That is not my favorite greeting, because it means the valet doesn’t recognize me. My response is always: “I’m the hotel doctor. I’ll be here twenty minutes. They hold my car.”
That’s my mantra to parking attendants, delivered a thousand times and followed by a moment of tension. Will he smile, accept my key, and park my car nearby? Or will he hand over a voucher, jump behind the wheel, and drive off into the bowels of the parking structure?
I have no problem tipping attendants, but I hate paying ten to twenty dollars to park. Accepting the voucher makes that a possibility, so I repeat the mantra, hoping he will reconsider or appeal to his boss who might know me or decide an elderly doctor with his bag deserves VIP status.
Once I accept, my next step, after caring for a guest, is to ask the desk clerk or concierge to validate. Sometimes they comply, but now and then…
“Sorry. The hotel doesn’t handle parking. It’s a separate company.” Hotels often outsource parking, but luxury hotels always accommodate me. Chains are unpredictable, even those where I go regularly. But once I hear this, I pay because I have a rule against arguing with hotel staff. Validation sometimes requires only that the employee scribble “comp – hotel doctor” on the voucher. Once, when refused, I scribbled it myself, and it worked, but I don’t do it. The chance of getting caught is very low, but the consequences are so humiliating that it’s not worth the risk.
After thirty years, I know the nearest street parking for every hotel; if it isn’t hot or raining, I’m willing to walk a few blocks. Downtown is a problem because, even during wee hours, homeless men hurry up, offering to watch my car. In the immense wasteland near the airport and hip entertainment sections of the Sunset Strip and Hollywood, street parking is often impossible. As with so many amenities, Beverly Hills is a pleasant exception.
I loved the temporary handicapped pass I used for six months after breaking my leg in 2003. Its benefits are no secret to the able-bodied; it turns out that eleven percent of Los Angeles drivers have one including not a few running the treadmills at my gym.
Sunday, February 19, 2012
Wednesday, February 8, 2012
Human Nature, Part 2
Cynicism is a cheap substitute for sophistication, but I find it as tempting as most people... The lady just phoned, full of apologies, and we're working on ways to get the money. It hasn't arrived, but I assume it will.
Tuesday, February 7, 2012
Human Nature
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.
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.
Friday, January 20, 2012
A No-lunch Day
The Langham called 11 a.m., a perfect time. I was finishing at the gym; I could shower, make the visit, and return home for lunch.
The gym is near the 405 freeway, a few miles from my home. It’s not my usual route for the 25 mile drive to Pasadena, being slightly further, but I decided to experiment. A mile after I set out, traffic stopped cold as far as the eye could see.
That’s when I remembered we are adding a single northbound lane to the 405 through Sepulveda Pass. There’s no room, so workers must rebuild every overpass, carve out and reinforce cliffs, and heap up dirt to widen the roadway. This six-mile addition will cost a billion dollars. I cannot think how much mass transportation a billion dollars would buy if there were any political support.
After fifteen minutes of creeping, I reached an exit and took old Sepulveda Boulevard past the construction. While driving, I answered a call from an insurance service and agreed to see a Brazilian boy with a fever in Huntington Beach. Huntington Beach is in Orange County, forty-five miles from my house. It could have been worse; it’s the same distance from Pasadena.
The Langham guest was a Washington Post reporter with a respiratory infection. He was covering a local convention, so the paper was paying for his room at the very posh Langham, but it wasn’t paying his medical expenses, so he had phoned several times before deciding on a visit. I delivered advice and medication before proceeding on my way.
The knowledge that I’ll miss a meal stimulates my appetite, so I suck on hard candy from a supply I carry. I never grab a bite at a hotel because I love eating and prefer to remain hungry and take care of obligations, so I can relax and enjoy it.
After shaking my hand, the Brazilian father reminded me that I had visited him a month earlier. Over most of the US, travel insurers send clients to clinics or emergency rooms. Having a doctor appear at their door is more pleasant, so Los Angeles travelers lose their inhibitions about asking for help, and I see many repeat customers. After examining his son, I explained this it wasn’t necessary to give him a cold shower for his 101 temperature. He would feel bad for a few days and then recover; I handed out four packets of Tylenol.
It was after 3 when I pulled into my garage and answered a call from the Westin at the airport. This was one of those what-might-have-been calls because I’d passed the freeway exit only blocks from the Westin half an hour earlier. I retraced the route to care for a lady with a painful eye, returning in time for supper.
The gym is near the 405 freeway, a few miles from my home. It’s not my usual route for the 25 mile drive to Pasadena, being slightly further, but I decided to experiment. A mile after I set out, traffic stopped cold as far as the eye could see.
That’s when I remembered we are adding a single northbound lane to the 405 through Sepulveda Pass. There’s no room, so workers must rebuild every overpass, carve out and reinforce cliffs, and heap up dirt to widen the roadway. This six-mile addition will cost a billion dollars. I cannot think how much mass transportation a billion dollars would buy if there were any political support.
After fifteen minutes of creeping, I reached an exit and took old Sepulveda Boulevard past the construction. While driving, I answered a call from an insurance service and agreed to see a Brazilian boy with a fever in Huntington Beach. Huntington Beach is in Orange County, forty-five miles from my house. It could have been worse; it’s the same distance from Pasadena.
The Langham guest was a Washington Post reporter with a respiratory infection. He was covering a local convention, so the paper was paying for his room at the very posh Langham, but it wasn’t paying his medical expenses, so he had phoned several times before deciding on a visit. I delivered advice and medication before proceeding on my way.
The knowledge that I’ll miss a meal stimulates my appetite, so I suck on hard candy from a supply I carry. I never grab a bite at a hotel because I love eating and prefer to remain hungry and take care of obligations, so I can relax and enjoy it.
