination and a prescription, collect all the receipts, and Kaiser would open a file for reimbursement.
A couple of hours later, I pried open my eyes, washed my hands, and headed out to the Great Portland Street tube. Unfortunately, because of maintenance on the Hammersmith and City line, the trip took longer than expected. Arriving in Latimer Road, I discovered that the London street app on my iPhone had been deceptively optimistic; I would need to take a bus from the station to the urgent-care center.