You never heard of giving steroids for sciatica?

It's called bilk the Canadian tourists with no insurance so that you can save enough to retire.

IM steroid injection (not ESI) for long standing sciatica? Any evidence, or thats how you do things? The patient has a 20 yr hx of ddd The patient had pain, no neuro symptoms, in fact wasnt even examined. Just given $40 worth of medicine for $1800.
The patient wasnt assessed he got a visit from a criminal with a visa terminal. And thanks for the neurology lesson. Sound like neurology for lawyers.

Yes, it's highly unusual. Otherwise we'd all be doing house calls to hotels instead of what we're doing now.

No I wasnt there but the patient was.
Anyway, I don't know why you called me a sodomite. You sound an awful lot like the obnoxious a hole I spoke to in Florida on Friday. Anyway faxing a copy of the bill and a complaint to the Florida State Board. And if it is you...have a happy day!

amazing...this guy gets treatment and medication at a moment's notice...then his canadian pcp sends a complaint to the florida medical board...have fun wasting your time! you're a traitor to the profession...

BTW, your complaint to the Board is little more than heresay. Don't be surprised if the Florida Board of Medicine tells you as much. Since you admit you weren't there for the encounter, commenting on the treatment, unless you have the full record in front of you, is not the most professionally appropriate thing to do either.

As to the costs, why didn't your patient go to an ER or a doctor's office? Ft. Lauderdale is crawling with doctors, and everyone takes credit cards. Servicing visitors is a part of most doctors' practice in Florida resort cities. Your patient ordered room-service medical care on-call to his hotel room, most likely through the front desk. Just like anything else ordered that way, he should expect to pay a significant premium. As a walk-in patient paying cash at a private office, he would have paid a small fraction of that charge for care. Plenty left for the cab, too. Your patient wasn't thinking. Did he take all his meals in the room, too?

I think that charge is over the top and should be negotiated down. I think that is the visitor's--your patient's-- business responsibility, not your business at all.

You got it wrong buddy. A physician that rips off a patient, charging $300
for 40 cents of demerol, thats a traitor to the profession. Thats why physicians are held in such low esteem. You shouldn't be leaping to the defense of such jerks.

Anonymous said...
>"You got it wrong buddy. A physician that rips off a patient, charging $300
for 40 cents of demerol, thats a traitor to the profession. Thats why physicians are held in such low esteem. You shouldn't be leaping to the defense of such jerks."

If I've got it wrong, you haven't offered more than your outrage at the charge to convince me. Did this patient call the doctor directly, or did he have his hotel's concierge arrange everything? Did he ask about what he would likely be charged for a minimum service? He should have, if he didn't.

Really, you seem to be the clueless one. Do you think the hotel is going to charge you the same for dinner if the chef brings a dining service to your suite and cooks dinner for you there and serves you there as you would pay if you went to the dining room and had dinner there?

Your patient is probably used to paying very little for care when he sees you. He certainly shouldn't expect the Canadian government to pay his Florida doctor for care, especially if he is ordering it room service.

And thanks, we are all too well aware how cheaply you all get medicines in Canada. U.S. retail sales are subsidizing that.

10:51 AM

The total fee appears high but I think it is reasonable. It is VIP service, after all, intended for the affluent. The hotel has to be paid for use of the facility for medical service and the hotel shares the liability for the service being rendered. I would have used Morphine istead of Demerol and not given Toradol with a corticosteroid for fear of GI bleed in an elderly (I assume) patient.

The hotel claims that they do not receive any money and that they merely provide the service's number. I have spoken to other providers of similar services around the US and the average price for a hotel visit is $250. Bumping up the demerol by 60,000 % is a tad excessive, don't you think? Does anyone here think that im solumedrol is a good idea in sciatica? Please provide a reference.

Yes I extremely outraged. I don't like affluent people being robbed anymore than poor people.

Its not like this guy got premium service...was seen by an osteopath with no completed residency in anything. D.O.s don't even exist in Canada...oh yeah we call them chiropractors.

we're not here to do library searches for you...do a google search "sciatica + solumedrol"...jerk...don't they have google in Canada?

A surcharge for the hotel facilities and staff. What facilities? Using the grand ballroom as an ER suite? Bell hop holding retractors? I can't believe the number of apologists on this website.

Some of these comments must be coming from docs who work for the service.

BTW if you pay the concierge for referring a patient tp you, that's a fee split. That's not a "facility fee".

Update....
Just got off the phone with the Hotel administrator.
Seems the same day I complained another guest got dinged for $1500 for a visit (another Canadian) ...oh yeah she only got one "shot".
Seems that service has been stricken from the hotel's list of providers.
One small step for mankind.

Hey don't mess with Canadians.

don't be too self-congratulatory...that service made enough money off you idiots that they can retire...

let's see ...($1500 x 666 stupid canadians + $1,000,000!) doh!

"There are almost as many stupid Canadians as arrogant Americans...well not quite"

Don't short-change Americans. There are plenty of stupid Americans.

