ARI SHAPIRO, HOST:
Emergency rooms are among the most expensive places to get medical care, even for minor problems. That's our starting point for our latest Bill of the Month. Dr. Elisabeth Rosenthal from our partner Kaiser Health News is here in the studio to explain. Welcome.
ELISABETH ROSENTHAL: Thanks for having me.
SHAPIRO: So tell us about this month's patient and how he wound up in the emergency room.
ROSENTHAL: This patient is a 40-year-old man named Matt Gleason. He did what many of us do and should do. He got a flu shot at work. But it didn't quite go the way he expected.
SHAPIRO: All right, let's hear what happened from reporter Alex Olgin of WFAE in Charlotte. She went to visit Matt Gleason recently.
ALEX OLGIN, BYLINE: Matt Gleason is incredibly organized and thorough. His house is immaculate, and he's been scrutinizing his medical bills for years.
MATT GLEASON: I've been doing that for the past 10 years.
OLGIN: So when it was time to choose an insurance plan at work, he had his data. He went for the low monthly cost and high deductible. He's 40, healthy and rarely goes to the hospital.
GLEASON: But it stings a whole lot more when you actually do have a visit.
OLGIN: In October, he decided to get a flu shot at his office.
GLEASON: This was right downstairs and free. Why not?
OLGIN: He was sitting at a table, waiting the obligatory 10 minutes post-shot. And then he fainted. He has a history of fainting, and I can relate.
When it happens to me, there's, like, a couple signs. And I sort of know it's coming. Is that your case?
GLEASON: For me, I maybe have I'm going to say 10 to 20 seconds. Like, I just feel my head start to go, and then I'm out.
OLGIN: He woke up on the floor with the nurse and someone from HR standing over him. They were on the phone with 911. Once the paramedics came and sat him up, he started vomiting. That was an unusual symptom for him.
GLEASON: So at that point, I was like, OK, you can take me to the ER.
OLGIN: An ambulance took him to a hospital in suburban Charlotte. After about an hour, he got an electrocardiogram to check his heart while video chatting with a doctor.
GLEASON: She didn't notice any abnormalities. But to be on the safe side, she wanted to order all these tests. She just had a bunch of tests. And so I just said, OK, I'll go with it.
OLGIN: Gleason ended up getting a blood test, a urine test and a chest X-ray. After five more hours, he saw another doctor in person, who sent him home. Two weeks later, the bills started coming.
GLEASON: I wasn't expecting $4,700 pre-insurance.
OLGIN: That didn't include the ambulance or doctor's bill. Altogether, after insurance, he owed his entire deductible for just this visit to the hospital.
So how are you feeling about the whole situation currently?
GLEASON: Disgruntled (laughter), bewildered, annoyed, kind of mad - the whole process is broken.
OLGIN: He's learned more about that broken process as he tried to fight this bill. After lots of phone calls, he finally got the hospital to send him the full list of all its charges, something known as a charge master. It was 250 pages. He searched for the fee he was charged.
GLEASON: Fortunately for me, it didn't take me very long 'cause my role as an analyst, I deal with gobs of data.
OLGIN: He found the fee he was charged didn't match the one on the price list. He was infuriated. He says imagine going to a McDonald's drive through and having the employee ask you...
GLEASON: Is this a preventative hungry visit or a actual hunger visit? Because there's pricing differences. And the person who made your Big Mac is sending you a bill for $5. And then because you had three items ordered, you now get charged a facility fee.
OLGIN: He says health care, like eating at a restaurant, is a service. But with health care, the patient has no understanding of the costs upfront.
SHAPIRO: OK, that's reporter Alex Olgin talking about the bills that Matt Gleason got after he fainted and went to the emergency room. Elisabeth Rosenthal, explain what's happening here.
ROSENTHAL: Well, the first thing to know is when you get a flu shot, some people faint. So, you know, take your time. Don't get up too quickly. That's a normal reaction. But the key in this case is that once someone calls an ambulance - and even more, once that ambulance delivers you to an emergency room, which they are going to do - you're kind of on a conveyor belt to high medical bills.
SHAPIRO: So his colleagues called 911. He went to the emergency room. The doctor ordered all these tests. Was all that really necessary?
ROSENTHAL: Well, you don't want to second guess an emergency room doctor because they're always thinking about what's the worst that could happen. But, you know, they're saying they ordered all these tests because they were worried he had a heart attack. Well, then why did he sit around for seven hours? A chest X-ray, a urine test - that story just doesn't add up medically.
SHAPIRO: So he is now personally on the hook for about $4,000. Is he going to have to pay all of that?
ROSENTHAL: He probably will because unless he can say a service wasn't delivered, which I'm - you know, we see the records; it was - he's probably going to have to pay.
SHAPIRO: Tell us more about the price list that he got. Those have been in the news a lot lately.
ROSENTHAL: Yeah. I mean, what we saw is as of January 1, the federal government said all hospitals had to post their price lists online. He got that price list. As he found out, they're often 250 pages long. They're in code. They're in medical abbreviations. So they're not that useful for hospital shopping at the moment. Hopefully, they will be over time. But at the moment, unless you're a kind of data person or a medical person, they're very hard to decipher. And it really wouldn't have helped him in advance.
SHAPIRO: Right.
ROSENTHAL: So the lesson for me is use 911 sparingly. I fell in New York after I was running, had a big bump, and my head was bleeding. Passersby said, we're going to call an ambulance. I was like, no, don't do that. If 911 is called and you don't feel like you need an ambulance, you can say, no, I don't have to go. People just kind of get swept up. And they should know what's at the end of that conveyor belt is potentially $5,000.
SHAPIRO: That's Elisabeth Rosenthal, editor-in-chief of Kaiser Health News. Thanks a lot.
ROSENTHAL: Thank you.
SHAPIRO: And if you have medical bills that you want us to investigate, go to NPR's Shots blog.