Seriously Burned

I awoke at my usual time, wrote for a few hours, ate breakfast, and went back to bed. Having made a wee-hour visit to a distant hotel, I was sleepy.

When business is slow, I take actions that encourage calls such as going to a movie or trying to take a nap. Unfortunately, this works when I don’t want it to, so the phone rang as I drifted off. It was a lady at the Custom hotel whom I’d seen the day before for a bad stomach virus. She was better and desperate to return home, but her insurance insisted on another exam before allowing her to travel. Making visits to guests who aren’t sick is a perk of hotel doctoring, and I was happy to comply.

Returning home I headed straight for bed, but the phone rang as my head touched the pillow. A lady at Le Parc explained that had undergone eyebrow waxing, and a clumsy cosmetologist had inflicted serious burns. I suggested that serious burns around the eye require more care than I could deliver on a housecall, but she demanded a visit.

I consoled myself with the knowledge that guests often exaggerate their problems. This proved to be the case when she showed me several pink spots over her forehead. These were mild, first-degree burns, I explained, similar to sunburn. I handed over a tube of soothing cream and assured her that they would heal completely in a week.

I was wrong, she insisted. Because of her extremely delicate skin, she would be scarred for life.

Another Perk of Hotel Doctoring

A travel insurer sent me to visit a woman complaining of asthma. When I arrived, she admitted that she had a little wheezing. She didn’t seem ill, and my exam was negative. She added casually that she had left home without her asthma inhaler, so I wrote a prescription for another.

When guests phone me directly because they’ve forgotten a medicine, I call a pharmacy to replace it at no charge. Guests who phone their travel insurance are often reluctant to admit their mistake, so they claim they’re ill. These are easy visits.

The World's Worst Travel Insurer

International Medical Assistance has a terrible reputation despite being my leading source of business. It often calls over a hundred times per year. Almost every doctor who knows IMA including the colleague who covers when I’m away, refuses its calls because it’s so hard to get paid.

Most travel insurers pay within a month or two. If they don’t, a call to the claims department corrects matters.

IMA never pays within two months. When I call, the claims department assures me that a check will be mailed in the near future or that my invoice never arrived. When I call a week later, I might hear the same explanation.

IMA was in business when I took up hotel doctoring in the 1980s and, for obvious reasons, happy to send patients. It didn’t take long for me to grow annoyed. Payment could take six month and required persistent phone calls. In 1993, with my practice prospering, I began refusing its calls.

In 1998, IMA changed ownership. A representative called to apologize for past difficulties and promise that it would now pay promptly.

But nothing changed. Checks didn’t arrive. I resumed pestering the billing department. By that time hotel doctoring was catching on so I had several competitors. IMA was irritating to deal with, but it provided plenty of business and – eventually – paid.

My frustration tolerance has diminished with age. In 2012 I was considering dropping IMA when a representative called to announce that it was again under new management. Payment would now be made every month directly into my checking account.

Sure enough, in January 2013, December’s payments appeared – minus several visits. Wearily, I picked up the phone. The problem remained when the February payment appeared, also for too little. The March payment was too much but it didn’t even out. April’s payment was also excessive; now I owed them. The May payment again missed several visits. By 2014 IMA had given up bank deposits and was back to sending checks. Slowly. That’s when I realized that IMA is cheap and stupid but probably not dishonest. Delaying payments saves money in the short run, but the P.R. damage far outweighs it. On the other hand, I have no competition for its business in Los Angeles.

You Think I Have a Soft Job

The phone rang at 1:10 a.m. An international housecall agency had a visit in Anaheim, forty miles away. I agreed to go but quoted a larger fee because of the hour and distance. The dispatcher, in Miami, said she would ask for approval and get back to me.

I dressed and waited. After ten minutes I called to ask about the delay.

“I’m sorry. We’re waiting for the E-mail.”

“E-mail!! Can’t you phone them?”

Apparently not. Approval had to come from Madrid or Buenos Aires. I waited another fifteen minutes before calling again. Learning that the E-mail still hadn’t arrived, I told the dispatcher I had changed my mind and went back to bed.

