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A reader writes:

I’m a family doc in Toronto. A patient of mine recently had a housecall service come to his hotel room in Ft. Lauderdale.
The patient has had a hx of back pain and multiple surgeries to his ls spine with little benefit. He had an acute back spasm while in Florida and called a service, that will remain nameless for now. The owner of the company came to see him. Th dx was acute sciatica.
Now the horror. the visit fee was $ 675 then the tx. Demerol 50 mg im x 2 @ $600, solu medrol 125 mg im @ $900 (an interesting, if unusual tx) and Toradol 60 mg im @ $600. Total bill $2,475. Not bad for a 1/2 hrs work. Please tell me this is unusual, even for the US.

Any comments?

Comments

Anonymous
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.
Anonymous
oh, i forgot, you’re canadian…
you expect the cost to be under $100 Canadian, and the patient to wait for a week to be assessed at which time he/she has developed foot drop and urinary incontinece/saddle anesthesia…have you heard of those symptoms?
Anonymous
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.
Bad Shift
Yes, a house call is unusual.
Eye Doc
Yes, it’s highly unusual. Otherwise we’d all be doing house calls to hotels instead of what we’re doing now.
Anonymous
I didn’t say I would give steroids (because of sodomites like you), but it is common practice…
and how do you know he wasn’t examined? were you there?
Anonymous
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!
Anonymous
Pretty outrageous bill for such a short encounter.
I’m a surgeon and don’t get anything close to that for a half-hour’s work. I’ll leave comment about the treatment itself to others.
As to the bill, if it went through the hotel’s concierge desk, you can bet that a big chunk of that charge went to the hotel, not the doctor (like maybe 50%).
Just one of those special services you can get at better hotels. People staying at nice hotels don’t want to spend their winter vacations laid-up.
Cash-paid high-price after-hours on-call medical consultation is common in resort cities, as are the add-on charges rendered by the hotel. Usually the hotel will have a service agreement with a contractior, who is the one hiring the on-call medical consultant and who also applies a commission fee.
Super convenient housecall service is certainly not going to cost what an office visit in Ontario will cost.
Treatment aside, a bill for several hundred USD for
that service is very reasonable.
Anonymous
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…
Anonymous
The person probably should of asked ahead of time about charges. Personally. I would have gone to an urgent care/(or ER), if I were that person. If you want convenience at a price (which is what your patient got).
Anonymous
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.
Anonymous
If you think about how the bill would code out: new patient encounter, level III or IV, administration of medications, housecall surcharge, after-hours surcharge, and medicines, all at book rate (i.e., not at insurer or Medicare discounted rates) then double it twice (once for the on-call service contractor, who probably pays its contract doctors a minimum fee per night on call, whether they get called or not) and again for the hotel, which does the billing and the collections, a huge bill for a seemingly simple service is not all that hard to understand.
The patient should have asked first about the room service rates.
Anonymous
ER wouldn’t have been much cheaper. Sodomite’s rule in Florida, so they may have admitted him, ordered a spinal MRI, neuro and neurosurgery consult, maybe a belly CT to rule out AAA.
Anonymous
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
Anonymous
As I recall fee splitting is both illegal and unethical. The hotel is not supposed to get any part of that fee. Neither is the concierge. We’re not talking about theatre tickets. You need an ethics tune-up my friend.
Anonymous
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.
Anonymous
At 11:31, Anonymous said…
“As I recall fee splitting is both illegal and unethical. The hotel is not supposed to get any part of that fee. Neither is the concierge. We’re not talking about theatre tickets. You need an ethics tune-up my friend.”
Blah, blah, blah . . .
Let us clarify a few things: first of all, I do not engage in this kind of consultation; second, I am not your friend, and third, I do not need “an ethics tuneup” either. Kindly put a lid on your ad hominem remarks; you are not winning friends or arguments that way.
This is not fee splitting. This is surcharge for use of the hotel and its staff and facilities. If the model being used here is that of other similar services, the doctor splits his fees with no one. These kinds of hotel medical services have been offered in other cities for many years, in fact the first public articles I read about them was for a company called Doctors on Call that did similar service in New York City.
In fact it is just like theater tickets, to use your example, In fact, it is like ordering 10th row center orchestra tickets to a sold-out show that night, if you want to be more specific, that, and asking your concierge to send an on-call tailor in with a couple of tuxes and shirts for you to try before the show.
Anonymous
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.
Anonymous
“I have spoken to other providers of similar services around the US and the average price for a hotel visit is $250.”