I regret posting on this blog. Actually a very good blog, but I only seem to have poked a stick in a hornet's nest of self serving free market physicians, who work in a health system that is the envy of no one save the very greedy.

I'm sorry you're all bogged down by HMO's and endless paperwork and your lawyered to death. Actually I'm not sorry, it seems you have the medical system you deserve.

"A surcharge for the hotel facilities and staff. What facilities? Using the grand ballroom as an ER suite? Bell hop holding retractors? "

Putting up with obtuseness?

Not any more than having the drycleaning contractor
press a suit at three times the streetfront price or having the room pickup for shirt laundry at eight or ten times the street price. These contractors frequently don't use hotel facilities either, yet markups are accepted. Since when have hotel-delivered services of any kind been a bargain? It is totally irrational to expect an office charge for hotel housecall and treatment.

Completely enlightening comments, that put things in perspective as to the question "what in the world is wrong with American medicine?"

Why, of course, it's the Drs. themselves that are bringing down our healthcare. Anyone that has any doubts only needs to read every comment on this post!

I can't wait for national healthcare to get here, to put some of you in your rightful place.

Who are you people? This was purely and simply a ripoff artist .I don't care what he pays for malpractice,his porsche payments or whatever.He or she has no place in a profession other than prostitution. All the obfuscations about choice of treatment,coding,fee splitting,etc,have nothing to do with the obscene chargesthis "doctor" billed. This used to be an interesting,thoughtful blog.Why is it necessary to call commenters names.Are the rude commenters arquements so weak that you have no other choice.

"I can't wait for national healthcare to get here, to put some of you in your rightful place."

That's as precious as it is pathetic and naive. With your national hhealthcare, you will get rationing, real rationing. Hope you'll like that, too.

Let me thank the good docs who see this behaviour for what it is...dishonest. If you are called to see a patient in pain, whether he is in a hotel suite or a mobile home, and you charge him not what the thing is reasonably worth but what you think you can get away with, then you have betrayed your profession, and worse what you probably once were, someone with ideals. And no amount of casuistry
will let you ecsape that.

Touche Kevin!

Sodomite? Greek chorus? Do I detect a theme? This isn't about left of center poliitcal correctness. Talk about tiresome! Is someone going to whip out Rush Limbaugh talking points? Hey, I know where Rush can get some primo demerol and Percs. Forgot to tell you all when I spoke to the housecall doc, who berated me for questioning his bill, he told me he thought the patient was drug seeking. Which must be why he gave him two demerol shots and prescription for Percocets. And yes, I think Visa is the place to go with this complaint.....not.

I also detect a certain hostility toward what some of you believe to be a wealthy, visiting tourist, as if that somehow makes him fair game.
I wonder if when you have a severe toothache your first question to the dentist is, how much? I doubt it, and I doubt you feel like haggling a la Turkish bazaar.

You know I'm really not shocked.Why should US doctors hold values that differ substantially from the society as a whole? Heck a majority of US doctors voted for Bush. Most of you want to be rich visiting tourists somewhere else, and believe
me each and everyone of you will scream bloody murder when you get ripped off.

I find it amusing to see so many of you circling your wagons around a scoundrel. The really interesting thing is this undercurrent of hostility towards the rich. Is it because US physicians as a class have fallen so far in rank, both socially and economically? I suspect so. I've never seen so much "right-of-center" contempt for wealth.

And why should you feel less sympathy for the patient because his physician is outraged? Or because "it's not even his own country"? Are you in kindergarden? You guys should be purging your own profession in your own country of crooks like this. And if you don't see it, well then maybe its you who needs to get a life. And if I've riled some of you, so much the better!

PS. I really do like that Greek chorus line.

Actually the ticket is to warn Canadians to be very careful when navigating US healthcare. To avoid it if at all possible as they are considered fair game by many of you folks.

That's a very fair comment/estimate.
I think the call was late at night which kind of precluded some of the cheaper alternatives. I doubt any insurer would pay more than a couple of hundred bucks for the care delivered. I think the mark-up on the shots was obscene.

Many critics on this site advance the notion that the free market should prevail. However, the playing field isn't exactly level when one guy's in pain and the other guy has
the painkiller.

Let's face it someone in severe pain may willing to pay any price to have it eased. And guys that will take advantage of that fact and hold those patients to ransom are beneath contempt.

Actual Bill

Housecall $675
Demerol 50 mg J2175 @ 300 x 2 $600
Solumedrol 125mg/ml J2930 x 1 $900
Toradol 60mg/ml J1885 x 1 $300


Total: $2475

Dx codes Herniated disc 722.2
Sciatica acute 722.1

And plenty of docs (I presume they are docs) think that this is reasonable. Go Figure.

I'm new to the site, but work as a family physician at a ski resort in Canada. I previously practiced private Hospital anesthesia Los Angeles. I charge $200 for house calls, including shots. I'm all for private enterprise, but the bill here was clearly gouging (unethical), and IM steroids are ineffective (larcenous if done for profit). Treating patients is a privilege, and they rightly expect us to do what is best for them. This was clearly not the case.