A Dog-Eat-Dog Business, Part 11

 “This is Doctor Oppenheim,” I repeated several times before hanging up. Caller ID identified the Doubletree in Santa Monica, so I phoned to ask if someone had requested a doctor. Someone had.

“You answered, but you couldn’t hear me,” said the guest. “So I called the front desk again, and they gave me a different number. Another doctor is coming.”

That was upsetting because the Doubletree is a regular. When asked, the guest gave me the 800 number of Hotel Doctors International, a service based in Miami.

“How much are they charging?” I asked.

“I don’t know. They just asked if I had insurance.”

That was a red flag. Many hotel doctor agencies charge spectacular fees and then assure guests that travel insurance will reimburse them. Forewarned of our rapacious medical system, foreign travelers rarely make a fuss – and foreign travel insurance generally pays outrageous fees. But American insurance doesn’t.

I told the guest, an American, that my fee was $300 and that he should call the agency and ask what it charged. It turned out to be $650 (far from the largest I’ve heard), so I made the housecall.

Afterward, standing on tiptoes to peer over the front desk, I saw the colorful business card of Hotel Doctors International stuck on the counter. The clerk, who had insisted that mine was the only number she knew, expressed surprise when I pointed it out. 

 

All In a Day's Work

 “She speaks Spanish. I’m not sure what’s going on, but she needs a doctor.”

 The caller was the night manager at the Torrance Marriott. The hotel rarely calls, but I go regularly for crew of LAN, Chilean Airlines. An LAN crewperson who falls ill is supposed to call her supervisor who calls the central office who calls Federal Assist, a travel insurer, who calls Inn House Doctor, a national housecall agency who calls its answering service who then calls me. The guest hadn’t followed the procedure. If I made a housecall at her request, getting paid would be a major hassle.

 I phoned the answering service which had no idea what do. I phoned Federal Assist who insisted it wasn’t responsible for arranging visits. I phoned the director of Inn House Doctor to alert him to the problem. Then I waited.

 It was 5 a.m. It’s dangerous to make these housecalls before official approval because it may never arrive. But the rush hour was about to begin, and I couldn’t resist. I jumped in my car and drove the twenty miles to the Marriott. The freeway moved smoothly, but two blocks before the hotel, barriers and police cars blocked traffic. A dead body had been found on the street. That I was a doctor making a housecall did not persuade the guard.        

I parked and walked toward the hotel. A policeman hurried over as I passed the barrier, but he accepted my explanation and escorted me past the tent concealing the body.

 The visit was easy, and official approval arrived while I was in the room. When I finished at 7:00, my sigalert revealed a solid red line of jammed freeway for my return. So I returned to my car, tilted the seat back, and went to sleep.

 

Christmas Day

 A travel insurer reported a sick child at the Anaheim Holiday Inn, near Disneyland forty miles away. Freeway traffic was tolerable, but when I arrived and knocked no one answered. 

I walked around the lobby. With my suit, beard, and black bag, I look like a doctor in an old Hollywood movie, but no one responded. A waitress in the hotel restaurant asked at everyone’s table, but no one admitted calling a doctor. 

I drove away in a good mood. When hotel guests call and then disappear, I’m out of luck, but travel insurers pay for no-show visits.  

I was a mile from home when the insurer called. The mother was on the line, claiming she had been waiting in the hotel. So I drove back to Anaheim. To my everlasting credit, I was entirely pleasant to the mother, waving off her excuses. The child had a cold.

Good Insurance

The caller spoke with a Hispanic accent, so I assumed he was a travel insurer, and I was right. It was StandbyMD, one of the good insurers. It phones; I make the visit; I fax an invoice; it sends a check. Latin Americans make up most of its clients, but anyone can sign up.

A guest at the Sheraton Four Points had been awake all night with an earache. The call arrived at 4:30 a.m., but that’s almost my time of rising, so I was not unhappy. Freeway traffic was light. I was at his room in half an hour.

One thing seemed strange. His name sounded American. This is not rare in Latin American countries, but he also spoke flawless English. He told me his pain began soon after he boarded a plane in Managua.

“So you live in Nicaragua?” I asked.

“No. Vancouver,” he said.

The light dawned.

“Of course,” I added. “You’re Canadian. No American would have such good insurance.”

American travelers buy American travel insurance. When they fall ill, they obtain care and then submit a claim to the insurer which pays as much as their fee schedule pays. Our insurers take a dim view of housecalls, so their reimbursement is not generous.  I can’t remember caring for an American hotel guest and then billing one of the dozen travel insurers that use me.   