After shaking my hand, the Brazilian father reminded me that I had visited him a month earlier. Over most of the US, travel insurers send clients to clinics or emergency rooms. Having a doctor appear at their door is more pleasant, so Los Angeles travelers lose their inhibitions about asking for help, and I see many repeat customers. After examining his son, I explained this it wasn’t necessary to give him a cold shower for his 101 temperature. He would feel bad for a few days and then recover; I handed out four packets of Tylenol.
It was after 3 when I pulled into my garage and answered a call from the Westin at the airport. This was one of those what-might-have-been calls because I’d passed the freeway exit only blocks from the Westin half an hour earlier. I retraced the route to care for a lady with a painful eye, returning in time for supper.
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.
Sunday, November 20, 2011
Returning from ten days out of town, I took my phone off call-forwarding, unpacked, and prepared to drive to Trader Joe’s for groceries. Before I left, the phone rang with a housecall at the Torrance Marriott, twenty miles distant. The good news was that it was Saturday evening, so freeway traffic was light, and the patient was seventeen, an age when illnesses are rarely complicated. The bad news was that he was Japanese, a people admirable in every respect except for their reluctance to learn English.
As I stepped out of the elevator, a middle-aged Japanese man rose from a chair. “Are you the doctor for the hotel?” he said.
I was delighted. “Yes. Are you going to interpret for me?”
He stepped back in alarm and waved his English-Japanese phrase book. Hiding my disappointment, I followed him to the room. When he began flipping through the booklet, I shook my head and pointed to the phone before dialing the guest’s Japanese insurance service for an interpreter. There followed a lengthy encounter as the phone passed back and forth between me, the parents, and the patient. The young man had suddenly complained of fatigue the previous day. He was otherwise in good health; he had no other symptoms, and I found nothing abnormal on examination. Sudden fatigue is an ominous sign in the elderly but rarely in an adolescent. I suspected an emotional problem, perhaps from the stress of travel. This is hard to explain across both language and culture, made even harder because I didn’t give a medicine. Giving medicine is a universal language; that’s why doctors prescribe even when it isn’t necessary.
Luckily these were Japanese, so they listened to my advice (get a good night’s sleep, continue with their itinerary, call if the problem persisted) with unfailing courtesy, nodding approval, and thanking me effusively as I left.
As I stepped out of the elevator, a middle-aged Japanese man rose from a chair. “Are you the doctor for the hotel?” he said.
I was delighted. “Yes. Are you going to interpret for me?”
He stepped back in alarm and waved his English-Japanese phrase book. Hiding my disappointment, I followed him to the room. When he began flipping through the booklet, I shook my head and pointed to the phone before dialing the guest’s Japanese insurance service for an interpreter. There followed a lengthy encounter as the phone passed back and forth between me, the parents, and the patient. The young man had suddenly complained of fatigue the previous day. He was otherwise in good health; he had no other symptoms, and I found nothing abnormal on examination. Sudden fatigue is an ominous sign in the elderly but rarely in an adolescent. I suspected an emotional problem, perhaps from the stress of travel. This is hard to explain across both language and culture, made even harder because I didn’t give a medicine. Giving medicine is a universal language; that’s why doctors prescribe even when it isn’t necessary.
Luckily these were Japanese, so they listened to my advice (get a good night’s sleep, continue with their itinerary, call if the problem persisted) with unfailing courtesy, nodding approval, and thanking me effusively as I left.
Wednesday, November 9, 2011
Can I Submit This to My Insurance?
The phone rang at 9:30 a.m., the perfect time. I was finishing breakfast. My routine is to work an hour on the computer and then go to the gym, but I’m happy to do a housecall instead. If two housecalls arrive, I skip the gym, an even greater pleasure.
The hotel was the Holiday Inn at the airport. The patient, a young Australian woman, had arrived after a tiresome flight during which she was forced to run back and forth to the bathroom. Urine infections are among my favorite diseases. They’re miserable but respond quickly to the antibiotics I carry. Patients are always grateful. This looked like a good visit. I quoted my fee.
“Oh… I didn’t realize it would be so much.”
This happens now and then. I remember guests at the Beverly Hills Hotel where room rates start at $300 who didn’t want to pay half that. In any case, once I mention the fee, I try not to refuse someone who thinks it’s too high. So I asked if $100 was OK. It was.
It was a satisfying visit. I tested her urine, announced she had an infection, and handed over a packet of pills. She was grateful. As I left, she indicated my receipt.
“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 happens regularly. In every advanced country outside the US, except Russia, China, and South Africa, if you need a doctor, you don’t first decide if you can afford it, so foreign tourists often pay little attention to their insurance.
The hotel was the Holiday Inn at the airport. The patient, a young Australian woman, had arrived after a tiresome flight during which she was forced to run back and forth to the bathroom. Urine infections are among my favorite diseases. They’re miserable but respond quickly to the antibiotics I carry. Patients are always grateful. This looked like a good visit. I quoted my fee.
“Oh… I didn’t realize it would be so much.”
This happens now and then. I remember guests at the Beverly Hills Hotel where room rates start at $300 who didn’t want to pay half that. In any case, once I mention the fee, I try not to refuse someone who thinks it’s too high. So I asked if $100 was OK. It was.
It was a satisfying visit. I tested her urine, announced she had an infection, and handed over a packet of pills. She was grateful. As I left, she indicated my receipt.
“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 happens regularly. In every advanced country outside the US, except Russia, China, and South Africa, if you need a doctor, you don’t first decide if you can afford it, so foreign tourists often pay little attention to their insurance.
Subscribe to:
Posts (Atom)
Posts
