You'd Better Ask How Much

Before leaving on a housecall, I tell guests my fee, but this is not universal among hotel doctors. Guests may learn when the doctor hands over the invoice at the end of the visit.

It’s often a bombshell. I recall a guest who showed me a bill for $1140, and I’ve seen higher. It takes huge balls for a doctor to do this, but it works. People who will quarrel with an unreasonable charge that arrives in the mail may keep quiet face-to-face with a doctor in a room far from home. 

Long, long ago I made visits for a national concierge agency that boasted it would fulfill a hotel guest’s every need. It was a luxury service, but not everyone in an upscale hotel is filthy rich. After collecting an immense fee from several resentful guests, I stopped accepting the agency’s calls.

Paying My Fee

It’s less than the going rate, but no one considers it cheap.

When guests phone, I focus on their problems. Half the time, a housecall isn’t necessary. Once we’ve agreed that I should come, I mention the fee. About ten percent of callers reconsider, but almost no one does so directly. I hear….

“Let me talk to my husband and get back to you.”

“Our tour leaves in half an hour. I’ll call when we’re back and set up the appointment.”

“I’m going to try to ride this out, but I’ll let you know.”

“I need to check with my insurance.”

All doctors maintain that they never turn away a patient unable to pay. This is not an actual lie - provided we’re the ones who decide who’s unable.

I’m generous with guests from motels and youth hostels who are clearly not affluent, but plenty of callers are paying a daily hotel bill well in excess of mine. They object to my fee just as they hesitate at $5.00 coffee at Starbucks or $200 for an orchestra seat at a hit play. They know that $1.00 coffee at McDonalds or a $50 balcony seat provides a similar experience, more or less. I direct them to urgent-care clinics that accomplish this.

Why I Like Foreigners

“Do you take insurance?” asked a Biltmore guest after learning my fee. She was  an American.

Hearing that she would have to pay up front and submit my invoice, she decided to wait. She was suffering an upset stomach which would probably clear up in a day. I gave advice and told her to feel free to call.

“Could I have your name and room number?” I asked before hanging up.

“Is that so you can charge me?” she asked.

“Phone calls are free,” I said. “I just need to keep a record.”  

An hour later she called to say she had changed her mind. Could I come?

Her vomiting had stopped but not her nausea and headache. After an exam, I gave her two packets of pills: one for nausea, one for the headache.

“How much are these?” she asked.

“Nothing.” I assured her that she was over the worst of her stomach virus. 

“So it’s a minor problem that’s already going away. You came, but you didn’t do much for me.”

I agreed that I hadn’t cured her but perhaps I had helped in other ways. I could have mentioned the convenience of a housecall and the medicines I hand over, and my long drive to the hotel. None of this would have worked. I simply expressed satisfaction that she was improving and told her to phone if problems developed.

“And then you’ll come back and charge me again?” she asked.

I explained that I rarely make a second visit for the same problem, but I would try to help.

Whether You Want Me or Not

If you want a housecall in Los Angeles, you’re likely to get me even if you don’t ask for me.

I don’t have a web site, but searching the internet turns up several agencies and a few individuals that promise to send a doctor at a moment’s notice. Many rely on me.

They also solicit hotels. Recently a national housecall service informed me that a guest at the Marina International wanted a doctor. The Marina International is one of my regulars.

After I phoned the guest, he asked me to come. I made a mental calculation before quoting the fee. The housecall service took forty percent, so I added forty percent.

Since those who call directly pay less, you might wonder why hotels don’t make sure guests get the best price. The answer, of course, is that hotels don’t know what doctors charge, nor do they care. Guests regularly ask me, but hotels never do.

A Dog-Eat-Dog Business, Part 6

People ask what sort of contract I have with hotels. The answer is none. Staff call because I’m easy to reach and quick to respond. Once they’ve called a few times, they’re not inclined to change.

But hotel doctoring is a glamorous occupation, so plenty of doctors yearn to break in.

How can they do this? Guests who want help ask a concierge, desk clerk, operator, or bellman. You might think that they’re given the name of the house doctor, but there is often no such person. Except in luxury hotels, selecting a doctor is not a priority, so the choice may be up to the employee.

This is no secret, so entrepreneurial doctors know who to approach. But how can he phrase a sales pitch? Proclaiming that he is caring, compassionate, and skilled sounds creepy. Doctor web sites and housecall agencies always proclaim this, but you should be skeptical. I’ve worked for dozens; they may check my license and malpractice history but never my competence.

