Wrist osteoarthritis treatment in 366 Orthopedic surgery clinics in Europe

Context: Foreign patient/tourist Lack of signage for foreign patients is what exacerbated this horrible experience not knowing what is the correct entrance, the fact that you can't go any doctor and must go straight to the emergency reception for example (flat fee is also 200 EU which luckily was refunded by my travel insurance) 1 receptionist out of 7 was friendly, rest were horrible to an ill person despite being polite as possible 1 doctor in the emergency ward was pretty careless after dismissing me from the hospital (and was dismissive), not even providing a proper dressed bandage for my wound after removing a drip needle that was never used to give fluids (something usually done for pain or dehydration - I was expecting some for relief but none was given) A trainee had better bedside manners The doctors in the gyni section were absolutely fantastic, explaining everything, being friendly etc. However, nothing was found for the cause of my pain which was distressing and no pain relief was offered even. A traumatic experience for someone traveling alone. I hope this review helps someone in the future. Will never be traveling back to Cologne as the reception to tourists is 99% of the time cold as ice.

First , I can not comment on medical services , but the buildings and the arrangements, the wide variety of specialties and advanced equipment all are amazing. Well organized campus.

My wife gave birth there. This was the only good experience we had in hospitals. I want to give thumbs up for the best team in the world and especially to Frau Hannah. 🙏

The hospital oncology is careless and amateur. They mistreared and misdiagnosed a friend of mine for months with cancer. They told him he is fine, whereas he had severe abdominal pain. What kind of doctors work there? Have they not sworn to do no harm??

They just don’t have the knowledge to be doctors or nurses. Sadly, all the hospitals in Spain are like this. You can find some good specialist and surgeons, but that’s about it. Free healthcare=Poor quality.

I have been in Emergency hospitals here in Spain, was first time I got decent treatment, from receptionists, nurses and doctors was perfect the attendance. Do not give 5 stars because they did not make any treatment, because was not my reference Hospital. I think it¨s absurd, anyway was the best I have been in Spain so far.

We also experienced the worst possible care. We were there the same night, September 11, 2023, when Marcia Lorena recently posted about the inhumane treatment toward her 87 year old grandmother, who the ER refused to treat. We are witnesses to this horrible treatment/nontreatment. We also were ignored for 3 and a 1/2 hours. We believe we were ignored because we are Americans. Several wonderful German women helped us by asking in German when my husband would be seen. They helped us four times. They were appalled that no one would see us. The desk person kept telling us that we had to wait and that they did not speak English. However, they told us a female doctor spoke English and would see us soon, but never did. It was 10pm at night and no one was in the Emergency Room and they still ignored us. During the 3 and 1/2 hours, we saw lesser cases come in and get assistance, while we continued to wait. We eventually left. I can tell you this would never happen in the United States of America. In the United States, they take you and care for you, no matter what country you are from. I wish these ER hospital personnel could experience the helplessness that we felt when they ignored us, when they are sick and outside of Germany, but unfortunately, if they are traveling in the United States, they will be well taken care of. Shame on them! Also, the Hospital Northwest should receive ZERO stars, but I had to give one, to do the post.

I was in for a sleeve gastrectomy and I could not have wished for better care in the week I was there. Absolutely amazing staff!

Management needs to be improved. A lady called me to cancel my OP the day before and said I have to wait 2 months even though I did all the pre-OP exams and of course arranged my work for sick leave before 1 week of hospital stay. When I asked if I can have the surgery with the same doctor who examined me, she started to yell, HE'S NOT MY CHEF ANYMORE in German and hung up before I responded. So I had to find another hospital to have OP. I don't understand how they can throw out a patient when their own doctor strongly suggests a surgery urgently. Also, why do they have to get ANGRY at patients just by asking questions who's already suffering and feeling already miserable?

Great experience. Went there on a Sunday evening urgently for our kid. The paediatrician on site suggested that a specialist should see her. They called him and he was there just for us in less than an hour.

Exorbitant prices were charged for a single D-DIMER blood test. We were charged 120 euros for this test, whereas at a private microbiological practice in the heart of Thessaloniki, without any insurance, the cost was only 10 euros. If you need to undergo basic blood tests, it's advisable not to choose this facility, unless you have private insurance. Furthermore, the staff responsible for blood sampling seemed to lack experience, and they appeared quite inconvenienced when I requested the use of a smaller needle.

