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I paid two medical bills last week: $306 toward an ultrasound and $126 for lab tests.

First, I called my health insurer, Blue Cross Blue Shield, to make sure I owed that much. The bills seemed steep, given that I have medical insurance. What's more, the ultrasound and labs were ordered in conjunction with my annual women's health screening, which I understood with the passage of health care reform should carry no co-payments or deductibles because it's recommended by the U.S. Preventive Services Task Force.

The phone rep told me the extended tests weren't coded by my doctor as preventive. I accepted that. But when I asked about the percentage I owed, I got confused. I assumed 20 percent, after my $500 deductible was met. But I learned my responsibility was 30 to 40 percent, depending on the federal tax ID of providers and whether they fell in the Blue Choice, Blue Preferred or Blue whatever networks. I have Blue Options, but it doesn't feel like I have options. Surely, there's a simpler way.

A new Oklahoma City-based startup aspires to offer physician, specialty and surgical care on a prepaid, monthly retainer basis. Meanwhile, even the state's SoonerCare Medicaid state-federal system which provides health care to largely low-income women and children moved from managed care to fee-for-service years ago to more efficiently provide care.

The Patient Protection and Affordable Care Act is like rearranging deck chairs on the Titanic, David Rothwell, a primary care physician and partner in the new company Salerno Health (salernohealth.com), told me last week. When it fully takes effect in January 2014, the legislation mandates health care for more uninsured Americans, but Rothwell said the nation is short some 225,000 doctors to care for the influx of patients. Moreover, he said, the act does nothing to control skyrocketing medical costs.

Insurance was meant to cover major medical and not preventive care, he said. Asking health insurance to cover X-rays, most blood tests, routine procedures and physician visits is equivalent to asking your car insurance to pay for a portion of new windshield wipers or an oil change, he said.

Launched June 1 with a dozen investors and six primary care providers in the greater Oklahoma City area, Salerno for $49 a month provides 85 percent of the health services the average person needs, Rothwell said. My ultrasound or an MRI or colonoscopy would have cost me $50 over their retainer, he said. For an additional $69 a month, or $118 total, people starting Oct. 1 can have specialty and surgical care, including cardiology and orthopedics.

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Health care choices lack simple answers