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Medical bureaucracy strikes again

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Probably there is no other situation which makes a foreigner feel less at home in any country like having to deal with bureaucracy. And dealing with medical bureaucracy is even worse, because you do it when you're sick, so it's a double frustration. Read how I was trapped in the labyrinth of the system here in Tel Aviv over a minor injury (friends, don't worry about me).

A leaflet I got along with my health insurance (provided by Harel) documents lists the hospitals and clinics in Israel that the insurance company recommends for English speakers. Bikur Rofeh clinic in the eastern part of the city is the only one for Tel Aviv. However, fortunately the insurance company has a customer service centre that operates 24/7. So I call there to find out my options.

The agent I talk to asks if it is an emergency. When I say that it is not too bad, yet I still want it checked, she gives me three phone numbers: one of the recommended clinic, and two of private doctors. She says the doctors should start working at 8 am. I decide to wait, because I don't know the city well enough as to find the 24/7 clinic at night. The next morning I call one of the doctors, who is supposed to work on the Gordon street - close to where I take Hebrew classes. On the phone, he says that he's not on Gordon, but on Shprinzak. This is far away, close to the Bikur Rofeh clinic, so I decide that if I have to go far, it's better if they give me full service there. I try the other doctor, and nobody is answering. I try the clinic then, which is supposed to work 24/7, but nobody answers either of my six or seven calls from 8 to 9.30.

I call the customer service again to inform them that the numbers they gave me proved to be of no use. They give me numbers of two more doctors. As for the first one, my phone informs me that this number does not exist. The second one answers, inquires about my problem and tells me to call the customer service again and tell them that, in his opinion, I need a specialist, not a GP. I do that and get two numbers of the specialists I need. They do not answer. I call again and get one more number. The agent tells me that if it doesn't work out, I should just go to the emergency room of a certain hospital. Although I'd generally shy away from bothering the emergency room with just a slight and bearable injury, I actually hope in secret that the doctor won't answer and I'll go to a place where service must be guaranteed for me. Yet the doctor answers and makes an appointment for me in three hours. I wait and then go. In fact, although the agent had said the doctor works on Raines street, he works on Shprinzak - ironic, no?

I tell my insurance data at the clinic and wait. The doctor is indeed English speaking, he checks the situation and says there shouldn't be anything to worry about, prescribes painkillers and an X ray. And now the culmination. The clinic doesn't do the X-ray, so they will fax the prescription to the insurance company, and then I must wait for a call to hear where and when to get the X-ray! I ask the receptionist at the clinic whether I should wait there, but she tells me to go home. Well, what can I do. I wait until 4 pm and then realise that probably there's no chance of getting X-rayed today. I call the customer service and ask them what I should do and when I am getting that call. The agent asks me whether I went to the hospital, because I was told to do so, and she's surprised I didn't. I explain them that they themselves told me to first try their recommended specialist, and that he assured that nothing is broken, yet I should get an X-ray. They tell me two addresses - one totally outside of Tel Aviv, in Bnei Brak, another in a suburb. I ask them if there is an X-ray anywhere in Tel Aviv. No, apparently only these two (a thought crossed my mind that maybe I should try to extract more addresses from another agent later). How wonderful! I wonder what people with serious injuries do in this city.

My first impression after all this was 'wow, it's actually worse than in Lithuania!' Back there, most of bigger clinics in cities are equipped with such basic things as X-ray machines, no need to go to Santariskes (the big medical centre in Vilnius) for that. The network of clinics is of rather optimal density, in my opinion. On the other hand, I don't know how it would work for an English-speaking foreigner. Maybe s/he would also be sent around in a desperate search of English-speaking doctors all across the city. But hello, Tel Aviv boasts as being a city where English is never a problem. And I don't need much Hebrew to get an X-ray.

The fact is that health insurance is not institutionally universal here in Israel. Different insurance companies are associated with different service providers. On the other hand, as much as I can deduct from the leaflet, in case of emergency money paid to any service provider will be reimbursed. In Lithuania, national health insurance requires individuals to register with one institution, which can later be changed, and, upon prescription, services are for free or for a reduced price. As for private health insurance, as far as I know, it reimburses expenses at any institution. All people studying, employed, retired or registered for unemployment services in Lithuania automatically receive health insurance.

Vilnius-based foreigners who read this blog: I'd love to hear your stories of dealing with medical bureaucracy! Please comment


Update. Friends tell me not to be naive: there are clinics in Tel Aviv, but unless someone is really splashing blood, the insurance sends them to the cheapest clinics so that it can pay less.


More update

So the next morning I set out to get the x-ray in Ramat HaChayal. The clinic is, fortunately, not too far from the bus stop. It's a huge building that reminds more of a shopping mall than a hospital. It has shops and cafes for those who are waiting or visiting. Everything is very spacious and very modern. So I go to the x-ray department... only to be asked, 'Where is the permission from the insurance to get an x-ray?' 'My WHAT???' my eyes nearly jump out of their eyeholes. I try to pass with the prescription, 'Isn't that enough?' 'No, it's from the doctor, you need a document from the insurance, stating that they will pay it,' - says a, fortunately, polite and friendly receptionist, to whom I speak Russian (this has already proved to be such an asset here in Israel). 'But... it was the insurance that sent me here! How do I get the document?' I'm overcome with frustration. The lady suggests that I call the insurance, explain the situation and tell them to send the permission by fax. She nicely writes down the Hebrew name of this document in the Cyrillic alphabet. The insurance does send the fax, and I can get the x-ray.

Now, the only thing I need is to find a place to receive a fax with the x-ray results, and then go to see a specialist again. I think this running around is worse for my health than the original trauma.

My advice: don't go to live in Israel unless you're perfectly healthy and have no inclination towards extreme sports, etc. And don't wear high-heels, just in case ;) Yet things can happen even in perfectly safe situations, as you see.

The next update will be a map of my 'medical geography'.