 

More Evidence of America's Leadership

 Opening an envelope from an international travel insurer, I expected a check but found only a form letter containing a dozen boxes, each listing a reason why payment was denied. An “X” through one box revealed that I had not submitted my invoice on an HCFA-1500.

That’s the claim form American doctors send to American health insurers. It’s complex, full of codes, questions, boxes, and charges – far longer than my simple invoice. Despite this, it’s badly organized. One must enter today’s date three times.

I found an HCFA form and filled it out, leaving many cryptic questions blank, guessing answers where I wasn’t certain, and including a fictional breakdown of services because I charge a flat fee. An American insurance clerk would post it on the office bulletin board for general amusement.

Two weeks later, a check arrived. Foreign insurers are not up to speed, but they’re trying.

 

 

Ultimatums Are Risky

 Could I see a gentleman at the Omni with an upset stomach?

The dispatcher for International Assistance was delighted to learn that I could. In most cities, dispatchers work hard to find a doctor willing to make a housecall but not in Los Angeles.

I copied the guest’s name, age, room, and insurance I.D. I quoted a fee. That was acceptable. I said I would arrive within an hour. He was pleased to hear that. Then I dropped the bomb. I would need a credit card number.

I could hear the air go out of his balloon.

“We always send a guarantee of payment.”

“You do. But then you don’t pay.”

Many travel insurers pay promptly. Others require repeated phone calls. Pestering a billing department relentlessly usually works, but sometimes I run out of patience, and many visits for International Assistance remained unpaid after six months.

“I’m not sure we have a credit card.”

“Yes, you do. Ask your supervisor.”

All travel insurers have company credit cards but they vary greatly in their willingness to give them out. Some do it routinely. Others require an ultimatum. I hated hearing from Universal Assistance until they coughed up a credit card number. Now I love it when they phone.

But ultimatums are risky. The dispatcher agreed to consult his supervisor and call me back, but I never heard from him.

 

 

 

 

A Dog-Eat-Dog Business, Part 9

I keep an eye on the competition, searching the internet for various combinations of “hotel doctor,” “house call doctor,” “housecall,” etc.

Once I came upon International Medical Services which promised to send a highly qualified doctor to a home, office, or hotel at a moment’s notice. When I phoned, its medical director knew my name, having dealt with me at previous jobs.

Like all new arrivals, he insisted that business was thriving. In fact, as we spoke, a hotel guest needed a visit, and I was welcome to go. I asked about the fee.

“We charge between $1600 and $2000. The doctor gets half.”

“Guests won’t pay that!”

“We don’t have trouble. These are generally foreigners with travel insurance. Foreign travel insurance knows about American doctors.”

He suggested I quote $1200 and then add a few hundred dollars for medicines and supplies. That was his doctors’ routine.

I visited a young woman at the Hampton Inn with a simple urine infection. She handed over her credit card without complaint.

That felt creepy. I mailed $600 with a note asking him not to call again.

The Hampton Inn is not an upscale hotel. How did he persuade its staff to refer guests? My legal advisor warns me not to speculate.

 

Lost in Translation Again

 6 a.m. Saturday is an ideal time for a call. I had finished writing and was sitting down to breakfast. I told the dispatcher that I would be at the hotel in an hour.

The freeway was clear. Parking, even downtown, would be easy. My phone rang as I drove. It was the guest’s travel insurer warning that there was no answer when he phoned to tell her when I’d arrive. When guests request my services directly and then vanish, I don’t get paid, but this is not the case with travel insurers, so I drove on. It was unlikely she had left the hotel.

At this hour, I check at the desk to make sure I don’t knock at the wrong door. The clerk confirmed the room, called, and reported that someone had answered and then hung up.

It was good news that she was present, not so good that she had immediately hung up. That’s a sign that a guest doesn’t speak English. 

A young Japanese woman greeted me at the door, ushered me inside, consulted her Ipad, then announced in triumph: “......stomach!!....”

One advantage of travel insurance is that dispatchers will interpret. Despite my admonition, they prefer to edit, abridge, and summarize rather than simply translate; their English is often rudimentary, and passing the phone back and forth makes for a long, tedious visit.

On the plus side, these guests usually have uncomplicated problems. It worked out. 

Trusting the Guest to Take Care of Things

A guest at the Crowne Plaza was feeling under the weather.

The guest spoke poor English but, through the bellman, asked if I took his insurance: April Assistance. I did, adding that, unless he wanted to pay me directly, he must call April and ask for a doctor. Then April calls me.

After giving April’s 800 number to the bellman who passed it on to the guest, I hung up and immediately regretted it. I should have asked for the guest’s insurance I.D. and then sent him to his room. Then I should have phoned April to tell them a client wanted a housecall. They would have phoned him to check and then approved. I’ve done this in the past; 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.