Having the Proper Credentials

A Brazilian woman suffered abdominal pain, but her doctor in Rio found nothing wrong. It went away, so she flew to the US where it recurred.

Her host lived in the Hollywood Hills and spoke excellent English. She may have been a show business personality because her walls were covered with celebrity photographs and posters. After examining the guest, I explained that she needed a further evaluation, perhaps including an ultrasound, because one possible diagnosis was gallstones.

Her host spoke up. “You are ordering an ultrasound? Where must we go?”

I explained that I wasn’t ordering an ultrasound but referring her to a doctor who could do whatever tests were necessary. I added that my next step was to go home, fax my report to the insurer’s American office in Miami, and follow it up with a call to alert the dispatcher. He would phone doctors in Los Angeles, preferably the ones I recommended, until he found one willing to accept the Brazilian insurance and then call her. It might take a few hours.

“I have a fax machine. Why not do it now?”

I didn’t know the insurer’s fax number. It was at home.

“Then I will call.” Examining her guest’s insurance papers, she found a phone number, but it looked foreign. As she dialed, I warned that the Brazilian office probably didn’t handle referrals, but she waved me off. 

There followed a long conversation in Portuguese. Afterward, she explained that she had laid out the problem. They promised to get back to her.

I returned home, faxed my report, and called the Miami office. Before I could report back to the Brazilian lady, she called me.

“What is your license number?” she asked.

“Why do you want that?”

“Brazil never called, so we came to Cedars-Sinai. The ultrasound department needs your license for the test.”

“Don’t do that!” I said. “The first step is to see a specialist. And the test will be very expensive unless the insurance approves.”

I phoned the Miami office to urge them to settle matters with Cedars-Sinai. Within minutes my phone rang. It was the Brazilian lady again.

“There is something serious…. Cedars-Sinai has no record of you.”

“I’m not on their staff.”

“They cannot find your name. I am very disturbed.”

I assured her I was a real doctor.

“How do I know that? When I called for a doctor, you came in an hour.”

She could Google me, I suggested.

I phoned Miami to warn that the patient had gone to Cedars. The dispatcher delivered equally bad news. He had phoned Brazil to obtain approval for the expense. Unfortunately, the Brazilian office had had an earful from the Brazilian host who emphasized her friend’s past suffering. This provided an irresistible excuse to claim a pre-existing condition and deny approval. 

After hearing this news, the patient and her host went home. I warned that she still needed an evaluation and offered to refer her to a colleague. The Brazilian host remained polite but informed me that the next doctor she consulted would have to have better credentials.

Catching the Flight Home

A tour leader informed me that a 70 year-old in his group had severe abdominal pain.

I explained that this was probably not something a housecall would solve. He would almost certainly need an emergency room visit.

“They understand,” said the tour leader. “But they want a doctor to come to make sure.”

He was not being honest, as I discovered. Anxious to avoid accompanying the man and his wife to the hospital, he had insisted on a housecall hoping that I would make the problem go away.

He had also not passed on my suspicions, so the couple was shocked when, after an examination, I repeated it. The husband refused to go, pointing out that their return flight left the following day. He added that he was merely constipated. Telephoned, his doctor at home had agreed and recommended an enema.

I responded that being on the spot gave me priority. The guest assured me he would think it over and go to an ER if the pain persisted.

I passed a worried night. In the morning, the wife declared that her husband felt a littler better. Feeling “a little better” in response to a doctor’s query means “no better.” I warned them not to board the plane if the husband had any abdominal pain. Two hours later the wife phoned to announce that he was entirely better, and they were leaving for the airport.

Cheating

“Could you put my name on the bill?” asked a guest. “I have insurance for this trip, but my girl friend doesn’t.”

“I’m afraid that’s illegal,” I answered. I’m not sure that was true, but it seemed a painless way to decline. The guest didn’t seem offended. From his point of view, there was no harm in trying.