Truly grateful to this hospital, my mother has been receiving treatment there for the past year and a half. The oncology department as well as the department dealing with international patients have truly showed exemplary service. The doctors that have helped us have been beyond amazing and I would not have chosen any other hospital. The nurses have also been helpful, joyful and kind. We now do all our medical services there, and travel cross country to get there, including myself and other family members.

As a study abroad student, this hospital was great at providing me the medical assistance I needed. If you need to see a general practitioner, head to the ER and walk to the international desk. They’ll get you all the help you need. Come prepared with documentation and ID!

I highly recommend Dr Gabriel Cardenas Rivera for his exceptional surgical skills and compassionate care. My recent surgery was a success because of her expertise. I had a great experience at HM Delfos. The staff were caring and the facility was clean and safe. I wholeheartedly recommend it for medical care.

My first negative review ever, but the situation calls for it. Please, be aware that the hospital charge EUR 450 for a visit - this is NOT something they will tell you in advance. They charge a deposit and when you ask them how much the visitation costs, they will not give you a straight answer. Naturally, as a private hospital the cost will be higher, however, with this one, there is 0 transparency. The doctor spent 1 minute looking at my symptoms with 0 examination (not even checking my temperature), and my case was re-directed to a public hospital, and then took EUR 450. I would be very careful before wasting time and money here.

If you call them and are lucky enough that your call gets picked up, and you ask the receptionist (in german) if she speaks english, she would in a very harsh tone say "NO" and slam the phone. I think she shouldn't be working in any field where communicating with humans is required let alone humans in distress at a place like a hospital/clinic. Pathetic!

Everyone waits in ER and i was happy to do so. The attending ER doctor was amazing anf really listened despite the chaos. I was admitted to Station 5A and the nurses were lovely. The rest fo teh doctors need to grow empathy and a heart. The hygiene of the Station was filthy and blood from my Roommate was not cleaned up for several days. The Orthodox Jewish female doctor gave me a heavy antidepressant that was touted a "to help me sleep", was totally uninterested and with an air of contempt and later that evening as were the rest of the doctors there, the male nurse tried to steal my phone charging cable thinking i was unconscious from the medicine, that thankfully i vomited. To the red headed trainee nurse, thankyou for looking after me and believing me, your hunch was correct. I have since been diagnosed from a real hospital with Post Vak (Uniklinik Marburg) who laughed at the arrogance and poor attitude in the Asklepios Artztbrief. Everything that was "unaufällig" turned out to be pleural effusions, neurological damage and a blood clot that SHOULD of been discovered easily by Asklepios. SHAME ON YOU.

I was extremely sick with high fever and attendees at the help desk was so rude and even deny to let the doctor see me. Pathetic people with no humanity!!!

Unfortunately, the attitudes of almost all the staff during a recent outpatient trip to emergency were extremely regrettable. I was initially refused any painkiller for hours, despite having a broken bone. I was made to wait 7 hours, more than all the other people who had come in, not all of whom were acute cases. And I was not given a medical report on leaving, which meant I had to make a separate trip back to the hospital to insist on receiving it. I attempted to politely follow this up through normal channels but the response was excessively defensive and factually incorrect. No apology, no points acknowledged. Very disappointing indeed. All I can say is that 80-90% of the staff there were unpleasant, seemed to hate their jobs and made a difficult situation for me and others like me far worse.

Supportive, very friendly staff and fast help. Large site/area needs time to orientate and find your way. Treatment was top and newest available.

Non-professionals, there is no good communication with the patient! If you have a serious problem, it s better to look for another hospital! It takes a very long time for them to respond, and when they do, they are never clear. It seems like they want to get rid of you or respond in a way that makes you give up and look for other doctors or hospitals. Be clearer that you are medical professionals! For station mund und kiefer.

Came with toothpain on sunday,didnt wait too long cca 2 hours, doctor and nurse were very kind,spoke English,helped me with pain,so im happy i came there,just parking is pretty expensive.

The emergency department is just a disaster. Organisational chaos. As a result- hours in a waiting line.

