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?
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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.
“There are almost as many stupid Canadians as arrogant Americans…well not quite”
Don’t short-change Americans. There are plenty of stupid Americans.
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!)
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.
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…
“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.
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!
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.
healthcare and doctors will put you in your place…unnecessary referrals, lab test, procedures, biopsies, prolongation of life during terminal illness…enjoy…
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.
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.
“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.
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.
Touche Kevin!
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.
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.
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.
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.
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.
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.
BTW, the figures quoted in the bill add up to more than the total bill. Not that they aren’t bloated either way.
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.
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?
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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