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Saturday, August 27, 2011

Various Way in Which I Didn't Get Paid -- Part 4

I didn’t charge eight guests because theirs was the first call from that hotel, and I wanted to make sure they had a good experience. I stopped when I realized that most hotels that call for the first time never call again. The important call is the second.

Assistcard, which insures travelers from Latin America, owes me for six visits from the 1980s. Other doctors had warned me of its reputation as a slow payer, but I was eager and young. After several years, innumerable calls to its billing department, and with my business prospering, I began refusing its requests. A few checks owed to me drifted in over the following year but not all.

After ten years, an Assistcard employee called to announce that the company was under new management and to promise to pay more reliably. Since then I’ve collected on every visit but often after months of reminders. I finally decided to cut back on pestering but add $100 to my fee. Assistcard knows this, but nothing has changed. Most of its bills are vastly higher than mine because they come from hospitals and emergency rooms, so delaying payment helps their bottom line so much that making an exception for me is probably too much trouble.

Thursday, August 25, 2011

Various Way in Which I Didn't Get Paid -- Part 3

Four times I arrived to discover another doctor in the room. The hotel had summoned another doctor. After waiting a few hours, the guest complained, so the hotel summoned me without mentioning the other call.

Eighteen guests gave me a bad check. Almost all were single males, and these occurred before I accepted credit cards. While everyone I managed to contact expressed surprise and promised to correct matters, this was not always a lie. In six other cases, guests sent a second, good check.

I mailed a refund to three guests on Medicare. Early in my career, I simply informed elderly American guests that I was not a Medicare doctor. Most assured me that was no problem, but it turned out many believed I meant only that I didn’t bill Medicare myself. When Medicare rejected their bill, they were outraged. Since then I explain in more detail that they can collect nothing from Medicare or any Medicare supplement insurance. Some agree to a visit; others accept my directions to an urgent care clinic.

I also reimbursed a guest who was unhappy to hear that an antibiotic would not help his flu. He went to an urgent care clinic later that day, received the traditional antibiotic, and felt better as soon as he swallowed the first pill. The hotel manager who passed on his complaint expressed sympathy, but I felt it best to make a refund.

Wednesday, August 24, 2011

Various Way in Which I Didn't Get Paid -- Part 2

Over the past thirty years, twenty-four guests cancelled. I don’t count those that arrive before I leave the house, so all occurred while I was on my way. To this I must add eighteen no-shows: guests who weren’t in the room when I knocked. This always annoys me because I tell guests when I’ll arrive. In my younger, passive-aggressive days, I would phone later. Guests would swear they had told the hotel and express outrage that the employee had failed to pass on the message. After hearing the same excuse every time, I stopped calling.

Fifty database files appeared under “No Pay,” meaning I wanted to collect but couldn’t. A minority were blunt refusals from guests who never intended to pay; a dozen were clearly mentally ill. Four guests had called the paramedics before I arrived, and they were already on the scene.

“No way!... Take it up with the manager” caused trouble until I saw the light. Hotels often pay if guests are injured on the premises, find bugs in the room, or believe they’re poisoned by hotel food. Unfortunately, sometimes the hotel refuses, and it’s a bad idea to argue. After leaving unpaid several times, I learned to stay alert during the initial phone call for situations when guests blame the hotel. If so, I tell them to discuss matters with management before I leave the house.

Saturday, August 20, 2011

Various Way in Which I Didn't Get Paid -- Part 1

In my database of over 16,000 visits, entering zero for my fee and searching turns up 789 files, but this includes 529 when colleagues covered. That leaves over 200 where I collected nothing.

On nearly 100 occasions, this was my decision. 50 patients were hotel employees whom I don’t charge even if they’re willing to pay. Most can’t afford the fee, and I’m happy at the thought that they’ll tell their co-workers about the experience.

In 19 cases, I arrived and realized immediately that the guest needed a referral, either to a specialist or an emergency room. I try to detect these during the phone call before the visit, because I feel guilty accepting a fee and then sending the guest off to pay a second fee. In four additional cases, I had decided to call the paramedics, and I remained in the room until they arrived. Naturally, these were distressing events. Everyone was preoccupied, and I felt inhibited about mentioning my fee. In other cases, the guest or his companions remembered, but these were the times they didn’t.

Poor people rarely stay in hotels, but a few cheap motels and youth hostels have my number, and college-age travelers often arrive in the US without health insurance. As a result, I sometime trim my fee and occasionally charge nothing if they come to my home. I’ve done that a few dozen times.

One guest was dead when I arrived. I didn't collect from his wife.

Saturday, August 13, 2011

Years ago, I noticed that International Travel Assist was taking six months to pay and then only after repeated phone calls. When it refused to give me a credit card number, I began declining its visits. With the stock market diving along with my retirement nest egg, I’m less inclined to turn away business. So I accepted an ITA visit to a middle-aged man with a bellyache.

“He has terrible pain,” his wife announced as she ushered me into his room. I dismiss many worried complaints (“His fever isn’t going away….” “His mucus is green…”), but this one often means bad news.

Sure enough, the man looked sick. He was feverish. His abdomen felt exquisitely tender and rigid, a sign of peritonitis. He needed to go to an emergency room, I informed them. I dialed ITA’s number to let them know.

Uneasily, I recalled that International Travel Assist had other ways to economize besides stiffing doctors. Sure enough, after hearing the news the dispatcher informed me that the patient must first go to the Airport Medical Center, an urgent care clinic. I often do the same when guests from nearby hotels need something I can’t provide such as an x-ray. It’s not part of a hospital, and the doctor on duty has the same training as I.

I gave the patient and his wife directions to the clinic. Since many doctors lean over backward to send patients to emergency rooms, a second opinion probably saves ITA money, but it wouldn’t in this case because my patient needed an ER. There was always a chance the doctor on duty would decide to send him home, so I phoned the clinic to make sure he thought twice.

Telling a doctor what to do is counter-productive, so I chose my words carefully. I was sending a man with bad abdominal pain and peritoneal signs, I explained. If it were an office patient, I would have sent him to the hospital for scans and a surgical consult, but his insurance insisted he go to an urgent care clinic.

He thanked me for the information. “We don’t have too many facilities here,” he added. “But we’ll do what we can.”

“Don’t do anything. Send him to the hospital,” would have been tactless, so I didn’t say it. Once a doctor decides a patient needs emergency care, allowing a test to change his mind is a bad idea. Thus, I thought the man had an abdominal infection. Had I ordered a blood count, an elevated white cell count would point to an infection. Good... But sometimes the test comes back normal. What then? The answer: send him to the ER anyway. It’s another rule of medicine that a doctor shouldn’t order a test that doesn’t change the treatment, but we disobey that all the time.

So the man passed a few miserable hours while the doctor ordered tests that doctors order when a patient has a fever and bellyache: a blood count and an abdominal x-ray. I have no idea of the results, but I checked to make sure he’d gone to the hospital, and he had.

Monday, August 8, 2011


A guest from Argentina reported his child had a fever. He spoke no English but, through the bellman, asked if I took his insurance: Universal Assistance. I did, adding that he must call Universal Assistance first and receive a go-ahead. Then Universal Assistance calls me. After giving its 800 number to the bellman who passed it on to the guest, I hung up and immediately regretted it.

I should have asked the guest’s name and insurance I.D. number and then sent the guest to his room. Then I should have phoned Universal Assistance to tell them a client wanted a housecall. When I’m lazy and trust the guest to take care of things, I often never hear back.

I called an hour later, but the bellman didn’t remember the guest’s name.