I really hope Google will someday let me give negative score to this place. I had to wait 2 months for an appointment, only to come here and sit in the waiting room for 1.5 hours (and the appointment is for a 2 minute consultation). The level of inefficiency and incompetence is just astonishing

I have been to this hospital twice, and both times I got disappointed. First time I needed a paper from the doctor that I was sick. She wrote incorrect information on the paper, and I only noticed it when I was home. My documents were not accepted by my uni as a result. Then, today I went to the Blutbank to donate my blood. I have a rare blood type, and I already had experience donating. I am also completely healthy and have enough muscle mass to donate without any conscequences for my own health. First, when they took a small sample of my blood from the ear, they put a plaster straight onto my hair. It was very hard to get it out of my hair later, and, mind you, very hurtful. Then, I had a talk with a very incompetent doctor/nurse. I speak english better than german, and at one point I asked her if she spoke any english. By the way, I do speak german, I just understand english better. So, I was told: "We speak german here, if you cant speak our language then there will be no donation." Excuse me?? I didn't know that the people I wanted to donate to have such a LUXURY to only have blood from people speaking fluent german. You would refuse half a liter of healthy blood on such a basis? So, in the end I did not donate, I got told to "come tomorrow". Honestly I don't think I will come here ever again. In less than 30 minutes all my will to help people got destroyed. I will make sure to avoid this hospital at all costs, and you should too.

Very long waiting times and you get send from one place to another. Some of the places have no real waiting areas. Once I did get seen the nurse was very friendly and helpul though.

Most racist doorkeeper ever :(

I was transferred back to the emergency department where I waited for hours in excruciating pain to be seen by J. Straub and Dr. med T. Mederer for less than 5 minutes each completely ignoring my recent scans and the notes from the referring hospital. One of these supposed medical professionals told me they have a program that could help me but that I couldn’t be treated any further because I only spoke English. They administered Iv pain medicine that made me feel worse and pushed me into the waiting area until my family could pick me up. I am requesting a formal response from the hospital administration and the head of Neurochirurgie Prof. Dr. N. O. Schmidt. I will also file a complaint against the hospital through Tricare.

US military here. I would definitely not recommend this hospital. Poor communication, rude staff (case management). Make sure they can 100% confirm your appointment on the first day of your visit (at least on your pre-op appointment)! Make sure your surgery is not "selective", otherwise they would schedule you and let you know 24 hours prior that your surgery was rescheduled for in another 6 weeks (almost like on aspace-available basis). This happened to me. If you are an active duty military member feel free to reach out to me. Unless you wanna be your commander's favorite and put in and cancel your convalescent leave as if you're a civilian... Also talk to your local Tricare office about this hospital.

I was extremely honoured to have been at Regensburg University Hospital. They outmost trained professional students and their highly educated doctors. Their program is unmatched and superb. Simply the best!

Two weeks ago I got a fixed appointment to see a specialist. When I showed up on time for the appointment, we were told that no doctor would be there today and the appointment would not take place! I was kept there for 4 hours with unsuitable staff and in the end I was just given a piece of paper with a different phone number so that I can try to arrange a next appointment. I was present with my mother in a wheelchair, who is chronically ill and in severe pain. The emergency room didn't help us either! Thank you, I hope you stay healthy!!

I had vomited 4 times, was in sever pain and fever. I went to the emergency for some assistance at 6am in the morning, the doctor and the receptionist refused to take me in and instead said you won’t die if you dont eat for another 2 days. Extremely rude and racist behavior. Never EVER anybody with a person of color should go there. Don’t deserve even 1 star.

Extremely rude attitude even at the reception. Then we visited the eye clinic and there the "head" of the department was arrogant, rude, mean and disturbingly angry. I would not recommend EVER! We were waiting for an examination of a child, but it never happened.

Extremely inflexible and unhelpful.

👌🏽👌🏽👌🏽

If I could give a no star I would. The worst experience me and my family had in this hospital. My dad was put into the ICU-intensive care unit. U would think each patient is in good hands Once handed over to any hospital but I wouldn’t say in this case. We waited for hours and hours until someone finally came back to tell us even what was going on..it was a mess and a poor communication even for a German citizenship like me. Unclear what he even had after so many hours waiting in the waiting area. Once my dad was “stabilized” we were able to enter. 2 nurses were attending him laughing and joking about some ridiculous joke they were talking to each other. (Keep in mind my dad was on the machine with pipes unconscious) and we as a family stood there in shock! A doctor in charge came along fiddling with the oxygen machine since it kept making noises. He just casually went oh get another cable from the Keller or any fake Chinese one will do. Well it hadn’t to do with any cables in the end. IT WAS BECAUSE IT WASN'T EVEN CONNECTED TO ANYTHING!! Starting with this and throughout the night readers can guess how it ended up with my dad! To the lady nurse who was a visitor that day from the neighboring hospital we thank you for giving us the time you gave us explaining us that dad had good chances of survival and giving us hope that our dad will come home again.

