Obscure Colleges

The lady who answered the door had no idea who I was.

“Carlos! Did you call a doctor?” she shouted over her shoulder.

He had. Carlos was a 19 year-old student from Chile renting a room in Hollywood. His hay fever was acting up.

Foreign students often have health insurance from their native country administered by agencies that call me, so I make many trips to UCLA and USC. Carlos was not attending either.

His room contained an amplifier, guitars, and an electronic piano synthesizer. He was studying composition but not at a university. It turns out Los Angeles contains music colleges that attract international students. These seem to operate like traditional schools; I often write doctor notes to justify missed classes.

Now that I think about it, Los Angeles contains plenty of obscure but internationally known educational institutions. Acting and film production come to mind, but they mostly enroll Americans so I rarely hear from them. I’ve cared for a dozen students studying jewelry and others in fashion design, architecture, cooking, graphic design, and business.  

Lost in Translation Again

“Spik Spanish?”

Not a phrase I like to hear. Ninety percent of Latin American guests speak enough English to get along, and Hispanic hotel staff are usually available. Unfortunately, this visit occurred at a small Super 8, and the single employee on duty was American. Under these circumstances, I shake my head apologetically and proceed in English.

“Tell me what’s going on,” I asked.

As usual when something exotic like an American doctor appears, there was a substantial audience. Usually someone volunteers to interpret. Sure enough, a man stepped forward. He tapped patient’s abdomen and then whirled his finger around his mouth.

“Is she vomiting?” I asked.

Blank looks from everyone, a bad sign. I waited, hoping someone else would contribute, but the man merely repeated his gestures.

I phoned the insurance agency’s 800 number. Its employees are Hispanic and willing to interpret.

“Would you ask what’s bothering her and tell me what she says?” I said after explaining the situation.

I handed over the phone and the lady began a long monologue. When she finally handed back the phone, I listened to the insurance clerk. “She is sick from eating. She give medicine from Argentina, but it does not help. She wants a medicine to help.”

That was too little information. I tried to be specific. “Would you ask what are her symptoms?”

Another long conversation followed by a short, unsatisfactory translation. Eventually I learned enough to thank the clerk, adding that I would examine the patient and then call back for more interpreting.

At the end I gave instructions and medication, and everyone seemed happy. I always leave with the uneasy feeling that the interpreter has left out a great deal. Fortunately the ailments I encounter are usually easy, and the occasional exception is obvious.  

Taking No Chances

A guest at the Westin wanted a doctor to look at a rash. I quoted the fee, always a tense moment.

“Do you take insurance?”

If the caller is American, the visit is doomed, but this one wasn’t. I asked the name.

“Assistcard.”

I know Assistcard, but it doesn’t allow clients to call the doctor on their own. They must phone Assistcard which confirms their eligibility and then phones me.

Most travelers know this. In the past, when I told the rare exception what to do and then waited for the call from Assistcard, it never came. So I told him I would arrange matters.

Foreign insurers have offices in the US, so their customer service is painfully familiar. I listened to a recorded welcome in Spanish, Portuguese, and English. I punched “3” to choose English. A recorded voice told me to listen carefully to choices on the menu because they had recently changed. I chose and then listened to muzak. 

After several minutes a dispatcher greeted me in Spanish. I proceeded in English which I suspected he spoke and this proved correct. He assured me that he would phone the guest, and arrange approval. He kept his word although an hour passed before he called.

During the wait, the guest’s wife decided that it wouldn’t hurt to have the doctor check her cold. The approval, when it arrived, added a consult with the wife, so it turned out to be a lucrative visit.   

Do You Accept My Insurance?

That’s the most stressful sentence a hotel doctor hears – more than “I’m having chest pain” or “my mother stopped breathing.”

American insurers look with deep suspicion on housecalls, and no hotel doctor wants to bill them. But almost no American has experience handing money directly to a doctor – and a housecall costs a good deal more than an office visit. Many of these guests agree to pay, but I often sense their discomfort. Other doctors are not so picky, but if they sound too reluctant I inform them of local walk-in clinics.

Foreign insurers are different. Many call me directly. Resigned to our rapacious medical system, they expect immense bills. I charge everyone the same, but I’ve been contacted by doctor-entrepreneurs who offer triple my usual fee to make their hotel calls in Los Angeles. They can afford this, they assure me, because they charge several thousand dollars for a housecall. This sounds creepy, but it apparently works because I’ve heard from these doctors more than once. 

Screwing the Guest

A February 13 Craigslist ad is recruiting hotel doctors.

If you read this blog, you know that I keep track of new arrivals and offer to work for them. They often take me up on it because it’s not easy to find a doctor on the spur of the moment. 

A few hours after my response, the phone rang. The caller introduced himself, adding that he knew me, admired me, and was certain that I was a perfect hire.

He operated a concierge hotel doctor service in big cities, he explained. Clients were busy businessmen who absolutely could not interrupt work to be sick. His doctors made sure this happened through aggressive treatment and powerful drugs, perhaps more powerful than a doctor would use in an office. He asked what injectables I carried and suggested others. His doctors sutured lacerations, drained boils, administered IV fluids and breathing treatments, incised hemorrhoids – whatever a guest need to keep going.

The charge was $3250.

“They pay that?” I asked.

“Just about everyone,” he responded. “Because there’s NO OUT-OF-POCKET EXPENSE!” (I write in caps because his voice grew loud). “We deal mostly with foreign businessmen. They have travel insurance that pays whatever we bill, so I promise they’ll have NO OUT-OF-POCKET EXPENSE, and no one has complained.”

