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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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.
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?
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, a house call is unusual.
Yes, it’s highly unusual. Otherwise we’d all be doing house calls to hotels instead of what we’re doing now.
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?
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!
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.
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…
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).
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.
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.
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 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
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.
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.
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.
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.
“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.
we’re not here to do library searches for you…do a google search “sciatica + solumedrol”…jerk…don’t they have google in Canada?
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.
“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.
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.
“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)?
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!
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