I want to give Zero star. There is not a single thing good in this hospital. I broke my foot (multiple hairline fractures) on 17 July. I went to the emergency department (Notfall) and waited almost 6-7 hours (there were hardly 5-6 patients). The doctor did only the XRAY and said no bone is broken. Please take Ibuprofen and sent me back home with an appointment to see me again after 5 days. On Monday i went again, the pain was unbearable. I told the doctor and they did CT scan (waiting time was again 4-5 hours). She told me later that my bones are broken and they put Gips on my foot. After every two weeks, i came for a basic check-up with an appointment but still had to wait 4-6 hours. Today, 04 Sept, i had an appointment at 11:00. I came on-time and still waiting (it’s been more than 4Hrs+). Is this how a developed country’s hospital should be? Why they are unable to manage a small amount of patients? There are hardly 20 patients. I’m really irritated, disappointed and angry on the public health care system of Germany. Better to get treated from a developing nation, where doctors are more competent and you get better service and treatment.

The worker here are so lovely and caring…despite I don’t understand German but I was loved

I made an appointment on Friday at 11:15 . I come to the appointment and they say they don't have it. They send me to the emergency room instead, where i wait for 3 hours. You sit there, without any clarity, afraid to going to the toilet so not to miss your precious turn, getting hungry and anxious, watching all your day plans crashing apart. Story #2: I've made an appointment, at "Notaufnahme", the doc told me "make it early", so I scheduled for 8:30. I spend 130eur on taxi to reach the Klinik from Clausthal (the only way to reach at this time). They have a complete haos (bad weather, understandable). Aftet 6h of waiting, it turned out that THEY LOST MY FILE. (and I asked about my file at the 6h of waiting and received then a rude "you have to wait", instead of them checking if my file was present). In total, my waiting time: 8;30-20:30, that is 12 (TWELVE) hours. From the nurses/admin I received no apologies nor kind words nor anything of this kind. The doctor was the only person who got into situation, and applied good "comm skills", kudos to him. So it happened twice: first, they lost my appointment and told me they didn't have it. (story #1). Second, they lost my documents (story #2). Story#3: that is a normal interaction: had an apntmt at Notaufnahme at 8:45, waited 1h, got invited, then doc said "surgeon is busy wait for more 30min, go have a tee if you want", came back after 30min, got "serviced". Thanks to the doc for clarity ("go have tee for 30min"). That is a positive interaction: only 1h30min waiting in total, everything was clear. Added one ⭐ (now one, prev 0zero). On the negative side: turned out my Monday visit with 12h waiting was absolutely useless. Story#4: so they gave me a receipt for physiotherapy, but put the WRONG name on it. I ve an appointments with the physio, waited for three weeks, attended 3 sessions, and the physio now cancelled all the other appointments bcs of the wrong name on that receipt that they gave me. Now I need to get another physio prescription from UniKlinik, then wait another three weeks (?) for new appointments with physio. And all this while doctors are urging me "you really need therapy, or you have big troubles with your joint". Lesson: always check the documents they give you, they make mistakes.

I spent 6 days in the urology ward. Both the doctors and all the nursing staff were always very friendly, helpful and made a competent impression. They took their time with the patients and always had an open ear. I have nothing negative to report. 👍

Absolutely .... No problem, nobody likes going to the hospital, but the people here are very friendly and helpful. It doesn't matter whether you're registering or on the ward. Medical ? I can't allow myself any judgement. I, for me (blood cancer) am very very satisfied. I feel looked after and cared for by professionals all around me. The nursing staff also has a professional knowledge that inspires. A very big thank you to the Department of Internal Affairs ab and cd. And to the kitchen ;-) I thought the food was ok. PS: very tasty roast beef. Thanks to

Worst experience.. I waited almost an hour. They simply sent me back because it’s not emergency. As a doctor., their minimum responsibilities to treat the patient. I have been suffering from itching from past 2months. Same thing I told them as I’m not getting Termin with Dermatologist. She simply said we can’t treat you. What kind of hospital is this , the god knows.