Guests occasionally ask me to cheat on their insurance. A carrier once called to question a charge of several thousand dollars. It turned out the guest had penciled in a zero when he submitted the bill.

People are more likely to cheat if there’s no chance of getting caught. I still remember my anger when, thirty years ago, I witnessed someone put a quarter into a newspaper dispenser, open the cover, pull out a newspaper and then pull out several more to give to friends. These dispensers are stocked by an independent vendor who buys the papers himself. I informed the man who hurried off, less concerned about his thievery than this stranger abusing him.

Dealing With Buenos Aires

“Can you make a visit to Palo Alto?”

“That’s four hundred miles away!”

“How much would you charge?”

“I’m in Los Angeles. Do you understand?”

“Yes. How much would you charge?”

In fact, she didn’t understand. To save money, many travel insurers have closed their US offices, so this call originated from the patient’s home country. Inevitably, dispatchers in Buenos Aires don’t speak English as well as their former colleagues in Miami. I carefully explained that the distance made a visit impossible.

Unlike American travel insurers who require clients to pay up front and submit a claim, South American insurers send a doctor and pay me directly. I’ve made over two thousand visits for them. They’re among my favorites because patients who don’t pay directly are less demanding. Also, these insurers send me to hotels that don’t call or, even better, to my competitor’s hotels. A downside is that, if I don’t listen carefully, they send me to the wrong address. In Spanish “v” and “b” have identical sounds; so do “y” and “ll.”  

Then there was the time an insurer called at midnight.

“Can you make a visit to Culver City tomorrow?”

“Yes… But why did you call so late?”

“Because it says on your profile that you are available 24 hours.”

How to Find a Hotel Doctor

Getting sick in a hotel far from home is miserable enough; you shouldn’t have to scramble for help. Here’s the best strategy.

1. Ask a hotel employee.

This often succeeds, but you may see him scratch his head. ‘... St. Mary’s is the nearest emergency room. Take Seventh Avenue about a mile, then...’ 

Ask others. Relations with the ‘house doctor’ are informal. He or she is never a hotel employee, and many on the staff are unaware of such a person. ‘You’re our doctor?  I didn’t know we had a doctor...’ is a comment I hear at hotels I’ve visited for years.

2. Ask the manager.

Every manager knows hotel doctors although you’ll often hear: ‘I’m sorry but we can’t recommend anyone.’ You are encountering one consequence of today’s malpractice crisis. The hotel’s lawyer has assumed (correctly) that a guest who sues the doctor will also sue the hotel that recommended him, so the lawyer has forbidden the staff to name anyone. When a manager clams up, you have four choices.

A. Demand a doctor and keep demanding.

Occasionally I visit an assertive guest who has refused to take no for an answer. I introduce myself to the manager afterwards, but he or she invariably insists that this was an exception, and the hotel can never, never mention my name.

B. Phone another hotel and ask for its doctor.

All luxury hotels (Four Seasons, Ritz-Carlton, Peninsula) have doctors; popular chains (Hilton, Holiday Inn, Hyatt, Ramada) are unpredictable, but the larger the hotel, the more likely you’ll succeed.

C. Phone a national house call service.

All claim to operate nationwide, but they’re a crapshoot if no moonlighter happens to be available. Some names to Google are Expressdoc, Standby MD, Inn-House Doctors, Hoteldocs. Their fee not only pays the doctor but the organization, so it can take your breath away. Ask how much and then ask for the extras because the meter starts running as soon as he walks through the door. I’m pretty sure I’m the only hotel doctor who charges a flat fee.

D. Call your family doctor.

The law requires that a doctor be available to patients. You should reach the doctor or someone covering. If not, complain to your state medical board.

What about insurance? Specific travel insurance pays for almost everything, and it’s cheaper than you think. Traditional health insurance may pay a fraction or apply it to your deductible. HMO’s are variable. All claim to cover emergencies, but they look skeptically on house calls. I hate to give advice no one takes, but  here goes: read your policy.

Cash Flow Problems

“Pick up card! Pick up card!” intoned the computer. Unlike other messages, this never means a typing mistake, but I re-entered the numbers and heard the same announcement.

