A COVID-19 test that costs more than a Tesla? It happened in Lewisville

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When COVID-19 hit last year, Travis Warner’s Dallas business became busier than ever. He is installing internet and video systems, and with people suddenly working from home, service calls have increased.

He and his employees took precautions like wearing masks and physical distancing, but visiting customers’ homes daily meant a high risk of exposure to COVID-19.

“It was like dodging bullets every week,” Warner said.

In June 2020, an employee tested positive. This sent Warner and his wife on their own hunt for a test.

Due to the limited availability of testing at the time, they drove 30 minutes from their home in Dallas to a stand-alone emergency room in Lewisville. They received PCR diagnostic tests and rapid antigenic tests.

When all of their results came back negative, it was a huge relief, Warner said. He hurriedly got back to work.

Then the invoice arrived.

Warner’s PCR bill of $ 54,000 was nearly eight times the most notable charge previously reported, at $ 7,000 – and its insurer paid more than double the highest reported charge. Health policy experts interviewed by Kaiser Health News called Warner’s bill “astronomical” and “one of the most egregious” they have seen.

It is, however, perfectly legal. For coronavirus testing – like many others in U.S. healthcare – there is no cap on what providers can charge, said Loren Adler, associate director of the USC-Brookings Schaeffer Initiative for Health Policy.

However, COVID-19 tests fall into a special category. When the pandemic hit, lawmakers feared people would avoid necessary testing for fear of the cost. So they passed bills requiring insurers to pay for COVID-19 tests without co-payment or cost sharing for the patient.

For network providers, insurers can negotiate prices for testing, and for off-grid providers, they are generally required to pay the price that providers publicly list on their websites. The autonomous emergency was off-grid for Warner’s plan.

While the policy was meant to help patients, according to health experts, it unwittingly gave providers leeway to charge arbitrary, sometimes absurd prices, knowing that insurers are required to pay and patients, who will not be billed, are unlikely to complain.

“People are going to charge what they think they can get away with,” said Niall Brennan, president and CEO of the Health Care Cost Institute, a nonprofit that studies the prices of health care. “Even a perfectly well-intentioned provision like this can be hijacked by some unscrupulous vendors for nefarious purposes. “

A Kaiser Family Foundation report released earlier this year found hospital costs for COVID-19 testing to range from $ 20 to $ 1,419, not including doctor or facility fees, which can often be higher. than the cost of the tests themselves. About half of the test fees were under $ 200, the report noted, but 1 in 5 was over $ 300.

“We have observed a wide range of prices for COVID-19 tests, even within the same hospital system,” the authors wrote.

Realistically, the cost of a COVID-19 test should be double digits, said Brennan – “low to triple digits if we’re generous.”

Medicare pays $ 100 for a test, and home tests are sold for as little as $ 24 for an antigen test or $ 119 for a PCR test.

Warner’s expenses were fully covered by his insurance.

But the premiums for insurance policies reflect the amount paid to suppliers. “If the insurance company pays astronomical sums for your care, that in turn means you are going to pay higher premiums,” Adler said.

Taxpayers, who subsidize market insurance plans, also face a greater burden when premiums rise. Even those with employer sponsored health insurance feel the pain. Research shows that every $ 1 increase in an employer’s health care costs is associated with a 52-cent reduction in an employee’s overall compensation.

Even before the pandemic, the wide variability in the prices of common procedures like cesarean sections and blood tests pushed up the cost of health care, Brennan said. These deviations “happen every day, millions of times a day.”

When Warner saw that his insurance company had footed the bill, he first thought, “At least I’m not responsible for anything.

But the absurdity of the $ 54,000 charge was gnawing at him. His wife, who had undergone the same tests the same day at the same location, was billed $ 2,000. She has a separate insurance policy, which settled the claim for less than $ 1,000.

Warner called his insurer to see if anyone could explain the charge. After a phone tag game with the emergency service and the emergency service billing company and several months of waiting, Warner received another letter from his insurer. He said they verified the claim and collected the money they paid from the ER.

In a statement to KHN, a spokesperson for Molina Healthcare wrote: “This matter was a supplier billing error that Molina identified and corrected.”

SignatureCare emergency centers, which issued the $ 54,000 charge, said they would not comment on a particular patient’s bill. But in a statement, it said its billing error rate is less than 2% and that it has a “robust audit process” to report errors. At the height of the pandemic, SignatureCare emergencies were facing “unprecedented demands” and processing thousands of cases per day, the company said.

SignatureCare’s website now lists fees for COVID-19 testing at $ 175.

COVID-19 testing is free to consumers during the public health emergency (currently extended until mid-October, and likely to be renewed for an additional 90 days). Warner did his insurer a great service by carefully reviewing his bill, even though he owed nothing.

Insurers are supposed to have systems that flag billing errors and prevent overpayments. This includes authorization requirements before services are rendered and audits after claims are filed.

But “there is a question of how they work,” Adler said. “In this case, it’s luck [Warner] remark.

At least one estimate indicates that 3-10% of health care spending in the United States is lost due to overpayments, including cases of fraud, waste and abuse.

Unfortunately, this means that the responsibility often falls on the patient.

You should always read your bill carefully, experts say. If the cost seems inappropriate to you, call your insurer and ask them to check and explain it to you.

It’s not your job, experts agree, but in the long run, less overpayments will save you money and money for others in the U.S. healthcare system.

Bill of the Month is a participatory survey of KHN and NPR who dissects and explains medical bills. Do you have an interesting medical bill that you want to share with us? Tell us about it.

IN THE BLINK OF AN EYE

The patient: Travis Warner, 36, is self-employed and has purchased coverage from Molina Healthcare in the insurance market.

Medical service: Two COVID-19 tests: a diagnostic PCR test, which typically takes a few days to process and is fairly accurate, and a rapid antigen test, which is less precise but produces results within minutes.

Total invoice: $ 56,384, including $ 54,000 for the PCR test and the balance for the antigen test and emergency service charges. The rate Molina negotiated for both tests and the setup fee was $ 16,915.20, which the insurer paid in full.

Service provider: SignatureCare Emergency Center in Lewisville, one of more than a dozen stand-alone emergencies the company has across Texas.

Which give: Throughout the pandemic, stories of insanely high prices for COVID-19 tests have abounded. A recent report from an insurance trade association noted that “predatory pricing by some providers continues to be a widespread problem”.


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