Ok

This review is well overdue. I came to this private clinic a few times and I had a great experience each time. I lived overseas for some time and I am used to high end medical services. Before I met Dr.Deutsch, I sworn I will never see a gynecologist in Romania ever again after a bad experience in a private clinic in Bucharest. I wanted to take this time to give a shout-out to Dr.Deutsch Horatiu! Needless to say I was pleasantly surprised after my first appointment and will be a returning patient. He is not only very kind and compassionate, he is also very patient and understanding. I no longer live in Sibiu buy will also come back for my anual here. Keep up the good work and thank you for your help and guidance.

Bunica mea o venit de 2 ori pentru nimic. Rdv a fost fixat și Dr. nu era prezent. Bunica de 80 de ani! My grandmother came twice, for nothing!!! She had an appointment but the doctor "wasn't there". Nobody called her to cancel. It's a shame!! My grandmother is 80 years old, they have no consideration. Boycott it!

I give one star, because I recently had an extremely unpleasant collateral experience with this PRIVATE hospital, as the mother of a patient, operated by the team of Dr. Dejeu Viorel, whose team I would give 1000 * if I could. My great dissatisfaction and great indignation come from the fact that the nurses and nursing ladies from this hospital, with whom my child had to deal, had a disastrous behavior, both professionally and in terms of communication. These female nurses should, according to my experience as a laboratory nurse with over 30 years of experience, be trained and retrained on the collection and communication side, and the nurses should be reminded that they go to work to do their duty, on full. My child faced a gross lack of professionalism on the part of the nurses, being "punctured" by needles, to collect blood, both pre- and post-operatively, the same thing happened to him when a trivial branula was put on him . In the ward, when her bra was changed, blood was filled on the pajama, on the bedclothes and even the wall was splashed. Even worse, the bed was left like that, unchanged until the next day, because the nurses did not bother to change it. They probably also operated in some room (please forgive my irony), and they couldn't do the job for which they are paid. I work in a hospital in a small town, a state hospital, without the claims that the Humanitas hospital would have, but something like this would never happen in our hospital and it shouldn't happen anywhere. I am sorry for this experience, I am outraged by the fact that my child paid 22,000 lei to the hospital and received humane treatment of 2 lei from the nurses. And yet, I only have words of praise for the work that the doctor did together with the dance team, I thank them and respect their work! RESPECT doctor Dejeu, doctor anesthetist, doctor nutritionist, psychologist and nurse Babi!

I had thyroid surgery on 27.10.2023 by Dr. Răzvan Simescu, a doctor with excellent professional training, very humane and patient. From the very first appointment, it was explained to me in detail what the problem was, what the operation consisted of, what the costs and consequences were. I was hospitalized one night after the operation and everything went very well and easily; all the staff I interacted with were kind and willing to help. The quality of the medical act was superlative. Thank you very much for your involvement and results.

Very unprofessional! I had an appointment at 11 o'clock and more than an hour passed before the doctor Barbos(at least she was nice)received me.I don't think it's acceptable, they don't care about people's time at all. At the reception they treated me with indifference when I asked how much longer, they didn't even know. I'm sorry I didn't leave right away

Kindly sir give me whatsup number, i want to come luxembourg for PG from Pakistan How i will do apply this hospital for PG job. kindly sir please give me information about the pg general surgery in this hospital so I'm waiting for your response???

Waited three hours for them to do nothing, they prescribed me a medicine that is not suitable for my disease, with a large list of side effects, which must be taken with another medicine ( they didn’t tell me this). They did not cure me, but made me worse.

It’s not bad, but the service is also not something to write home back about. Paperwork took quite a while, but I have to note it was my first time there. Personnel was nice to me, even though I don’t speak a word French. Also notified me of an approximate bill for the all procedures. Maybe it depends on a type of your emergency, a doctor who’s treating you or they just improved, but for me it was not so bad at all!

