When the covid-19 hit last year, Travis Warner’s company was busier than ever. He installed an internet and video system, and when people suddenly worked from home, service calls surged.
He and his employees took precautions such as wearing masks and physically separating, but daily visits to the client’s home mean that there is a high risk of covid exposure. Did.
“It was like dodging bullets every week,” Warner said.
In June 2020, employees tested positive. It sent Warner and his wife to hunt for their own tests.
Due to the limited availability of tests at the time, they took a 30-minute drive from their home in Dallas to a separate emergency room in Lewisville, Texas. They underwent a PCR diagnostic test and a rapid antigen test.
It was a great relief when all the results returned to negative, Warner said. He enthusiastically returned to work.
Then came the bill.
patient: Travis Warner, 36, is self-employed and purchased insurance from Molina Healthcare, which is far from the insurance market.
Medical services: Two covid tests: a highly accurate diagnostic PCR test, which typically takes days to process, and a rapid antigen test, which gives results in minutes with less accuracy.
Total billing amount: $ 56,384. This includes a PCR test of $ 54,000, an antigen test balance, and an ER facility fee. Molina’s negotiated rate for both tests and facility charges totaled $ 16,915.20, which the insurance company paid in full.
Service provider: The Signature Care Emergency Center in Lewisville, one of the company’s more than 12 stand-alone ERs throughout Texas.
What you get: Throughout the pandemic, there were lots of stories about the surprisingly high prices of covid tests. “Price cuts by specific providers continue to be a widespread issue,” according to a recent report from an insurance industry group.
However, Warner’s $ 54,000 PCR bill was $ 7,000, almost eight times the most notable rate previously reported, and his insurer paid more than twice the highest rate reported. .. Health policy experts interviewed by KHN called Warner’s bill “astronomical” and “one of the worst.”
Still, it’s perfectly legal. Lauren Adler, Associate Director of the USC-Brookings Schaefer Health Policy Initiative, said that, like many other health care products in the United States, there is no limit to the amount that a provider can charge for covid testing.
However, Covid tests fall into a special category. When a pandemic occurred, legislators were worried that people might avoid the necessary tests for fear of cost. As a result, they passed a bill requiring insurance companies to pay for joint testing without the patient’s own expense or sharing of costs.
For in-network providers, insurers can negotiate test prices. For off-network providers, insurers typically have to pay the price that the provider publishes on their website. The self-contained ER was off the network in Warner’s plan.
This policy was aimed at helping patients, but knowing that insurance companies had to pay and unclaimed patients were less likely to complain, unintentionally arbitrary and sometimes ridiculous prices to providers. Health experts say they have given them room to claim.
Neil Brennan, president and chief executive officer of the Healthcare Cost Institute, a non-profit organization that studies healthcare pricing, said: “Even such a perfectly well-meaning provision can be hijacked by a particular malicious provider for malicious purposes.”
Hospitalization fees for the covid test range from $ 20 to $ 1,419 and do not include doctor or facility fees, according to a KFF report released earlier this year. This is often more expensive than the cost of the test itself. According to the report, about half of the test fee was less than $ 200, but one in five was over $ 300.
“We have observed a wide range of COVID-19 testing prices, even within the same hospital system,” the author writes.
In reality, the cost of the covid test should be double digits, Brennan said. “If you’re generous, the three-digit number will be lower.”
Medicare pays $ 100 for testing, home testing costs $ 24 for antigen testing, and $ 119 for PCR testing.
Warner’s fees were completely covered by his insurance.
However, premiums reflect the amount paid to the provider. “If the insurance company pays an astronomical amount for your care, that means you’re paying a higher premium,” Adler said.
Taxpayers who subsidize the market insurance system also become a heavy burden when insurance premiums rise. Even those with employer-sponsored health insurance feel pain. Research shows that for every $ 1 increased in employer health care, employees’ overall compensation is reduced by 52 cents.
Even before the pandemic, large fluctuations in prices for common procedures such as caesarean sections and blood tests were pushing up medical costs, Brennan said. These discrepancies “occur millions of times a day, every day.”
resolution: When Warner saw his insurance company pay the bill, he first thought, “At least I’m not responsible for it.”
But the absurdity of the $ 54,000 claim bit him. His wife, who underwent the same examination at the same place on the same day, was charged $ 2,000. She has another insurance policy and settled the claim for less than $ 1,000.
Warner called the insurance company to see if anyone could explain the charges. After waiting a few months after the phone tag game between ER and the ER billing company, Warner received another letter from the insurance company. They audited the claim and said they had regained the money they paid to the ER.
In a statement to KHN, a Molina Healthcare spokesman wrote, “This issue was a provider billing error that Molina identified and fixed.”
The Signature Care Emergency Center, which issued a $ 54,000 claim, said it would not comment on the claim for a particular patient. However, the statement states that the billing error rate is less than 2% and there is a “robust audit process” that flags the errors. At the height of the pandemic, SignatureCare ER faced “unprecedented demands” and processed thousands of records a day, the company said.
The SignatureCare website states that the covid test costs $ 175.
The point: The Covid test must be provided free of charge to consumers during public health emergencies (currently extended until mid-October and may be renewed for an additional 90 days). Warner greatly benefited his insurance company by looking carefully at his invoice, even if he hadn’t borrowed anything.
The insurance company should have a system in place to flag billing errors and prevent overpayments. This includes approval requirements before the service is provided and audits after the claim has been filed.
But “there is the question of how well they work,” Adler said. “In this case, it’s lucky [Warner] noticed. “
According to at least one estimate, 3% to 10% of medical costs in the United States are lost due to overpayments such as fraud, waste and abuse.
Unfortunately, that often means that the responsibility lies with the patient.
According to experts, the invoice should always be read carefully. If you think the cost is inappropriate, call your insurance company and ask them to reconfirm and explain.
It’s not your job, experts agree, but in the long run, less overpayment will save money for you and others in the American health system.
This month’s invoice is a crowdsourced survey by KHN and NPR that analyzes and explains medical costs. Do you have any interesting medical expenses you would like to share with us? Tell me about it!
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