Texas resident billed $ 54 for COVID-19 test - ForumDaily
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Texas resident billed $ 54 for COVID-19 test

When the COVID-19 pandemic hit last year, Travis Warner's company is busier than ever. He's setting up internet and video systems in Texas, and as people suddenly start working from home, help desk calls have skyrocketed. Warner and his staff took precautions such as wearing masks and physically distancing themselves. But daily visits to customers' homes meant a high risk of contracting the coronavirus. How the COVID-19 test cost him $ 54, the man told the publication NPR.

Photo: Shutterstock

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

In June 2020, one of his employees tested positive. This sent Warner and his wife on a dough hunt.

Due to limited testing opportunities at the time, they drove 30 minutes from their home in Dallas to a freestanding emergency room in Lewisville, TX. They did PCR tests for coronavirus as well as rapid antigen tests.

Warner breathed a sigh of relief when all of their results were negative. And he eagerly returned to work.

Then the bill came:

  • Patient: Travis Warner, 36, is self-employed and purchased his health plan from Molina Healthcare through HealthCare.gov.
  • Medical service: two "COVID-19 tests" for the coronavirus - a PCR diagnostic test, which usually takes several days and is fairly accurate, and a rapid antigen test, which is less accurate but provides results in minutes.
  • Total score: $ 56, including $ 384 for PCR tests, antigen tests, and emergency room fees.
  • Service Provider: The Lewisville SignatureCare Emergency Center, one of more than a dozen autonomous emergency rooms the company operates across Texas.

Throughout the COVID-19 pandemic, there have been many stories of shockingly high prices for coronavirus tests. A recent report from the Association of Insurance Companies noted that "overpricing by some service providers continues to be a widespread problem." The company's $ 54 bill was "astronomical" and "egregious," according to health policy researchers.

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However, it is completely legal. For coronavirus tests — like much else in American health care — there is no limit to how much companies can charge, according to Lauren Adler, associate director of the USC-Brookings Schaeffer Initiative for Health Policy.

However, coronavirus testing is in a special category. When the pandemic hit, lawmakers worried that people might shy away from needed testing out of fear of high costs. So they passed a law requiring insurers to pay for these tests—with no copayment or cost sharing for the patient.

For on-net providers, insurers can negotiate test prices, and for off-net providers, they usually have to pay whatever price the providers publicly list on their websites. The stand-alone item in Warner's plan was offline.

While the rules were designed to help patients, they inadvertently gave healthcare providers the option to charge arbitrary, sometimes absurd prices, knowing that insurance companies are obligated to pay and that patients who are not billed are unlikely to complain.

“People will do what they think they can get away with,” says Niall Brennan, president and CEO of the Health Care Cost Institute, a nonprofit that studies health care prices. “Even such a well-intentioned rule can be interpreted by some unscrupulous suppliers for nefarious purposes.”

A Kaiser Family Foundation report this year found hospital costs for coronavirus tests ranged from $20 to $1419, not including physician or facility fees, which can often be higher than the cost of the tests themselves. The report noted that about half of the tests cost less than $200, but one in five cost more than $300.

“We observed wide variation in prices for COVID-19 testing, even within the same hospital system,” the authors wrote.

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According to Brennan, the actual cost of such a test should be in double digits.

Medicare pays $ 100 for the test, and home tests sell 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 premiums reflect how much providers are paid. "If the insurance company is paying astronomical amounts of money for your treatment, that means you'll pay higher premiums," Adler says.

Even people who have employer-sponsored health insurance feel the burden of increasing premiums. Research shows that every $ 1 increase in employer health care costs is associated with a 52 percent reduction in total employee benefits.

Even before the pandemic, wide variations in prices for routine procedures such as cesarean sections and blood tests were driving up the cost of medical care, Brennan said. These inconsistencies "happen millions of times a day every day."

When Warner saw that his insurance company had paid the bill, he thought at first, "At least I'm not responsible for anything."

But the absurdity of the $ 54 bill worried him. His wife, who took the same tests on the same day at the same location, was billed $ 2000. She has a separate insurance policy.

Warner called his insurance company to see if anyone could explain the situation. After telephone conversations, and after several months of waiting, Warner received a letter from his insurance company. It says the insurer checked the claim and took most of the money it originally paid.

In a written statement, a Molina Healthcare representative said, "This was a billing error that Molina identified and corrected."

SignatureCare Emergency Centers, which issued the $ 54 bill, said they would not comment on a particular patient's bill. However, the written statement says the billing error rate is less than 000% and there is a “robust auditing process” to identify errors. In the midst of the pandemic, SignatureCare emergency services faced "unprecedented demands" and were processing thousands of records a day, the company said.

The SignatureCare website now lists a $ 175 coronavirus test fee.

According to laws passed by Congress, coronavirus testing should be free for consumers during a public health emergency (currently extended through mid-October and likely to be extended for another 90 days). Warner did his insurer a great favor by scrutinizing his account, even though he owed nothing.

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Insurers must have systems that detect billing errors and prevent overpayments. This includes pre-service authorization requirements and post-claims audit.

“But the question is how well they work,” Adler noted. “In this case, it’s good that Warner noticed.”

One estimate is that 3% to 10% of US health care costs are overpaid, including cases of fraud, waste and abuse.

Unfortunately, this means that the responsibility for maintaining even slightly more reasonable costs often falls on the patient.

Experts point out that you should always read your account carefully. If the cost seems inappropriate, call your insurer and ask them to double-check and explain the cost to you.

Experts agree that it doesn't have to be your job, but in the end, fewer overpayments will save you and others in the American health care system.

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