Had my appendix removed about two months ago only complains I have are in the emergency department I was told by one of the doctors I was getting surgery, he was then pulled out of the room by a nurse and never returned. When asked do I know what’s happening for my surgery later that night I hadn’t a clue cause the doctor never came back and told me what it was for or when. The nurses on the ward when I went up where amazing looked after me so well really reassured me not to worry. The nurse that took over their shift after was out of surgery was completely different I had gotten sick after coming out of surgery she left the sick bag on my table the entire night along with the blanket I had gotten sick on, I was too unwell to even realise I had been sleeping in my sick the whole night. The next nurse to take over her shift had not been too impressed with me for not throwing the sick bad out or the sheets even though my iv was attached to the bed so I couldn’t physically move from the bed to do anything. It was only these two nurses that made my experience bad at the beacon as I’ve been before for a separate issue and it was absolutely amazing. I would recommend their hospital and I wouldn’t let them two nurses stop me from going to them again, but I would say it really did make me feel worse especially spending so much money to stay and be in their care.

As an American who has always been treated at the top clinic of Mayo Clinic my entire life I was scared to death to experience healthcare anywhere else. After breaking my foot I’ve been pleasantly surprised by how great the staff is here. The nurses, registration, consultants..everyone. I feel a lot of comfort after being seen here now multiple times and having surgery. It’s a different process than I’m used to but that’s a learning curve on my part. Thank you to all the staff for putting my anxiety to the way side.

Just back from taking my elderly mum for a CT in the Beacon Hospital. Lauren in radiology reception was fantastic with her. She was clear, helpful, friendly and very patient with with mum. CT staff were fantastic and efficient, meaning we were in and out in no more than 30min.

This clinic is very poor, you are dealt with like you are a sheep and made to feel like you are another number to make cash from. They provide no explanation and point you towards the most profitable procedure not what's best for the patient. Once admitted the care is lacking and hygiene poor, they only gave me a bed for ten minutes after surgery before whisking it away and plonking me on a wheelchair in the so called "holistoc room", they had no intention of making it a place you would want stay, clearly once they have there money they boot you out to get the next paycheck in. Highly recommend going elsewhere where you may get treated as a person.

Doctor and nurse in emergency room so nice to me, also mri staff lovely.

Very futuristic and beautiful clinic, was leaving somebody else off but even know visitors were not allowed at the time of posting, I was able to stay through the check in process. Staff were very friendly and always had time to help. Dinner for patient was presented by a menu, and you got choice. I would highly recommend this hospital/clinic for anyone who needs urgent help. There is also an in-house Chapel, pharmacy and small shop.

Incredible experience from start to finish. Appointment time 230. In doctor's office at 235, out on the road home by 345. Staff extremely friendly. Could not have asked for better. Also exquisitely clean. 10/10

Overall, not a great experience and wouldn't use them again. I went in for a heart ultrasound, stress test and a plaque test. The stress test was a nightmare. I was put on a running machine with a face mask. I kid you not. I was forced to undergo a stress test on a running machine where I could barely breathe. It was an horrendous experience. I really thought I was going to have a heart attack there and then on the machine as they increased the stress on my heart. How they could expect to get accurate results based on that is beyond me. I paid on the day and shortly afterwards got an additional bill....then another bill. I still don't know what the additional costs were for were for. I couldn't work out the statement that accompanied the bill as it was overly complicated. I went to my doctors a few months later about another minor matter and though it might be a good time to discuss my tests. He didn't know what I was talking about. He'd received nothing. I tried ringing radiology several times and it always went to voice mail. The receptionist told me to send an email which I did. I wrote an email and I did receive a reply saying they would send out one of the test results to my doctor but wanted his address. This was odd as my details and those of my doctor were on my initial induction form. I explained in a replying email that there were several tests...not just one and could they forward them onto him as well....nothing. No reply. I've never heard anything back and at this stage have given up trying to get my results posted out. I really would not recommend them based on my experience.

Had an unfortunate accident which brought me to the ED. The receptionists were very efficient and very pleasant to deal with. I was so fortunate to have had Dr David Foley looking after my case, he was extremely empathetic to my predicament and made me feel at ease at such a stressful/painful time. He referred me to Dr Stefan Byrne in Orthopedics who dealt with me very promptly, he was very professional. I left confident in his care and thankful for the kindness of his receptionist. Overall for such a traumatic time I was so grateful to everyone for making it that bit easier.....except for the pay for parking machine which refused to give a receipt one day and also refused to give my ticket back another day after paying