Patients shocked by freestanding ER bills

KUSA – On Monday, 9Wants to Know told the story of a man who received a $2,300 bill – after his insurance kicked in – from a freestanding emergency room (FSER) for a large splinter in his thumb.

If the response to our "BuyER Beware" series is any indication, the freestanding emergency room boom in Colorado is leaving some mystified and angry patients in its wake.

PREVIOUS REPORT: Buyer Beware on freestanding ERs - http://on9news.tv/1j4ctA6

Since then, disgruntled patients have filled 9Wants To Know's "SendUsYourBills" email box with dozens of copies of bills from local freestanding ERs. Many of the bills – some for relatively benign conditions such as back pain or nausea -- reach well into the thousands.

One calls it her $2,000 mistake. Another wonders why it would cost $1,700 to figure out if she had the flu.

SEND US YOUR BILLS: How to share your bill with 9Wants To Know: http://on9news.tv/1H53ave.

Most come from UCHealth ER which currently operates 14 ERs in Colorado. UCHealth purchased the majority stake in all of the state's First Choice ERs in July. The billing is still handled by First Choice of Dallas, Texas.

As of now, there are 24 FSERs in Colorado. 9Wants to Know has reviewed records indicating there will be at least 35 by the summer of 2016. Many supporters say the trend is a direct response to overcrowded hospital ERs as well as the fact that many growing communities are underserved by hospital ERs.

INTERACTIVE MAP: Where are the freestanding ERs and urgent cares near you? - http://on9news.tv/1NXlw2F

"There is clearly a need for emergency care," Dr. Richard Zane, the head of the UCHealth ER system in the state, said. "Patients decide whether they're going to go or not, and so far they're deciding these are good emergency departments."

And while the patients who communicated with 9Wants To Know have few complaints about the nature of the care, it's clear the cost of the care is another, completely different, issue for them.

Emergency room medicine is not cheap. Under federal law, ERs must screen all patients, regardless of their ability to pay. Many times patients who will never be able to pay are seen and treated.

In addition, emergency rooms are staffed 24 hours a day with emergency-medicine physicians, nurses, and other staff members. They work with expensive equipment that must be capable of handling a wide variety of conditions.

TIPS: When to go to an emergency room

All UCHealth ERs have costly CT scanners, for example.

In addition, it's now routine for ERs – whether attached to a hospital or not – to charge what's known as a facility fee to help justify the cost of the equipment and personnel.

Those facility fees frequently make up the most expensive part of the bill. At UCHealth ER, for example, bills analyzed by 9Wants to Know indicate the facility fee ranges from roughly $700 to $6,200.

Jen Martin, who went to a First Choice ER in June, jokingly referred to her $6,200 facility charge as the cost "to get a room."

"If you want to have medical care, you have to pay what they bill you," she said.

The facility charge is hardly the only concern. According to bills analyzed by 9Wants to Know, the mark-ups at freestanding emergency rooms – like all emergency rooms -- can be steep.

For example, in July one patient at UCHealth ER was billed $7 for Tylenol. If you buy 100 pills at a local grocery store, you can get one for roughly 9 cents.

Another patient was charged $333 for a tetanus shot. The same shot would run a patient at Walgreens $63.99.

It is important to note hospital charges don't always reflect true cost as insurance companies routinely negotiate lower rates for customer. Just because someone was billed that, doesn't necessarily mean he or she will have to pay it in full. Even still, the mark ups are steep.

Anthem Blue Cross/Blue Shield of Colorado remains, as of now, the only insurance provider that is considered in-network with UCHealth ER. A spokesperson for UCHealth says more health insurance companies will be added to in-network in the coming months.

INFORMATION: Resources to help if you're stuck with a big ER bill - http://on9news.tv/1NFHv9D

Janet Pogar, the regional Vice President for Anthem, told 9Wants to Know many of their customers remain confused with the growing FSER model.

"Members think it's an urgent care. It's not an urgent care. It's emergency care," she said.

The distinction carries a wide variety of cost.

Data provided to 9Wants to Know by Anthem shows why patients should feel the need to become better educated on that distinction. These are average cost for common problems in Colorado (or at least what would be allowed by insurance). These numbers do not distinguish between hospital ERs and FSERs.

