Shocker: $1,400 bill for sore throat

AUSTIN (KXAN) - An Austin man was hit with a $1,400 bill after he took his daughter to what he thought was an urgent care facility in Bee Cave.

He admits he learned the hard way that not all of today’s urgent care-style centers are the same.

Scott Stephens’ daughter complained of a sore throat and fever one afternoon in October after he picked her up from a soccer game in Bee Cave. He did what any  parent would do, and brought her to the nearby urgent care center.

“They gave her a blood pressure check, and they looked down her throat, and ultimately gave her a prescription. And we left. The total bill came to just under $1,400 for 12 minutes,” Stephens told KXAN. 

Stephens says he signed a clipboard of paperwork. And he recalled seeing wording that indicated he was at an emergency room and could be billed appropriately. But his version of what was appropriate was more like a $20  insurance co-pay.

 

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Help for health care consumers

• How patients are billed
• Filing complaints against physicians
• Filing complaints against facilities
  Filing medical billing complaints

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Some hospitals such as St. David’s Healthcare are now reaching out to the community with modern, well-equipped facilities that are more akin to stand-alone emergency rooms than daytime clinics located in a strip mall. And they bill accordingly, as if they were attached to the hospital.

“I had no intentions of taking my daughter to a hospital,” he said.

Dr. Edward Lee is a physician at St. David’s Emergency Center in Bee Cave, the facility Stephens went to have his daughter treated.

 “We go through great pains, like right at the very front (of the facility there is a sign) to say this is an emergency department," Lee said. "Unfortunately, that message doesn’t always reach everybody.”

The Texas Department of Insurance recently implemented new medical billing legislation that is supposed to clarify this for consumers.

Agency spokesman John Greeley told KXAN the new rules "require disclosure to consumers at the time of service that … insurance policy coverage for the facility and for the physicians operating at those facilities may vary.”

In Texas emergency rooms, emergency centers and some upper-level urgent care clinics that treat Medicare patients can bill at or near hospital rates.

In Stephens’ case last October, documents show he was charged a $150 emergency room fee up front, and later billed $900 for the facility and $333 for a separate physicians’ charge.

Unfortunately for Stephens, there was a traditional urgent care clinic open just two miles up the road. But he says he drove to the first facility that looked like it would suit his needs.

St. David’s Emergency Center staff say before they opened the facility a year ago, they made efforts to distinguish its building, which sits in the parking lot of the Hill Country Galleria. It features a large clock tower wit the words "Emergency Center" emblazoned in red lighting on its sides. It even has an ambulance bay.

Urgent care clinics by contrast, normally are not open around the clock and do not have the same level of diagnostic tools emergency centers can have, like CT scans or highly trained staff on duty, such as trauma nurses or board certified doctors.

And in the end, Stephens got caught up in hospital admissions rules that come from the state. Texas law states as soon as you step through the doors of any ER and agree to be helped, doctors must treat you first, and talk financials later.

St. David’s Healthcare Senior Vice President Mark Clayton said the state rules are in place to prevent scaring away a potentially critically ill person, with a discussion about payment options. He said informing the patient of the billing side of things happens after the clinical process. But a patient can ask questions at any point.

“So what may be an emergency to you may not be an emergency to me, so it’s always important for a patient to use their best judgment,” Clayton said.

He also recommends before any emergency, learning what services your insurance will cover and where the closest urgent care center is to you and what its admitting and billing policies are.

Apart from Bee Cave, St. David’s has two other emergency centers in Pflugerville and Bastrop . They are growing communities that VP Mark Clayton says are too far away from full-service ERs. 

As for Scott Stephens, he has learned his lesson.

“I know definitely that from now on, no matter where I am to be more diligent in understanding what type of facility I’m in before I take my daughter,” he said.

Stephens took his concerns to St. David’s billing department and ended up getting a discount of about $130. off his out-of-pocket bill. That’s after his insurance company agreed to pick up about half the total.