Wearily, I phoned International Assistance to explain that their credit card had been rejected. The dispatcher put me on hold for several minutes before returning with another card number. In the past, I’ve gone through several before hearing the computer’s approval, but this one worked, and I left for the hotel.

International Assistance insures travelers from Latin America. It’s sent me on nearly 900 housecalls since the 1980s. It was always a slow payer, but since the turn of the century it began requiring months of pestering before sending a check. Finally I lost patience and demanded that it pay by credit card. Although credit cards charge about six percent of my fee, they’re a big convenience. I punch in a series of numbers; two days later money appears in my bank account.

Slow payment usually means an organization is struggling. It’s maxing out its credit cards and getting them cancelled but keeping others in reserve. A few have gone out of business, owing money, but International Assistance has been irritating doctors for decades; many colleagues refuse its requests. It’s the oldest of half a dozen travel insurers that call me, so this may be a reliable tactic for minimizing cash flow.

Things Guests Say Again and Again

“Can you come up right away?”

It’s surprising how many guests believe I am sitting in an office downstairs. In fact, I’m at home or going about my daily business when the phone rings. I keep a suit jacket, tie, black bag, and paperwork in the car, a mild inconvenience because I must park in shade on sunny days to prevent the heat from melting my pills.

“I’ll call you back.”

Middle-class Americans are mostly insured. Talking to a doctor willing to make a housecall is already disorienting; hearing that they’ll have to hand over money comes as an additional jolt, so they often reconsider (“I’ll talk to my husband and call you back…..”). No one who says this ever calls.

“Sorry about the mess”

Entering a room, I look for a place to set down my clipboard and bag, so I hear this as someone hastily removes the pile of articles covering the desk. After putting a thermometer in the guest’s mouth, I announce that I will wash my hands, so I hear it again as someone rushes ahead to clear a space around the sink. 

“Do you accept insurance?”

My answer is yes – if the guest is foreign. Billing US carriers is so complicated that offices employ trained billing clerks. I work alone.

Fatal Diarrhea

Coris USA, a travel insurer, sent me to see an Argentinean lady with diarrhea at the Beverly Hills Hotel. Diarrhea is usually an easy visit.

Arriving, I learned that her illness was entering its sixth day: too long to be the ordinary stomach virus. She felt weak and feverish, and she had recently taken antibiotics, so I wondered this was Clostridium difficile colitis, an occasional consequence of the avalanche of antibiotics consumed by humans everywhere.

Every antibiotic you swallow kills trillions of germs, mostly harmless, living in your bowel. They are immediately replaced by other germs that can grow in the presence of that antibiotic. Most bowels don’t harbor C. difficile, but if yours does, antibiotics may convert a small population into a large one, and it produces an irritating toxin that causes a severe, occasionally fatal diarrhea. 

Diagnosing Clostridium requires more than suspicion, and there were other possibilities. She needed a thorough evaluation.

Fortunately, Coris USA is a good travel insurer: meaning that it (a) pays promptly and (b) takes my advice. These sound unrelated, but I’ve found that good insurers do both, bad ones do neither.

I phoned Coris’s Miami office with the news and the name of the doctor I recommended. The dispatcher contacted the main office in Buenos Aires for authorization; it appeared within the hour, and the patient went off. If I were dealing with a bad insurer, authorization would be denied or remain pending indefinitely. I often send patients off, warning that they will have to pay up front and try for reimbursement later.

Tests were positive, and she began improving after a few days of treatment: an antibiotic but one different from the one that caused the problem.

A Hotel Doctor's Database, Part 2

Men travel more than women but are less likely to call a doctor so I’ve seen more women (9833) than men (8483). My database contains 124 patients under age one and seventeen over 90, the oldest 97. The smallest of the small hours are not silent. I’ve made 858 housecalls between midnight and 5 a.m.

My leading diagnosis is the same as that of any family doctor: respiratory infections, 4700 visits. In second place are upset stomachs with vomiting and diarrhea: 2672.

