Nov. 7--SCHUYLKILL HAVEN -- Franklyn Bryson knew his lack of medical insurance would make an emergency room trip costly, but he still thinks $1,500 is a little pricey for a bottle of Neosporin and some antibiotics.

"How did we arrive at this cost?" Bryson, 51, of 14 Reedsville Road, said during an interview at his home Wednesday. "I came to the emergency room for a rash, and the doctor only saw me for half an hour, and you send me a bill for $800, $900, $1,000?"

Bryson said he has had health insurance for most of his working life, aside from a few years when he struck out on his own as a cafe owner.

But now he is working as a part-time cook at Blue Mountain Family Restaurant, Shartlesville, and finds himself uninsured. He tried to put off seeing a doctor about a rash on his right thigh, but after more than a year of increasing irritation, he went to the emergency room at Schuylkill Medical Center-South Jackson Street.

Bryson said a doctor theorized he might have bruised a vericose vein. After a half-hour visit, Bryson had some blood drawn and headed to a drugstore to pick up Neosporin and antibiotics.

He was asked to visit the doctor the next day. According to Bryson, the doctor said the vein looked better, but he went through two prescriptions without reduced pain. Then came the bills: $850 for the first visit, $130 for the follow-up, and $500 from the doctor's agent.

In a telephone interview Friday, M. Michael Peckman, director of public relations for Schuylkill Health System, prefaced comments by noting he did not know the details of Bryson's visit, and would need a release to discuss a specific patient's medical records.

"More broadly, you have to recognize an emergency department should not be used as a replacement for your doctor. An emergency department is staffed 24 hours a day," Peckman said.

Although the price tag seems high, Peckman said, many services at both Schuylkill Medical Centers come in among the lowest rates in the state, according to the Pennsylvania Health Care Cost Containment Council. Those figures are available at phc4.org under the Western Region Hospital Performance Reports.

"I would suggest to anyone that they contact the hospital if they have hardship paying the bill," Peckman said. "We have programs in place to help with that, and we're very proud of those programs. But a person has to inquire first."

One new program could be of particular interest. Peckman said an "easy care" program that began a month ago established a 3 to 11 p.m. clinic for minor injuries, illnesses, colds, strains, sprains and other ailments. Peckman said the area was created in response to increasingly busy emergency rooms, especially during cold and flu seasons.

"If I went in there because I got run over by a vehicle and I lost a limb and you're trying to attach the limb back together, then I could understand," Bryson said. "But I come with a rash on my thigh and you see me for half an hour, and you're sending me a bill for $850, plus $130?"

Judy Schweich, the executive director of Schuylkill Alliance for Health Care Access, said those fees sound about right for someone in Bryson's situation.

"It's $500 a minimum to walk in the door at the emergency room," Schweich said in a telephone interview Thursday.

Schweich said the Alliance is a private, nonprofit group that helps uninsured, low-income county residents with medical bills. The group uses a three-party pay system divided among the patient, the Alliance and the hospital.

"Say a visit is $27. The client will pay $13.50 at the time of service, and the doctors will bill us, and we'll pay $13.50," Schweich said. "And normally the visit is $50. The doctor is taking off a portion."

In the hospital's defense, Schweich said, high prices are partially driven by the procedural requirements hospitals must follow to protect themselves from malpractice lawsuits. The uninsured are often not long-standing patients, so doctors don't have their charts on file or know the patient's medical history.

"They want to have all their ducks in a row so they know who they're treating and who can tolerate what," Schweich said.

Schweich said low-income patients are usually referred to the Alliance by hospitals. Interested Schuylkill County residents can also contact the office directly, but Schweich said they must call in advance.

"We are overwhelmed. There are so many unemployed people who are uninsured that we have a two-week waiting list just to get in our door because we're with limited staff," Schweich said.

If others are in need in Schuylkill County, Bryson said he hopes his story helps them come forward.

"I hope it touches somebody here, that somebody would say, 'You know what, there's something going on,'" Bryson said. "I don't know. If it's at the Pottsville hospital, it's going on all over. That's a debate today in this country: reforming health care."

Bryson said he's glad he has a job and no young children to compete with his ability to pay the bill.

"If it takes six years to pay for it, I will pay for it," he said, but he wonders how many similar stories there are in Schuylkill County, and why rates are so high.

"How many people receive something like that and say, 'Oh my God? Look at this bill. How am I going to pay for that and send my kids to school and buy food for dinner tonight?'" Bryson said.

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