The Impegnativa, one very important Italian document

Perhaps a better title for this post is The Italian Medical system, part XXX .  Seems I could write on this topic endlessly!  It's a subject I get asked about frequently in emails and in conversations with tourists from almost every country imaginable, but mostly from Americans wanting to hear first hand what I think about the differences between medical services here and back home.

I spent a bit of time this rainy morning over at Ospedale Civile while waiting for an appointment with an ear specialist, and that got me to remembering a previous visit to an ear specialist back about 6 years ago.  It was my famous visit to ex-Ospedale Giustinian, over in Dorsoduro, the afternoon I got lost and locked in the bowels of that huge, dark, scary Venetian building and ran into the worker wearing only his underwear. An afternoon I would like to be able to forget, but unfortunately that image is forever etched in my brain.

Last week when I was making this appointment, I flatly refused any and all possible appointment times offered at Giustinian. No, never again. Trust me. Never again. I'll go anywhere else, even to Mestre on the mainland, but not Giustinian. Thankfully this morning finds me at Ospedale Civile in Campo San Giovanni e Paolo.

I couldn't help but do a re-play of that horrifying afternoon in my head while passing time in the waiting room this morning. When my turn was called, I took my place at the sportello (counter) where the intake nurse processed my paperwork. Finished with all that, I asked if she could help me with one other matter.  I've been having a real run around trying to get appointments for injections in my knee for months now, and since Orthopedics share the same office space here I thought I'd just try my luck one more time. I already had an impegnativa (see photo above) for the injections, but for unknown reasons every time I tried to make the appointments, I was given another reason why they could not make an appointment on this doctor's calendar. It has been months, and still nothing. 

I'd discussed this problem with my regular doctor the week before, and she gave me yet another impegnativa for the injections with the advise to try again at the hospital appointment desk. I did try, but was told only my Orthopedic dr. could give this prescription, and I must wait on him.  Yes, I've been waiting. Months. And now the knee has decided this isn't fun any more.  So today, I explain that I now have 2 impegnativas and still no appointments. My regular doctor had also advised me that if I still didn't get an appointment to go take the matter up with the woman who runs the Office of Public Relations. That woman was my next stop this morning, after the ear dr. finished up with me.

The second secretary in the office, who was listening to my explanation of the multi-impegnativas,  turned from her computer screen to face me and told me to come see her when I had finished up with the ear doctor.

Back in the waiting area, I waited for my turn for the doctor. When my number was called, I was
introduced to a fairly young Ear, Nose and Throat specialist. Instead of asking me what brought me to him this morning, he asks what brought me to Italy. I should have been prepared, as this is a very common question, especially in any medical office. I proceed to give him the brief history of Karen becoming an Italian. Why is this so curious?

Next question from the dr. , " Is it true American doctors are all rich? My friend told me this. "
My response: "Doctors in the US do make more than most doctors in Italy, I am sure of this." He turns to his nurse and begins a fairly lengthy discourse on how medical services here in Italy are free or so inexpensive compared to in the US. He seemed quite unhappy with the whole scenario.

As he is examining me, he relays his family story of how his nonno (grandfather) immigrated after the war, how one uncle ended up in the US, another eventually in Germany. The examination conversation took a few more turns, ending with the doctor writing another impegnativa for yet a different examination. As you may have deduced by now, the impegnativa (see photo above)  is like the Willy Wonka Golden Ticket.  This gets you appointments with specialists; blood tests, x-rays and ekg's etc.; and prescriptions. It's a crucial document.

I remembered to stop by that secretary's desk on my way out. She took both of the impegnativa's for the knee injections, looked them over, hit a few keys on her computer and asked me if next Thursday at noon worked for me.  Absolutely yes. No matter what I might have planned for next Thursday, I will be cancelling. There was no way I'd miss an opportunity to get these shots. I asked her about the other 2 dates. She responded, "Don't worry. Get here on Thursday and we'll work all the rest of that out."  I thanked her profusely. She adds, "I remembered you from when you had your knee operated on. The American woman. "

Yes, the American woman. I must seem like a freak show to these Venetians.

Veritas.(truth).... not really.

Yesterday in the mail I received our current trash/water bill from Veritas, the water utility company.  The bill was a harsh reminder of a recent, very unpleasant, visit I paid to the Veritas company. On the days when I feel even slightly like I am beginning to belong, some administrative nightmare jolts me right back to reality. No, I am not, and will probably never, fit in here. Does that stop me??? No, never.

Here's a recap of my latest adventure with the Italian adminstrative devils (opps, I meant darlings :) ).  When we moved into the new apartment back in October, one of the tasks to be done was have accounts set up at each of the utility companies.  The electric and gas companies were easy. I filled out the paper work and our real estate agent faxed all the documents over to them. The water/trash company, Veritas, wouldn't accept a fax, I needed to see them face-to-face.

I  had geared up for the visit, practiced all the Italian I might need to make myself understood, and made sure all of my documents were filled in properly, including the authorization form for them to deduct our payments directly from our Italian bank account. My visit went surprisingly smoothly. Perhaps that should have been a big red flag. I naively took it as my ability to communicate in Italian had improved dramatically.  The months went by. We received our electric and gas bills in the mail with no problem. We never received any statements from Veritas. I wondered if this was a problem, but figured, what the heck, those payments come directly from our bank account. Still I would have liked to have received a statement.

About 3 weeks ago, Veritas jolted me right back to reality.  Around 11 am one morning, our doorbell rang. Thinking it was the postman wanting to be let in, I buzzed open the front door. From downstairs came a yell, "Signora!!!!!".  The guy downstairs was summoning me to join him. Down I went, to discover this guy had a registered letter for me, from the water company. First bill I had ever received. He opened the letter in front of me, and explained that I had an overdue water/trash bill that must be paid in 24 hours or the water would be turned off.  He also explained exactly what I needed to do to make sure this was accomplished properly, which included paying the bill, then faxing a copy of the receipt to the water company. I should have listened to my internal warning bells. I KNEW something wasn't right!

I immediately walked down the street to the nearest Tabacci (tabacco shop. Yes, you pay bills there), and had him fax of the receipt for me. Step one completed, I could at least sleep that night.

The next morning, I paid a visit to the Veritas office at Piazzale Roma, armed with copies of all my documents. After queuing up and waiting an hour, it was my turn. I stepped up to the sportello (counter, in Italian- there's nothing sporty about this at all), and proceeded to explain my little problem to the girl on the other side of the desk.  When I asked if she spoke any English, just in case things got over the limit of  my command of Italian. She responded "Not much", but smiled and yelled over to Diego, down the row of sportellos. Diego, she told me, speaks pretty well. He's now my lifeline call in case I need him.   After a bit of exploration on the computer, she discovered what the problem was. Statements had been mailed, but they had been sent to my name at an address in Treviso, not Venice. She was perplexed.  She then went  to a back room and returned with an enormous red binder. She flipped through all the account folders in the binder, pulled out my account, and sure enough, the original documents submitted on the day I set up the account have the correct address in Venice on them.  Someone made a mistake entering data into the computer, thus the address of Treviso. That explains why I never got any statements. Also, the information to set up direct payment from my bank account was correct on my forms. It just never got done by whoever processes that stuff at Veritas. So there we have it. Nothing was done right. We discovered the truth- Veritas!!!

I was expecting an apology. None came. Before I left the office we verified that the address was now correct and that future bills would be mailed to me.  I crossed my fingers and sent a prayer to Saint Anthony- the patron saint of lost things and missing persons, and left the Veritas office.

St. Anthony, and Veritas, came through. The latest bill arrived just fine.