I’ve been around long enough to see 77 patients with chicken pox, another 83 with gout, 12 with mumps, 61 with herpes, 29 with poison ivy, and 149 suffering a kidney stone. Victims of kidney stones rarely delay calling a doctor, and since they are rarely emergencies I visit a fair number.  I’ve seen 82 guests with chest pain and sent fifteen to the hospital. Far more of my 30,000 callers complained of chest pain, but I work hard weed out emergencies over the phone. Those fifteen were mistakes.

My most numerous foreign patients are from Argentina, 1854, barely surpassing Britons at 1821. That’s because South American travel insurers mostly began there and are still mostly based in Buenos Aires. But they are expanding, and since 2000 I’ve seen more Latin American guests from Brazil. 

I’ve cared for guests from Andorra, Tonga, Malta, New Caledonia, and Curacao but not from Latvia, Estonia, Yemen, and half a dozen African nations. Russians didn’t travel until the fall of the Soviet Union. I saw my first in 1991. The Chinese don’t appear until 1998. So far Cuba has sent one.

Six guests died – fortunately none in the room after my visit. One was dead when I arrived. Four died soon after I sent them to the hospital and one after the ER doctor (mistakenly) sent her back. I called the paramedics after examining sixteen guests. To my great distress (because that means no payment) paramedics were there when I arrived six times. Many more guests needed attention but weren’t urgent. Leaving after obtaining their promise to go to an emergency room is a bad idea. If the guest decides to wait, and something dreadful happens, I’m the last doctor he or she saw, a situation that focuses the attention of malpractice lawyers. When a guest needs an emergency room, I offer to drive them. I’ve done this 48 times.

28 guests cancelled while I was still driving. 47 weren’t in the room when I arrived. 60 refused to pay. 21 paid with a bad check, but not all were deliberate. I eventually collected on 8. Four times, when I arrived, another doctor was there.  I don’t record guests who get a discount but 173 paid between $5 and $50. 110, mostly hotel employees paid nothing. I will not deny that I have a category for “celebrity.” It has 95 entries although that includes their wives and children. I try to head off drug abusers, but 78 slipped through. The diagnosis on four was “drunk,” but that’s certainly too few.

A Hotel Doctor's Database, Part 1

Few things besides wine and cheese improve with time, but a personal database is among them.   

It didn’t seem significant when I began in 1983, but now I can look over 18,316 visits. So when I claim to have made more housecalls than any doctor now alive, I have the evidence . It’s a fascinating trove of information. I saw 967 patients from Brazil, for example; 42 of them suffered skin problems. Of those calls from Brazilians, 70 arrived between 11pm and 6am, getting me out of bed.

Of the 18,316 nearly 12,000 (11,849) were of calls directly from a hotel. The remainder came from four other sources. 

The second source is agencies that insure travelers visiting America: 3490 visits. Few come from Europe or Australia whose insurers follow the American strategy of insisting that clients pay up front and apply for reimbursement later. Asian and Latin American carriers do better. Their clients phone the 800 number of the agency’s US office; the agency phones me; I make the housecall and send my invoice to the agency which pays exactly what I bill (American carriers undoubtedly roll their eyes at this archaic behavior).

Inevitably some insurers are less easy to deal with than others. Some have adopted the American system of requiring elaborate forms, itemization, and codes for every procedure. Others pay slowly and only after many pestering phone calls. When my patience runs out, I stop accepting their calls.

This doesn’t mean I stop seeing their clients, because they transfer their business to my third source of calls: competitors with 1760 visits. That includes other Los Angeles hotel doctors who ask my help or cover for me when I’m busy as well as one of the national housecall services. They have names like Expressdoc, AMPM Housecalls, Hoteldoc, Global Med. If you live in a large city, they may be available, but be warned that some are reasonable but others charge fees that will take your breath away.