I have 3 urgent care centers in the Southwest. This visit including the shots would have cost $200 for the insured or uninsured. The insurance company will be billed $300 and we’ll probably be paid $200. If the average price for a hotel visit is $250, you should all avail of that service and good luck in finding one at that price.
Anonymous
we’re not here to do library searches for you…do a google search “sciatica + solumedrol”…jerk…don’t they have google in Canada?
Anonymous
folks…this is not insurance we are talking about…this is a foreign national who needs treatment…a doctor can charge whatever he/she wants to…and there is nothing this canadian doc or anyone else can do about it…it’s called capitalism…unfortunately you have to rip off the few that can pay to make up for all the denied claims, etc.
Anonymous
“sciatica + solumedrol”…jerk…don’t they have google in Canada?
Yeah, they have google in Canada, the problem is in the U.S. it’s called “sciatica”, leading to a neurosurgery referral and 6 months disability. In Canada (and every other country) it’s called “back pain” and you go back to work.
Anonymous
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.
Anonymous
“BTW if you pay the concierge for referring a patient tp you, that’s a fee split. That’s not a “facility fee”.”
It depends on who is doing the billing. If I charge a fee to the patient and then send a kickback to the hotel, that is a fee split. If I (or my agency) charges the hotel, and they in turn apply a surcharge and put the service on the patient’s room bill, that is not fee splitting. I have kept my whole fee and others add what they add, a little or a lot.
By your reasoning, a hospital couldn’t mark up its medicines above cost (and they can and do). But I keep forgetting, drugs are so cheap up north, would you even notice?
So far, the only thing the Canadian doctor posting on this thread has convinced me of is that the charges were high. I see cause for the patient to try to negotiate down the charge, with the only valid argument being that the charges were out of line for similar privileged services. But I still don’t see what business a third-party Canadian doctor has here, when he neither referred this patient nor was present for any of the treatment he disputes. Is consumer advocacy after-the-fact your objective? And who cares what degree the attending doctor had; how is that at all relevant, except to expose your bias? Do you think your patient should have been charged less because his doctor had an osteopathic degree or because he wasn’t board certified (I can see you have spending some time on this, slow day)?
Anonymous
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!
Anonymous
There are almost as many stupid Canadians as arrogant Americans…well not quite.
If a concierge refers a patient to me, and I tip the concierge, or we have an understanding that he gets X dollars for every referral…thats a fee split. The hotel isn’t in the loop on this one.
You’re right his degree is of no importance, and I regret posting that comment.
Anonymous
“There are almost as many stupid Canadians as arrogant Americans…well not quite”
Don’t short-change Americans. There are plenty of stupid Americans.
Anonymous
it’s interesting how this self-described “family doc from canada” (about as low on the totem pole as you can go) is putting down DO’s (by the way, I’m not a DO!)
Anonymous
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.
Anonymous
I am sorry Canadians are saddled with a health care system where they have to wait 2 months for a lap chole…actually, I’m not…it looks like you people have got what you deserve too…
Anonymous
“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.
Anonymous
trust me, no one waits 2 months for a
needed chole. what are you reading Forbes? what 40,000,000 with no insurance? how many unvaccinated kids, heck Cuba has lower infant mortality.
what do you pay in malpractice?…my premium is about $1500 per year. There is now a net movement of Canadian docs coming back to canada rather than going to the US.
Only western country without universal healthcare. Hey its a great country if your not black, hispanic, native, poor. But a rich white guy can have an effing lap chole today! What a great countr!
Anonymous
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.
Anonymous
healthcare and doctors will put you in your place…unnecessary referrals, lab test, procedures, biopsies, prolongation of life during terminal illness…enjoy…
Anonymous
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.
Anonymous
Thank God there someone sane here. I just can’t see how MDs can condone phoney criminals that masquerade as doctors. Guys like this are a scourge on the profession whether its in the US, Canada or anywhere else.
Anonymous
“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.
Anonymous
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.
Anonymous
What “shocking behavior” do you really see? Are you “shocked” just because you read opinions that you disagree with? Because not everyone is in agreement with the doctor from Canada? Except for the “sodomite” comments–which I think are abrasively unnecessary as well as becoming repetetively tiresome– there isn’t anything said on this thread that is “shocking”, unless you find that comments that don’t conform to your standards of liberal political correctness and left-of-center social and economic policy an affront to your dignity. So the solution must be to do what, ask the site moderator to edit out whatever you don’t agree with? Get yourself a life.