This was probably true. Aware of the rapacious American medical system, foreign insurers may be inured to spectacular bills.

When I asked about American guests, he segued seamlessly into another monologue. American insurers are less generous, but his service was vastly superior, effective, convenient, and cheaper than the five or ten thousand dollars charged at an emergency room. Hearing this, many paid and express gratitude afterward.

Unlike the previous harangue, this was not true, but I encounter it on web sites and publicity from competing hotel doctors. It puts me in a bad mood.

“So you’re not screwing the guests, you’re screwing the insurance companies.”

“Why shouldn’t I? They screw us!” he exclaimed, adding that many of his doctors are forced to work for him to make ends meet because of piddling insurance reimbursement. Surgeons who once made $1500 for repairing a hernia are now getting $1000.  

This did not improve my mood although I share his low opinion of American health insurers. Foreign insurers give me little trouble, but I’m not billing them $3250. 

“You’re selling yourself short,” he exclaimed after learning what I charge. I responded that I have no complaints about my income.

“You do realize you’re running a business,” he added on hearing that I don’t charge for phone calls. That’s probably true, but I’ve noticed that every doctor who announces that medicine is a business is an asshole.

He is not the first entrepreneur to discover that sick hotel guests, trapped in a strange city, are an easy mark and that foreign insurers are even easier. You can read about another on my September 3 post. 

My Best Customer

I’m the doctor for scores of Los Angeles hotels, but even the largest (the Bonaventure) rarely generates five visits per month.

National housecall agencies and international travel insurers provide more business. My leading client is Inn House Doctor, a national agency run by an entrepreneur based near Boston. You can google it.

He solicits hotels, including mine, but they are not an important source of business. Since Inn House collects a cut of the fee, guests who call hear a large quote.

Many travel insurers use Inn House Doctor for their clients in America. It would make more sense for them to call me directly, but I earn my usual fee, so I don’t care. I prefer Inn House when guests live far away, because insurers often refuse to pay a larger fee. Inn House understands.

Its biggest clients are foreign airlines who need doctors for sick crew. In the past some airlines called me, but I’m happy to work for Inn House because it handles many more.

I don’t solicit distant hotels, but airlines, always searching for the best deal, may house crew fifty miles from the airport. I make half a dozen very long trips every month, but airline crew make excellent patients – not demanding and rarely very sick.

Lost in Translation, Part 2

5:30 a.m. Saturday is an ideal time for a call. I had finished writing and was sitting down to breakfast. I told the dispatcher 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 call 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’s English is not good. 

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, hotel guests usually have uncomplicated problems. It worked out fine. 
  

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 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.

Tooting My Horn

Would I see a lady at the Airport Hilton with an eye problem?

I asked the dispatcher from Amerilink, a travel insurance agency, for details, but she couldn’t provide them.

It turned out that the lady had no complaints. Apologizing, she explained that she had neglected to pack her glaucoma drops. Would I write a prescription? I was happy to comply. Amerilink would pay my usual fee.

These delightful visits are not rare. Travelers with insurance who forget a medicine often lie because they suspect, correctly, that the carrier will not pay for the truth.

When a hotel calls directly, I always speak to the guest. If he or she has forgotten a legitimate medication, I phone a pharmacy to replace it, gratis. I don’t have the gall to collect a fee for delivering a prescription.

Readers of this blog know what a humble physician I am, but this is one time I will boast. Many competing hotel doctors charge for any service they perform over the phone, including simple advice. If a guest calls the 800 number of one of the half-dozen national housecall services that advertise widely, he or she will have choice of (1) a paying visit, (2) going to an emergency room, or (3) nothing.

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.

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

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? There's nothing strange about the women's fashions, but the men look like dorks. My generation had long hair and tight clothes. Nowadays it’s short hair and baggy clothes. They 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 over a third of the enrollment. They speak perfect English, so they’re clearly American. Where were they when I attended?

In my day, when you entered a university building, you found a door and entered. Today all doors 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 who comes down to escort me. The dorm rooms are tinier than I remember, and little studying occurs because the desks are piled with personal items. Delivering medical care is easy, but it’s summer, and foreigners believe that air conditioning is unhealthy, so the rooms are hot.      

A Week's Vacation

Returning from a week’s vacation, I took my phone off call-forwarding. Knowing that I keep detailed records, the colleague who covered E-mailed me the information I needed.

Seven hotels phoned; he made four housecalls and took care of three over the phone.

Universal Assistance, a travel insurer, called once. He asked for their credit card number which they gave, and he made the visit.

World Aid, another travel insurer, called twice but refused to give a credit card, so he refused the calls. I fax my invoices to World Aid which usually pays in a month or two. When they don’t, I phone to remind them. Many hotel doctors hate pestering agencies for payment, so they insist on a credit card.

International Assistance called three times, and he declined as soon as they identified themselves. IA still owes him for visits in years past. International Assistance has a poisonous reputation among hotel doctors because it often took six months to pay when it paid at all. Institutions such as clinics and hospitals can deal with this (state-run Medicaid programs are not much better), but individuals soon give up.

Ironically, my patience with IA has been rewarded. After the latest change of ownership a year ago, it got its act together. It now pays reliably every month and provides a great deal of business, but a long time will pass before it lives down its reputation among my colleagues.

Inn-House Doctors called five times, and he made two visits: one to Hollywood and one to the airport area. A national housecall service, Inn-House serves a few hotels and travel insurers but many airline flight crew. In their eternal search for better hotel rates, airlines have been boarding crew further and further from Los Angeles airport which is twenty miles from my colleague’s home. He declined two visits to Long Beach (45 miles) and one to Anaheim (60 miles).