The new doctor might offer to charge less, but he never does. The free market doesn’t apply to a medical fee, and hotels don’t care about it.

So what’s left? Services selling to a hotel (florists, tours, masseurs, limousines) often pay a kickback, and there is a long tradition of hotel doctors doing the same. It’s illegal for a doctor to pay for a referral, and I hasten to admit that I have no evidence that anyone is doing that, but when I start hearing “have you forgotten something?....” hints from bellmen et al, I wonder if a new competitor is making the rounds.

"Wow! Hotel Doctors Charge That Much?"

Guests don’t say that. Mostly I hear: “Could I talk to my husband and call you back.…..?”

Unlike the competition, I don’t confine myself to upscale hotels. Plenty of Holiday Inns, Ramadas, and motels call, and I quote fees less than the going rate. Colleagues complain but admit that it’s not a competitive advantage because hotels don’t care what the doctor charges. Still, counting driving time, a hotel visit rarely takes less than an hour, so it’s not cheap.

Helpless in a strange country and forewarned that medical care in America requires vast sums, foreign guests are easier to deal with.

America medical insurance takes a dim view of housecalls. No hotel doctor accepts it, so Americans, already disoriented at finding a doctor willing to make a housecall, learn that they must pay out of their pocket. It’s a shock.

Like all doctors, I like to present myself as a humanitarian, and I often reduce my fee if the guest feels too miserable to leave the room, but mostly, when Americans object, I send them to an urgent care clinic.

Walking through a clinic door costs around $100. While this is much less than a housecall, clinics charge extra for tests, procedures, shots, and supplies, and the patient must find a pharmacy and then pay for the prescription. I don’t charge extra for anything. Telling all this to guests sounds too much like a sales pitch, so I simply send them to a clinic. Insurance might pay part of their bill.

How a Hotel Doctor Collects His Fee

Many guests pay cash; most foreigners have travel insurance, and I accept credit cards. Technology makes this easy although the company takes about six percent for the convenience. Using a phone, I dial a computer whose automated voice instructs me to enter half a dozen codes (my bank number, my merchant number, the credit card number, the fee…).

In the past I used the room phone until I noticed guests looking uneasy and remembered that hotels charge for phone calls. Now I use my cell phone, an awkward alternative because the small keypad encourages mistakes. At the end, the computer announces its approval and recites an authorization code which I dutifully copy.

Occasionally it denies approval – not by telling me the card is bad or that I’ve entered the wrong number but by announcing cheerfully, “please hold on while we transfer you to a customer service representative.” Hearing this, I immediately hang up because the company charges anytime someone speaks to customer service. I then dial again and re-enter the numbers. Sometimes this works. If it doesn’t, there is a scramble as guests search for another card or their wallets.

Bringing the Housecall into the Twenty-First Century, Part 2

My July 2 post concerned Medicast, a service that arrived in Los Angeles with the goal of bringing the housecall into the internet age. Anyone can download the Medicast app. Clicking connects you to a dispatcher who records your credit card information and sends a text message to the doctor on-call who arrives at your “home, office, or hotel” within two hours. You can Google Medicast.

Its fees are less than those of traditional hotel doctors (who don’t advertise) and much less than the entrepreneurial concierge doctors who do.

Always alert to competition, I contacted Medicast whose directors expressed delight at my experience and welcomed me aboard. I attended an orientation where doctors learned to deal with their software. We left carrying an iPad.

Over thirty years, a dozen national housecall services have come to Los Angeles and, mostly, gone. Size is their great obstacle. When I collect a fee, I keep it all. After paying the doctor, a service has other people to pay. Success requires either a high patient volume or high fees.

My maximum volume has been about 2,000 calls per year, and I have never grossed more than $130,000 – a great deal to most of you but peanuts for a doctor. It’s unlikely any organization can match my volume.

One national housecall service has operated since the 1990s. Its site emphasizes the quality of its doctors, and this was certainly true when I was one. It called 26 times between 2000 and 2002 when I stopped working for them. I collected my usual fee. The service charged three times more, but dispatchers often failed to tell guests how much. As a result, when I handed over my invoice they expressed shock. Worse, they blamed me for the fee and did not hesitate to express their displeasure to the hotel. This cause me some difficulty. I'm sorry not to mention its name, but I'm as paranoid about being sued as the average doctor.

Getting back to the present, over the next two months, I received 16 calls from Medicast, the last in mid-July. Last week a director phoned to explain that calls were increasing but not to the extent they expected, so they were adopting a different business plan. Two days later, a courier arrived to reclaim the iPad.