Foreign airline crew make up the fourth source: 913 visits. American airlines have no interest in crew who fall ill when laying over. They have medical insurance but with no transportation or knowledge of facilities in a strange city, they are out of luck. Occasionally I deal with their pitiful calls and treat them as charity cases. As with American insurance carriers, it’s hopeless to bill an American airline for a housecall. 

A minor fifth category is what I call “private-parties:” 293 visits. These are people who learn about me from another source. That includes locals as well as former patients who return to the city and call me directly.

The Wonders of GPS

My wife and I wanted to visit the Riverside photography museum, seventy miles away.

During this time there was a 50-50 chance of a hotel call, but only half require a visit. Our luck didn’t hold, and my phone rang after forty miles; someone was vomiting, not a visit I can stall. When I asked directions to the address from my iPhone, it claimed no such location existed. Since this was an insurance call, the patient was not an English-speaker. She had phoned the insurance office in Miami whose dispatcher (also not a native English speaker) phoned me. Addresses often become garbled.

I called the patient’s number and heard a busy signal, always a bad sign on today’s phones. I was forced to call the insurance number, spending a few minutes on hold before reaching a different dispatcher who spent several minutes researching before turning up the correct address.

Then the iPhone GPS worked its magic, laying out a very specific route to an obscure area near Long Beach thirty miles away. While I took care of the patient, she looked up a nearby restaurant on an iPhone App. We ate lunch and returned home.

Two days later we repeated the drive, this time successfully. Most photography museums are art galleries, but Riverside’s is part of the University of California, so it delivers large dose of history with displays of old cameras and old photographs. Driving home with the rush hour approaching, I kept an eye on the iPhone GPS, marveling at its accuracy at predicting freeway jams.

Why I Discourage Appointments

“The guest will be in the room at six o’clock and would like to see you then,” announced the concierge at two o’clock.

Tactfully, I suggested that she not make appointments without consulting me. The Torrance Marriott is eighteen miles away, and I didn't want to drive across town during the rush hour to see someone who wasn’t sick enough to leave work. I phoned to tell the guest that I could come immediately or at nine p.m. She chose nine.

Arriving ten minutes early, I knocked, and no one responded. Reached by cell phone, the guest reminded me that the visit was scheduled for nine. She was dining nearby, she added, and would hurry back. Twenty minutes passed before she arrived, but during that time another hotel phoned with a visit on my way home, so it looked like a good evening.

The guest arrived, apologized, and described her problem, a minor eye irritation. After I finished she mentioned that her husband felt under the weather. This is usually pleasant news because this couple had travel insurance. My routine is to ask the patient to phone the insurance to obtain approval, so I could care for him and be paid. But obtaining authorization takes time. It was late, and I was anxious to see the next patient who seemed genuinely ill, so I treated the husband’s cold gratis and hurried off.  

Don't Do Anything!

The guest was feverish, and his abdomen felt tender and rigid, a sign of peritonitis. He needed to go to an emergency room. I phoned his travel insurance to let them know.

This particular agency was a slow payer, usually a sign that it would be hard to deal with. 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. It’s not part of a hospital, and the doctor on duty has the same training as I.

Getting a second opinion before sending a client to an emergency room saves the agency money, but it wouldn’t in this case because my patient needed to go. There was always a chance the AMC doctor would send him home, so I phoned the clinic to make sure he thought twice.

No sensible doctor tells another doctor what to do, so I chose my words carefully. I was sending a man with bad abdominal pain and peritoneal signs, I explained. I felt he needed to go to an emergency room and be admitted, but his insurance insisted on 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. For example, an abnormal blood count points to an infection. Good. But what if the blood count comes back normal? The answer: send him anyway. Doctors shouldn’t order a test that won’t change the treatment, but we do it all the time.

So the man spent a few miserable hours while the doctor ordered tests that doctors order when a patient has a fever and bellyache: blood work 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.

Three Discouraging Words

In rudimentary English, a Hilton guest explained that his rash needed attention.

“I’ll be there within the hour,” I said and quoted the fee. He replied with a phrase that makes a hotel doctor’s heart sink.

“I have insurance.”

