St. Louis Post-Dispatch Bill McClellan column

Aug. 02--Michael Donat is a waiter at a fancy steak house in Clayton. He is 41 and has a degree in psychology from the University of Missouri. He has been in the restaurant business for years, sometimes in management, sometimes in non-managerial positions. Sometimes he has had health insurance and sometimes he has not.

Right now, he doesn't.

He looked at the policies available under the Affordable Care Act, and decided that the high-deductible policies he could afford, he didn't want. He'd pay a lot out of pocket before the insurance kicked in. Those policies would be worthwhile if he were to get really ill, but not so worthwhile if he were to remain healthy.

On one hand, he had a history of heart problems in his family. On the other hand, he had no such history himself. What to do? It is a decision that millions of middle-class American have to make. Donat opted to go without health insurance.

On the night of Feb. 11, he felt a pain below his left armpit. He is single and lives alone. He decided to drive himself to the ER at nearby St. Mary's Hospital. He arrived about 11 p.m. He was given an electrocardiogram. The EKG indicated he was not having a heart attack. He was sent back to the waiting room.

Later, he had X-rays taken and blood drawn and he was examined by a doctor. When nothing seemed amiss, he was given another EKG, which confirmed that he was not having a heart attack. He was given pain medication and sent home. He had told the receptionist he had no insurance. She said he would be billed later.

Before we go any further, let's acknowledge that the health care system worked. Donat was not turned away because he had no health insurance. He received the same service a person with health insurance would have received.

A couple of weeks later, he got a bill from the Schumacher Group. That company provides medical staffing, including emergency room physicians, to hospitals. The bill was for $1,686. Three items were listed: emergency physician charge of $1,572, electrocardiogram report for $78 and medical services for $36.

Donat called the toll-free number on the bill. The person he spoke with agreed to reduce the bill by 40 percent if he would agree to pay it immediately. He agreed. The bill was reduced to $1,011. He paid it.

The day after he got the first bill, he received a bill for $182 from Comprehensive Pathology Service. That seemed to be for the blood work. He paid it.

Two days later, he got a bill from SSM Health Care. Total charges were $2,339, but there was a "patient adjustment" of $1,739. He owed $600. He called the number on the bill and was put into a zero interest payment program. He would have $30 a month automatically taken from his checking account.

Then he got a $28 bill from SLUCare Physicians. That seemed to have something to do with the X-rays. He paid it.

Shortly thereafter, he received a bill for $66 from St. Mary's HC PHY Billing. It was for a professional fee for the EKG.

"I decided to be a jerk and dispute it," he said. He wrote a letter saying this was the fifth bill he had received overall and the third that mentioned the EKG tests. He got no response, but a month later, he received the same bill. He ignored it, and a month later, he received a bill for two professional fees for the EKG tests. This time the bill was $132. He called to complain, and the bill was reduced to $34. He paid it.

I had just written about some confusing bills I had received after an emergency room visit -- I have health insurance -- so Donat called me. I called SSM Health Care. After Donat waived his confidentiality, media specialist Jamie Sherman arranged a meeting for me with Paul Sahney and Karen Rewerts, SSM Health Care officials who understand medical billing.

They said that emergency room care is the most expensive care in the system, and the most confusing. The bulk of the work is done by the Schumacher Group, so that group is going to send a bill. The hospital bills for the emergency room, but limits that to $600 for the uninsured. Some of the other doctors work at St. Mary's, but not for St. Mary's, so they bill separately.

The confusion about the last EKG bill's doubling is that the first two bills did not include the cost of reading the second EKG.

Donat remains philosophical about the whole thing, but he thinks hospitals could learn something from restaurants. You just get one bill when you eat out, he said. You don't get separate bills from the hostess, the kitchen staff, the waiter and the busers. Restaurants make it easy.

He's got a point, but, then again, we could always choose not to go to restaurants.

?Bill McClellan is a columnist for the St. Louis Post-Dispatch. Read his columns here.

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