A family’s billing experience with a Missouri hospital

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Mansi Bhatt panicked when her 2-year-old son burned his hand on the stove and blisters started to swell up on his palm.

She faced a choice: treat the burn at home or rush him to the emergency room. The 34-year-old mother contacted the family’s pediatrician, who, after looking at photos of the burn, told her to go to the local children’s hospital.

“I was very much worried,” she told The Washington Post.

Bhatt took her son, Martand, to the emergency room at SSM Health Cardinal Glennon Children’s Hospital in St. Louis. After checking in, seeing a nurse who took her son’s vitals and then waiting an hour and a half for a surgeon, Bhatt left with her rambunctious toddler before seeing a doctor or receiving any tangible medical treatment.

Within days, Martand’s burns healed, and the Bhatts thought that was the end of it.

Then came the hospital bill – $1,012.

Bhatt’s husband, Dhaval, 37, was shocked. He spent the next seven months fighting the charges and struggling to figure out what they were for.

The Bhatt family’s experience reveals a practice many Americans don’t know about: Some hospitals start charging emergency room patients almost as soon as they walk in the door, whether or not they see a doctor or get treatment. Sometimes they even charge a “facility fee” for telehealth appointments during which patients are home and never set foot in a medical facility.

SSM Health spokeswoman Stephanie Zoller Mueller told The Post in an email that the Bhatt family’s charges were appropriate. She said the hospital values transparency, which is why it posts information about pricing online and at the hospital itself, although she admitted it can “cause confusion for patients.” In the case of the Bhatts, hospital staffers explained that the charges were based on several factors, including “acuity of condition, traumatic wound care and numerous other assessments.”

“A patient does not have to receive additional treatment – procedure, labs, x-rays, etc. – to validate an ED [emergency department] level charge,” Zoller Mueller told Kaiser Health News, which originally reported the Bhatts’ emergency room charges.

The Bhatt family’s medical billing ordeal started on April 7. As Dhaval prepared for an upcoming yoga retreat in Tennessee, which was to last several days, his wife, Mansi, made them tea. Although she had turned off the stove, the burner was still hot when Martand, just weeks shy of his third birthday, reached to get something, touching the stovetop in the process.

His parents put his hand under cool, running water and slathered the burn in antibiotic ointment, the Bhatts told The Post. Martand was in pain and cried a bit but seemed fine as his father left for the retreat.

But when his mother checked the burn the next morning, blisters had started to form. With her husband away and the weekend approaching, she worried about getting her son medical treatment if his condition worsened.

Undergirding the decision of whether to seek medical care was her husband’s aversion to engaging with the American health system. Before moving to the United States from India 13 years ago, Dhaval Bhatt had been warned that going to emergency rooms was expensive. Bhatt told The Post he’s avoided them – and going to the doctor generally – ever since, preferring to treat minor ailments at home.

“It’s mainly because of how crazy the charges are,” he said. “It’s not just the ER [where] the charges are high.”

Still, Mansi decided to seek care for their son, in part because she was going to an address the pediatrician had given her, not knowing it was an emergency room. After arriving and checking in, a nurse looked over Martand, listened to his heart and stomach, and peered in his nose, mouth and ears, according to notes prepared by the hospital that Bhatt shared with Kaiser Health News.

The nurse assessed the burn but didn’t order tests or change the homemade dressing the Bhatts had put on the wound, according to Kaiser Health News.

“My objection to this is that there was no care provided,” Dhaval Bhatt wrote when communicating with Kaiser Health News.

The nurse left, telling Mansi a surgeon would come to check on Martand. With a toddler bouncing around the room, Mansi decided to leave with her son after about 90 minutes.

The bill came a few weeks later. The hospital had charged $1,012. Dhaval Bhatt’s insurance, UnitedHealthcare, had covered $153 of that, leaving the Bhatts with an $859 bill.

Most of that – $820 – was a “facility fee,” not for any treatment that was provided. According to Kaiser Health News, hospitals defend facility fees as necessary to keep emergency rooms open 24/7.

Dhaval Bhatt didn’t pay the $859. Thinking the hospital had made a mistake, he called several times to try to get representatives to lower or waive the bill. He reached out to his insurance company, which confirmed that, in its assessment, the hospital had charged him appropriately. Bhatt contacted the human resources department at Washington University in St. Louis, where he works as a pharmacologist and research scientist. He emailed the Missouri Department of Health, whose officials told him they don’t deal with billing issues.

“I tried pretty much everything,” Bhatt told The Post.

All of his efforts failed, and in October, the hospital sent his debt to a collections agency.

Bhatt tried one more thing: In early fall, he contacted Kaiser Health News, and in November, reporter Noam Levey responded. The two began working together to figure out the charges.

Bhatt finally broke through. After Levey reached out to the hospital, officials there waived the facility fee, lowering Bhatt’s bill to just under $39 – the cost for seeing the nurse.

Bhatt said he paid that bill.

Bhatt said he thinks the whole thing was unfair and sees it as validation for his years of avoiding the U.S. health-care system. If he had been home when his wife spotted the blisters, Bhatt said, they would have stayed put.

“People always told me to avoid the ER in America unless you are really dying,” he told Kaiser Health News.

Bhatt told The Post a story to illustrate his point. In November, Martand got hurt in another accident. While climbing and jumping on the couch, he fell and hit his head, opening up a deep cut in his brow, right between the eyes. Again, their pediatrician recommended they take him to the emergency room.

This time, the Bhatts didn’t go. Instead, they treated the cut themselves.

“We just stayed home and let it heal on its own,” he said. “Nothing happened. Everything was fine.”