Can I Submit This to My Insurance?

The guest’s symptoms suggested a urine infection, one of my favorite diseases. They’re miserable but respond quickly to antibiotics. This looked like a good visit. I quoted my fee.

“Oh… I didn’t realize it would be so much.”

This happens. I remember guests from the Four Seasons where room rates start at $600 who didn’t want to pay half that. In any case, once I mention the fee, I consider it tacky to refuse someone who complains. I quoted a lower fee. That was OK.

It was a good visit. I tested her urine, announced she had an infection, and handed over her medicine. She was grateful. As I left, she indicated my invoice.

“Can I submit this to my insurance?”

“You have travel insurance?”

“I think so. They made us buy something for this trip.”

It was too late to ask why, if she had insurance, she had objected to my fee. But this also happens. In every developed country except Russia and China, if you need a doctor you don’t first decide if you can afford it, so foreign tourists often pay little attention to insurance.

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.

Extremely Easy Housecalls

The desk clerk at an upscale hotel informed me that a guest wanted my services. The call arrived at 3 o’clock on a Sunday afternoon. I had no plans till dinner. Freeway traffic would be no problem. It was a perfect time for a housecall. What a great job….

The desk clerk added that the guest was not actually in the hotel. He would check in at midnight. Could I come then? So I set the alarm that evening and dozed until it went off.

                                                                                                                          

I regularly complain of how far I drive, but sometimes I hit the jackpot. I once saw a patient in my own neighborhood, a mile away. He suffered a minor illness, so I was there and back in half an hour. As I was faxing my bill, the phone rang.

“Did the patient pay the deductible?” asked the dispatcher for the insurance service.

“You didn’t mention a deductible.”

“I forgot. There’s a $75 deductible.”

That was annoying. Cheap travel insurance requires a deductible, and guests never remember to pay. When dispatchers forget to tell me to collect it, I insist the carrier pay the full amount. They always agree but, being cheap services, it requires several pestering phone calls until the check arrives. Since this patient wasn’t far, it was easier to get in my car and make a second trip.

I Save a Life

The phone rang at 5 a.m. but I am an early riser. April Travel Insurance told me of a lady with a cough at the Residence Inn in Manhattan Beach. Vacationers hate to get sick, so even a bad cold produces wee-hour calls.

This sounded easy. It was a fifteen mile drive, but the freeways were clear, and I would return before the rush hour.

Guest often feel obligated to demonstrate how miserable they feel, and this lady coughed loudly from the time I walked in. Listening to her lungs was difficult because she wouldn’t stop, but what I heard was not reassuring. A bad cough doesn’t necessarily mean a bad disease, but this patient had one ominous sign: she was my age.

I phoned April Insurance to explain that the lady needed a chest x-ray and possible hospitalization. This is bad news for an insurer. An ordinary emergency room visit costs over a thousand dollars, a hospital admission for pneumonia twenty times that. Some insurance services work hard over their fine print to avoid paying for expensive incidents, and I occasionally urge guests to go to the hospital after they’ve learned that their insurance won’t cover it.

April doesn’t do that. The dispatcher explained that he would arrange matters. Later that day, the husband informed me that his wife had been admitted for pneumonia.

Lost on Campus

It was after nine when I left for Long Beach, thirty miles away. Freeway traffic moved swiftly; the patient was a sixteen year-old with a sore throat, usually an easy visit.

Google maps guided me to 1250 Bellflower Boulevard which was the student union of California State University in Long Beach. That also turned out to be the address of the university. The student union was deserted. It was the summer break. I left messages at a phone number that may or may not have been the patient’s.

A couple walking nearby pointed me in the direction of distant residence halls which, when I arrived, seemed endless. I phoned the travel insurer who had sent me. The dispatcher managed to contact the patient in her room and then passed on her directions. She was not familiar with the campus, so these were unhelpful. It took persistence, but I convinced the dispatcher that, since the patient was an adolescent, she was undoubtedly part of a group with a group leader.

The patient agreed that such a person existed and went off to find him. After a considerable delay he came on the line, determined my location, and talked me through a complex warren of streets to the proper building. As usual, delivering medical care was the easiest part.

I'm Not in It For the Money

The phone rang at 3:30 a.m. An airline pilot at the Costa Mesa Hilton needed a doctor, explained the caller. Could I go?

That Hilton is 46 miles away, but I drive there regularly for an agency that provides medical care to foreign airline crew when they lay over (American crew are on their own). It’s an easy drive at this hour. I accepted for several seconds until I woke up and remembered that the 405 freeway closes at the Orange County border during the wee hours for major construction. Despite the hour, closing the freeway produces an immense backup, and the detour through city streets is slow and tedious. Forced to go, I take a different freeway which is ten miles longer and only slightly less tedious.

