SAN ANTONIO -

A new type of  emergency room is beginning to emerge in neighborhoods,  prompting confusion for some patients who are billed much more than they expected.
When John Havel awoke with a scratchy throat one Sunday morning in May, he decided to go to the new Elite Care Emergency Center located  in the shopping strip at San Pedro Ave. and Bitters Rd.
"I walked in and told them, 'I've got a sore throat, do you handle that type of case?'" he said.
Within minutes Havel was seen by a doctor, treated for what he said turned out to be allergies, paid his $125 co-pay and left.
"They did a very good job," he said.
However, two months later, Havel received two bills in the mail.  He still owed $1802.
"I was shocked,"  Havel said. "I was like, 'What are these for?' I called up. They said it was for my emergency room visit."
Havel  said he was "unaware" he had gone to an emergency room and thought he had gone to a medical clinic, like the many urgent care clinics located throughout the city. Instead, he had gone to what's known as a freestanding medical emergency department.  Elite Care is the first to open in San Antonio.
Freestanding ERs are the new thing in emergency medicine. They are typically located in strip malls in well-traveled neighborhoods, not attached to big hospitals.
Baptist Hospital operates a new emergency room just north of Elite Care on San Pedro in a former shoe store.   Christus Health Care recently opened an emergency room at the Alon Market Centre.  Both operate under their hospital licenses.
Elite Care is license by the state of Texas as a freestanding medical emergency department and is regulated as such.
"My goal is to change the culture of health care and make a miserable experience a nice one," said Dr. Abel Longoria, one of the group of Houston physicians that own and operate Elite Care facilities in Texas.
The experience begins in a well-appointed lobby complete with flat screen TV and refreshment bar.
Freestanding ERs, as licensed by the state, must be equipped and medically staffed at higher level than what's called an urgent care clinic.
"This makes us different from urgent cares, " Longoria said, pointing out his radiological suite complete with ultrasound, x-ray and CT-scan equipment.
"Emergency departments must have a CT-scan on site, must have radiology on site, must by open 24 hours, seven days a week," he said. "Urgent cares don't have to have any of that."
Therefore, the bills can be considerably greater than those at an urgent care clinic, which Longoria admits has caused some confusion.
Havel said he was unaware he was in an emergency room and that it would yield emergency room sized fees.
"I think there should be more disclosure on this, more discussion," he said.  "There was no emergency. I drove myself there. I drove myself home."
When Havel called about his unexpected bill, he said he was surprised to learn he had been classified as a "level three out of five emergency."
Havel, self-employed, has a high deductible and therefore received the bill.  For most patients, the bill would be sent to their insurance carrier to be paid.
At Elite Care, Longoria said they are equipped to handle any emergency, from heart attacks to gunshot wounds to babies with fevers.
Should a patient need surgery or to be admitted, he would be transported by ambulance to a hospital bed, bypassing that hospital's emergency room.
Longoria said they try to make it "very clear" patients are walking into an emergency department, but said more education is needed because the concept of freestanding emergency rooms is so new.
"This is just our way, our answer to access to health care," he said.
Plans are under way to open more locations within the year.

To view a list of recent stories Marilyn Moritz has done, click here.