From an American, this usually means no visit. Collecting from American carriers requires either a trained billing clerk or far more patience than I possess. I refer these guests to a local clinic.

Foreign travel insurers are better. I send a bill, and (unlike American insurers) they send a check for the identical amount. I asked the name of his insurer. It was Assistcard, an agency that’s called since the 90s.

The proper step was to ask the guest to phone Assistcard who would confirm his eligibility, and phone me. This never happens quickly, but it’s rarely a problem because 95 percent of travelers call their insurance first, so I don’t hear about the visit until it’s approved. This guest had mistakenly called me. I told him I would arrange matters.  

After listening to my explanation, the Assistcard dispatcher said she would call the guest, confirm his coverage, and call back. To pass time, I booted up my copy of Sim City. This worked too well; after 45 minutes of wrestling with urban problems I realized the phone had remained silent. Calling, I discovered that my dispatcher had vanished, perhaps to lunch. After putting me on hold, another dispatcher assured me that the wheels were turning. I phoned the guest to make sure he hadn’t wandered off only to learn that no one at Assistcard had called and that his tour was leaving in two hours. I called the dispatcher who explained that the guest was Indonesian. Assistcard was in Argentina, so getting approval from Indonesia might take a while.

Once the guest left for his tour, the visit would evaporate, so I decided to drive down and take my chances. My phone rang while I was on the freeway. The dispatcher informed me that no one could find the guest’s proof of insurance, but it might eventually turn up. Learning I was on the road, he offered to call the guest and suggest he pay me directly and try to claim reimbursement. That rarely works, but it worked this time.

Night of the Concierge Doctors

Hotel doctoring has always been a dog-eat-dog business, but after 2010 another tiresome phenomenon appeared: concierge doctors.

These provide a personal service for a large fee in cash, no insurance -- American insurance -- accepted. Google “concierge practice” for the creepy details. When asked, these doctors insist that they’re not in it for the money which means that they’re in it for the money.

Building an office concierge practice from scratch takes a long time, but hotels are low-hanging fruit. Ambitious concierge doctors visit the general manager, something I never do. Even more effective is telling the staff that every call is worth $50. It’s illegal for a doctor to pay for a referral, and all deny doing this, but bellmen and concierges have begun hinting that, maybe, I’d forgotten something when I walked by on my way out.

I charge $300 to $350 for a housecall. Concierge doctors charge between $600 and $3000…. $3000?! Who pays $3000? The answer is: foreign travel insurers. Everyone in the world knows about America’s rapacious medical system so when an insurance clerk in Spain or Japan gets a bill for $3000, he probably assumes that that’s the going rate. This is no small market; insured foreigners make up a third of a hotel doctor's business.

At the lower end, American hotel guests will usually pay $600 to $1000, although they grumble. There is no free market in hotel doctoring as in all other areas of medicine. If guests want a housecall at a hotel served by a concierge doctor, that’s what they pay.

The Great Credit Card Gamble

AXA insures foreign tourists but has grown fond of American insurer tactics which means it has a number of reasons for not paying me.

It took months, many phone calls, and repeat faxes to collect for previous visits, so I lost patience. After accepting a recent call and copying all the information, I told the dispatcher I’d arrive at the guest’s hotel in an hour. Then I threw the dice. I asked for AXA’s credit card.

 “We don’t have a credit card,” he said.

“Yes you do,” I said. All carriers have credit card, but they vary in willingness to give out the number.

“Let me talk to my supervisor.”  There followed a wait of several minutes before he returned.

“We’ll e-mail a guarantee of payment.”

That’s a legalistic statement describing what the carrier covers and how much it will pay. It doesn’t guarantee anything.

“Go ahead,” I said. “But I still need the card number.”

There followed another long wait.

“I’m afraid we’re unable to supply a credit card.”

I wished him good luck in finding a doctor. Since that 2009 dialogue, AXA calls once or twice a year and we have the same exchange.

I should add that I send bills to many agencies that pay reliably. When they don’t, I ask for a credit card. Some carriers agree, but it’s risky.