Our Canadian doctor is annoyed that not everyone validates his expression of outrage at the high charge his vacationing patient and fellow countryman received for in-room consultation and treatment. So what. This is a comments thread, not your own personal Greek chorus. If you don’t like opposing opinion, go write your own blog and edit the comments all you please.
As for the patient, he should have inquired about the charge beforehand and considered whether the trip to an ER or a doctor’s office wouldn’t have been more appropriate. It is not impossible to get an estimate of the minimum charge beforehand. It seems as if he didn’t want to bother. If he thinks he was overcharged, then let him dispute that with the doctor and his credit card company. The idea that he would try to make his personal physician act as his agent by going to the Board of Medicine of a state not even in his own country makes me feel less sympathy for the patient. It sounds as if he is an affluent and overly-expectant person used to having people wait on him hand and foot both at home and abroad.
Anonymous
Touche Kevin!
Anonymous
As a doc who has worked in both Canada and the US, these ad hominem comments about our Canadian colleague are uncalled for, ridiculous, and offensive. First of all, to denigrate family physicians in Canada is to denigrate the entire Canadian medical system , since the majority of physicians in Canada are family docs. Most of them are excellent and take care of a large group of patients without the CYA technology we use here in the U.S. Regarding this topic this family Doc was being an advocate for his patient. I don’t see how you can fault a family doc for being a good patient advocate. Patients in Canada don’t sue their docs, so they have a better relationship then in our country.
Anonymous
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.
Anonymous
Guy takes a Florida winter vacation. Has a history of longstanding back problems, even surgery. Has seen plenty of doctors. Back starts acting up again on vacation. Should I just go see a doc here in town? Naw, I’ll just call the front desk and have them call one in. Doc comes, gives me a couple of shots and goes. When the bill comes, holy smoke, I could have gone to the doc for five years for less than that back home. What to do? Call the credit card company? Call the doc who must have made a mistake here? Naw. I call that doc I see at home and have him take care of it.
Advocate or lackey?
Patient complaining about bill in Florida? Got burned I think, really high charge. $600 for Demerol! What a ripoff; I pay what, 0.40 CAD for that. Do some math.
Patient thinks I should do something here. What? Tell him to call his credit card company and complain of fraud? No. Tell him to call the hotel and complain? No. Tell him to complain himself to the hotel and the doc? Tell him to write to the Florida board and ask them to investigate? Call other doctors in Florida to get a quote for a hotel visit of the same kind? No. I’ve got it, I’ll do all these things myself, and then to validate my outrage, I’ll post on an internet blog page just to make myself feel virtuous and justified in taking such a strong and leading role here. That’s the ticket.
Anonymous
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.
Anonymous
Maybe better advice is to first buy travel medical insurance when going to the US. Then advise vacationers to go to the doctor’s office or a walk-in clinic or if seriously ill, an ER, rather than ordering a housecall consultant. That isn’t hard advice to follow.
I think the charges are high enough in this case to call fraud. That is something the patient should take up with the credit card company and possibly the hotel, himself. If he needs an advocate, call a lawyer, that is something they are supposed to be able to do.
All the same, if you asked me to give an estimate for the fair charge for a housecall like that, I would expect the charge to start at whatever I would expect to collect in gross on average in my office for the time spent in the consultation, including my travel time. Any procedures done or materials consumed might be extra. Roughly figuring, giving a half-hour travel time each way and a half-hour visit, and that is likely to be at least $600, minimum. It is a lot, which is why no one does house calls anymore, because you can’t get people to pay that and you can’t run a practice on less.
Anonymous
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.
Anonymous
BTW, the figures quoted in the bill add up to more than the total bill. Not that they aren’t bloated either way.
Anonymous
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.
Anonymous
My name is Steve and I am new to this site. I am amazed at what I have read. I learned in school that doctors are there to help the sick. Anyone who happens to be ill is just that, regardless of nationality. What does it matter if they are from Fort Lauderdale, Boca Raton (where I live), Riviera Beach (a poor area of Palm Beach County), or Canada? The important thing is that they get the help that is best for them, and that it be for a reasonable fee.
Ps. why all the anonymous posting?
Mike Figurski, MD
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.

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