SORE THROAT/INFLAMMATION

• Doctor's Office: $135
• Urgent Care: $367
• ER: $1,500

ANKLE SPRAIN/STRAIN

• Doctor's Office: $174
• Urgent Care: $564
• ER: $1,644

EAR INFECTION

• Doctor's Office: $118
• Urgent Care: $414
• ER: $1,188

URINARY TRACT INFECTION

• Doctor's Office: $155
• Urgent Care: $488
• ER: $2,414

"On average, our ER costs are well over $2,000," Pogar said.

The average cost of an urgent care visit is $200.

Denver Health Medical Center's Dr. Christopher Colwell said patients could save themselves a lot of money simply by gauging when a visit to an urgent care or a doctor's office might suffice.

"Severe, new and sudden symptoms tend to indicate an emergency where you should get checked out now," he said. "I think what you need to ask yourself is, 'Is this a sudden, new symptom that I'm experiencing, or is this something that's been going on for a bit, something that's reaching a stage where I really want it taken care of.'"

9Wants To Know is choosing only to use first names in an effort to protect the medical confidentiality of the patients who submitted their bills.

Derek sent 9Wants To Know two bills he received from an August visit to UCHealth ER. Both bills totaled $4,286. He said his daughter went there after nearly fainting. Derek said she spent about an hour inside and was given an ECG as well as a bottle of Gatorade.

"I love Gatorade as much as the next guy, but it's not worth almost $3,000 a bottle," he wrote.

Patients to UCHealth ER routinely receive bills from both First Choice ER as well as National Medical Professionals, a Texas-based provider who employs the physicians. National Medical Professionals operates in the same Dallas business park as First Choice and, as of now, is considered out-of-network with every insurance carrier in the state of Colorado.

Sarah said she received bills totaling $5,700 after her insurance kicked in "for them to do a CT scan [to] tell me I have a kidney stone" as well as some pain medication.

James wrote:

"I went in [UCHealth ER on Chambers and Mississippi] very dehydrated, and they immediately took me to the back. The doctor came in, asked a couple questions and then left. The nurse came in and gave me two IV bags, a steroid and Tylenol. After about 20 minutes, I was feeling better and was on my way. The bill I got totaled $7,276 for that visit."

Ann visited Health One's Saddle Rock ER in September.

"No tests, barely a Dr. visit just to look at my throat and walked away with a scrip and subsequently billed for over $2.400. My insurance covered most of it, but I am responsible for over $600." Ann said.

Dr. Jeff Rice founded HealthCareBluebook.com to help speed up the process of transparency in health care.

"Patients need to do their homework before they get their care," he said from his office in Nashville, Tenn.

His website offers, what he believes to be, a fair price, based on location of service, for certain medical procedures. He said it's routine for there to be wide variations in cost from place to place.

"So an MRI might cost $500 in one building or $3,000 to $4,000 in another," he said.

In Colorado, more than half of the health-insurance plans now offered are considered high-deductible plans – plans that require patients to pay for all services received up until the point when the deductible is hit.

In addition, patients typically are responsible for a share of cost up until a maximum-out-of-pocket point is reached.

Take, for example, a patient with a $3,000 deductible and a $5,000 max out of pocket plan. Let's say that plan includes an 80/20 split after the deductible is reached.

If that patient receives a bill for $8,000 from an ER - and hasn't put anything toward the deductible yet - he or she would have to pay $3,000 to cover the deductible and then 20 percent of the remaining $5,000 of the bill. That comes out to $1,000. So the total cost for the patient would be $4,000.

Dr. Rice said the popularity of high-deductible health-care plan puts pressure on patients to ask questions of providers before services are rendered.

"If a health-care provider can't tell you the price before they give you the service, that's a really good warning flag that they have really high prices, and they don't want to tell you their prices," he said.

It's a bit more complicated in an ER setting due to restrictions of federal law that require ERs to screen all patients and treat emergent conditions no matter the patients ability or inability to pay.

But patients who might be on the hook for thousands have a right to ask questions.

Brothers Gustav and Eric Hoyer recently founded MyChoiceMD in Colorado to offer more transparency in medical cost. They said they sympathize with patients who struggle to know what anything might cost in the world of medicine.

"I don't know if there is anybody watching the space of healthcare who would say the system is working well," Gustav Hoyer said.

He said people routinely know the price of everything else we buy before we make a purchase, from a car to an apple at the grocery store. It doesn't work that way in medicine.

"And yet we accept that," Gustav Hoyer said. "We are paying our own money for the most part, and [providers] are going to accept that we are going to start acting like consumers on our own behalf."

"It's time for things to change," Eric Hoyer said.

(© 2015 KUSA)