An elderly Mexican psychoanalyst was attending a psychoanalytic convention, but a cold was making her so miserable that she wanted to return home early.
This seemed an excellent call in many ways. It arrived during the evening rush hour, but the Royal Palace was only two miles away. It was my first visit to that hotel, always a delight, and I planned to introduce myself to the management. Finally, the lady’s stuffy ears dominated her concerns, so she probably wouldn’t demand useless antibiotics which Latin American doctors prescribe for colds as often as we do.
Everything proceeded smoothly. I finished my traditional lecture on preventing ear pain when flying (generous use of nasal sprays); she expressed gratitude and laid down an American Express card.
American Express charges a larger service fee than other credit cards, so some companies that handle transactions don’t cover them. That includes mine, but I wasn’t concerned. So far everyone has had cash or another credit card, but on learning that I only accept Visa or Master Card, she expressed dismay. She only used American Express, she explained. Her plane left the next morning, and all she had was cab fare.
While I considered my next move, she snatched the phone, dialed the front desk, and poured out her distress. The doctor they recommended wouldn’t take her credit card; she had no money, and she needed help. I cringed at this terrible P.R. She wasn’t complaining about me, but it’s never good for a hotel to hear a guest having problems with the doctor. Luxury hotels will advance money and add it to the bill, but the Royal Palace, while comfortable, was not in that class. The desk clerk suggested she find an ATM.
Long ago, I drove a guest in search of an ATM, and I’ll never do it again. Begging my forgiveness, she swore that when she returned to Mexico City she would phone with the number of an acceptable credit card. I had no other suggestion, so I brushed off her apologies, and we parted on good terms.
That was several weeks ago; I don’t expect to hear from her.
My practice where almost no one see me a second time and everyone lives far away is a supreme test of integrity, and it’s discouraging how few measure up. Guests have already agreed on the fee before I arrive, so it’s rare that I leave unpaid. When this happens, guests are invariably upset and embarrassed. Once home and aware that there will be no unpleasant consequences if they don’t pay, only about twenty percent come across.
Showing posts with label doctor housecall hotel emergency. Show all posts
Showing posts with label doctor housecall hotel emergency. Show all posts
Tuesday, February 7, 2012
Saturday, January 7, 2012
The American Way
“This is AXA insurance about the patient you saw last month, Mrs. Diaz. We are asking you to accept a lower payment. In exchange, we list you as a preferred provider.” The offer was for less than half what I billed. I declined. AXA would eventually pay my regular rate although a few months would pass.
AXA sells travel insurance to Latin Americans. Its US agency and a dozen others phone me to make housecalls. Afterward, I fax my invoice, and (here American doctors will recoil in amazement) the carrier sends a check for the full amount. I’ve made thousands of such visits.
Working alone, I can’t accept American medical insurance with its complex requirements and unreliable reimbursement. The universal American claim form (called the HICF 1500) is cryptic and ambiguous, requiring mysterious codes and far, far more writing than the form I use. Thus, mine has a single space for today’s date; a HICF form requires today’s date in four or five places. Under “place of service” there is no box to check for “housecall.”
Not accepting American insurance is no problem for me, but I’m a special case. As soon as the average doctor opens an office, every American carrier makes an offer he can’t refuse. If he agrees to become a “preferred provider” and accept a reduced fee, the insurer will send patients. If not….
While foreigners look with horror on our medical care system, foreign insurance carriers have long admired their American counterpart’s techniques for saving money. Inevitably, the temptation has grown irresistible. I’ve long since stopped explaining that, including travel, a housecall may take ten times as long as a clinic visit. These callers are not negotiating; they want a “yes” or “no” answer. They lump all doctor visits together, so housecalls get no special treatment.
American doctors have not taken this lying down. One advantage of the Byzantine American billing system is that a resourceful doctor can tack on charges for tests, injections, medication, dressings, complexity-of-visit, length-of-visit, etc. so that he ends up collecting what he thinks he deserves. After decades of dueling with insurers, the typical American medical bill has become a purely fictional creation.
I quote my fee on the initial phone call. It’s larger if the call gets me out of bed or requires a long drive but never changes once I set off. I’ve made 700 housecalls for AXA over twenty-five years but only four during 2011. This is less tragic than it seems.
Confronted by my refusal to become a preferred provider, AXA and a few other travel insurers transfer their business to one of the national housecall services with names like Expressdoc, Hoteldocs, Travel-Med, AM-PM Doc. All boast that they can send a doctor on a housecall in any US city. Since none employ doctors, when a request arrives, their dispatchers consult a list of moonlighters and begin phoning. Tracking down a doctor willing to make a housecall can be a tedious business except in Los Angeles where calling me always succeeds. I’ve made thousands of visits for these services.
I quote my usual fee. To make a profit these services must bill AXA et al several hundred dollars more. If this seems illogical, you should realize that every insurance carrier knows that the “preferred provider” policy saves money, so no one questions it.
AXA sells travel insurance to Latin Americans. Its US agency and a dozen others phone me to make housecalls. Afterward, I fax my invoice, and (here American doctors will recoil in amazement) the carrier sends a check for the full amount. I’ve made thousands of such visits.
Working alone, I can’t accept American medical insurance with its complex requirements and unreliable reimbursement. The universal American claim form (called the HICF 1500) is cryptic and ambiguous, requiring mysterious codes and far, far more writing than the form I use. Thus, mine has a single space for today’s date; a HICF form requires today’s date in four or five places. Under “place of service” there is no box to check for “housecall.”
Not accepting American insurance is no problem for me, but I’m a special case. As soon as the average doctor opens an office, every American carrier makes an offer he can’t refuse. If he agrees to become a “preferred provider” and accept a reduced fee, the insurer will send patients. If not….
While foreigners look with horror on our medical care system, foreign insurance carriers have long admired their American counterpart’s techniques for saving money. Inevitably, the temptation has grown irresistible. I’ve long since stopped explaining that, including travel, a housecall may take ten times as long as a clinic visit. These callers are not negotiating; they want a “yes” or “no” answer. They lump all doctor visits together, so housecalls get no special treatment.
American doctors have not taken this lying down. One advantage of the Byzantine American billing system is that a resourceful doctor can tack on charges for tests, injections, medication, dressings, complexity-of-visit, length-of-visit, etc. so that he ends up collecting what he thinks he deserves. After decades of dueling with insurers, the typical American medical bill has become a purely fictional creation.
I quote my fee on the initial phone call. It’s larger if the call gets me out of bed or requires a long drive but never changes once I set off. I’ve made 700 housecalls for AXA over twenty-five years but only four during 2011. This is less tragic than it seems.
Confronted by my refusal to become a preferred provider, AXA and a few other travel insurers transfer their business to one of the national housecall services with names like Expressdoc, Hoteldocs, Travel-Med, AM-PM Doc. All boast that they can send a doctor on a housecall in any US city. Since none employ doctors, when a request arrives, their dispatchers consult a list of moonlighters and begin phoning. Tracking down a doctor willing to make a housecall can be a tedious business except in Los Angeles where calling me always succeeds. I’ve made thousands of visits for these services.
I quote my usual fee. To make a profit these services must bill AXA et al several hundred dollars more. If this seems illogical, you should realize that every insurance carrier knows that the “preferred provider” policy saves money, so no one questions it.
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