I was in luck. Wee-hour patients usually suffer intense symptoms such as vomiting; they don’t like to wait. This guest had a cold and didn’t object to a visit later that morning.

I breathed a sigh of relief and went back to sleep. The delay would cost me $150 because the agency pays less for daytime housecalls, but it was worth it.

Going Back to College

Every summer, a hundred Brazilian adolescents descend on UCLA’s dormitories to study English. When one gets sick, a counselor phones April Travel Insurance which phones me.

I graduated UCLA fifty years ago, and returning is a strange experience. Crowds outside the dormitories shriek, laugh, and chatter. It sounds like a kindergarten. Were we that noisy? Women’s fashions don’t seem to have changed, but the males look dorky. My generation had long hair and tight clothes. Nowadays it’s short hair and baggy clothes. Men wear shorts. Don’t they realize how silly they look? We kept books in lockers. Now everyone has a backpack. Especially odd is the number of Asians who make up a third of the enrollment. Most speak perfect English, so they’re clearly American. Where were they when I was a student?

In my day, when you entered a university building, you found a door and entered. Today all except the main entrance are locked. Students manning the front desk consider names and room numbers privileged information. Using the elevator requires a key which all students carry. This is identical to hotel security and probably no more effective.

On arriving, I phone a counselor from the lobby who comes down to escort me. The dorm rooms are tinier than I remember, and I suspect little studying occurs because desks are piled with personal items. Delivering medical care is no problem, but it’s summer, and foreigners consider air conditioning unhealthy, so the rooms are hot.

Middle-class teenagers suffer respiratory infections, upset stomachs, and minor injuries almost exclusively, so, once I learned to deal with UCLA’s draconian parking policy, I found these easy visits.

It Never Hurts to Check

Universal Assistance asked me to visit a sick Costa Rican in Downy, a suburb of Los Angeles about thirty miles distant.

She gave the hotel address: 9640 Bell Avenue.

“Is that B – e – l – l?” I asked, spelling it out because English is never the native language of travel insurance dispatchers.

“Yes,” she said.

On Google maps (“29.4 miles; 39 minutes”), that address turned up in an adjacent city five miles away but not Downy itself. My first instinct was to accept it. As a visitor, the Costa Rican was unfamiliar with local geography. But several unhappy experiences persuaded me that it never hurts to check. 

“Not ‘Bell,’ said the desk clerk when I phoned. “It’s B – u – e – l – l.  Buell.”  Google found it in Downy.

The Occasional Surprise

A travel insurer asked me to see a lady in Mission Hills complaining of high blood pressure.

I drove off confident that this wasn’t her problem because high blood pressure causes no symptoms. Mostly patients are suffering a headache or anxiety or dizziness.

Now and then I’m surprised. In hotel doctoring, surprises are generally unpleasant but not in this case.

She didn’t have high blood pressure, admitted the lady apologetically. She’d lost her thyroid pills and only needed a prescription.

When I learn that a hotel guest needs a legitimate medicine, I phone a pharmacy to replace it, and I don’t charge. Guests with travel insurance don’t call me but their agency’s 800 number. Embarrassed to use insurance for a trivial problem, they lie. Sometimes hotel doctoring is easy.

"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.

Disappointment

Loews guest was suffering flu symptoms, but mostly he worried about his temperature. I explained that the fever was not an ominous sign. If he wanted to check, he could buy a thermometer. Or I could come to the hotel. He opted for the visit. I told him how much it would cost.

“Oh… I thought it was free,” he said.

I’d heard that before. Your doctor doesn’t answer when you dial, but I do. Naïve guests think I’m downstairs awaiting their call.

He was from Chile. Did he buy travel insurance before coming to the US, I asked. He did. I explained that travel insurance pays for housecalls, and most insurance agencies call me. However, he must phone the insurance first to obtain approval. He promised to do so. 

Half an hour later my phone rang. It wasn’t Loews but the Doubletree. An elderly man had undergone electrical cardioversion for atrial fibrillation – an irregular heartbeat – a month earlier, and he was worried. His heart didn’t feel right. I asked him to count his beats; he counted 80 per minute. That is not particularly fast. I assured him that he wasn’t describing anything dangerous. He wanted me to check him.

These are the best visits. A guest is worried, and I’m already convinced that there’s nothing to worry about. Sure enough, the exam was normal. He was delighted at the news, and I was delighted to deliver it. Everyone was happy.

I was even more delighted to drive to the Doubletree because it’s only a few blocks from Loews. At any minute, I expected a call from the Loews guest’s insurance agency for another easy visit. But it never came.