Out-Of-Network COVID Tests Could Cost You More Than You Think

While diagnostic tests for COVID-19 are more widely available now, you have to be careful when paying with insurance and where you are getting them. One woman in Houston paid for her son’s rapid-response drive-thru test with insurance and it should have cost $175, but the freestanding emergency room tried to bill $2,479. Marshall Allen, healthcare reporter at ProPublica, joins us for how out-of-network covid tests could cost you more than you think.

Learn more about your ad-choices at https://www.iheartpodcastnetwork.com

See omnystudio.com/listener for privacy information.

Episode Transcript

Speaker 1 (00:00):
It's Tuesday, August four. I'm Oscar Emiraz from the Daily
Dive podcast in Los Angeles, and this is reopening America.
While diagnostic tests for COVID nineteen are more widely available now,
you have to be careful when paying with insurance and
where you are getting them. One woman in Houston paid
for her son's rapid response drive through tests with insurance

(00:21):
and it should have cost a hundred and seventy five dollars,
but the freestanding emergency room tried to build two thousand,
four hundred seventy nine dollars. Marshall Allen healthcare reporter at
Pro Publica, joins us for how out of network COVID
test could cost you more than you think. Thanks for
joining us, Marshall. Thanks for having me here. I wanted
to talk about this aspect of coronavirus testing. I've always

(00:42):
been very interested in how much does it cost? Because
while states and the government has said, hey, nobody should
have to pay for a coronavirus test, that's not always true.
Sometimes you go to a doctor's office, in the case
of the story we're talking about today, you go to
more like emergency room services is and those aren't covered
for free all the time. Your insurance can pay for

(01:03):
some of it, and it gets pretty weedy. But men,
this story that you wrote about how a one seventy
five DO COVID nineteen tests led to two thousand, four
hundred seventy nine in charges, it's just crazy the things
that they were trying to charge for this. So Marshall,
tell us a little bit about this story and how
they got to such high charges. I think one of

(01:24):
the big lessons in American healthcare is that nothing is
ever free. And so even though Congress has passed some
laws that protect patients from spending a lot out of pocket,
our insurance plans can still get charged some exorbitant prices
for these COVID tests. And I wouldn't call it the norm.
I mean, most of the time, if people go to

(01:45):
an in network facility or an in network lab, or
an in network doctor, then their insurance plan has a
negotiated rate for that COVID test, and so the patient's
not going to pay anything out of pocket. And in
those cases, the insurance plan is going to pay a
reasonable rates, but without of network providers, and that just
means a lab, or a doctor or a clinic that

(02:06):
doesn't have a contract with your insurance company, They can
charge almost any amount that they want, and the insurance
companies have to pay it. So what they are doing
some of these out of network providers. In this case,
I wrote about one of these freestanding emergency rooms in Texas.
They charge exorbitant, extremely high charges, at least according to
the experts that I talked to. So in this case,

(02:28):
they charged two thousand, four hundred and seventy nine dollars
for the test, and then that becomes the negotiating price
to get reimbursed from the plan. So they may not
get seventy nine dollars, in fact, they probably won't, but
they'll probably get a lot more than if you would
pay out of pocket. So in this case, if you
paid out of pocket, they would have taken a hundred

(02:49):
and seventy five dollars, But once they get access to
your insurance, they're going to go for the seventy nine. Now,
this facility in particular is called Signature Care. As you
mentioned in Texas, and you profiled a woman named Rachel Cordova.
She went to get a test. She also had to
get a test for her son, and that's really where
they got the itemized account for this big charge, but

(03:12):
right off the bat for her own tests that she
didn't end up getting because she didn't want to go
through all of this. In the fine print, it says
all the different things they can charge you. The facility
fee can be anything between five hundred dollars to one
hundred thousand dollars. Observation fee could range from one thousand
to one hundred thousand dollars. So it's just like such
an open ended spectrum of money they can charge well,

(03:34):
and it really is ridiculous. I mean, you know, if
you go someplace and they hand you paperwork and they
say we may charge your insurance plan up to one
hundred thousand dollars for a facility fee or for an
observation fee, that's gonna cause people to think twice before
they signed that paperwork. And Rachel de Cordova is an
attorney in Houston, and so she reads the fine print.

(03:54):
So when she got handed this disclosure statement, you know,
she had just gotten there for a drive through COVID
test that was advertised for a hundred and seventy five dollars.
She gets handed this paperwork and she sees these potential
fees charged her insurance company, and she said, well, hey, look,
I don't want to run it through insurance because I
don't know what this is going to cost my health plan.
I'll just pay for it out of pocket. And she

(04:16):
offered them her credit card and they actually said no,
they wouldn't let her pay out of pocket. They said
they were afraid it might be insurance fraud, which it's
not insurance fraud, just to be clear, but that's what
they told her. And so she ended up leaving without
getting the results of her test. She had already done
the test, but they didn't give her the results. And
that's also a public health hazard. You know, if they
let people leave a testing site without telling them whether

(04:39):
they tested positive or negative, that's really not a best practice, right,
And I'm willing to bet there's a lot of people
that would be confronted with paying different sets of money
like that and just saying, hey, you know what, it's
a public healthress, but I don't care. I'm not gonna
pay that money and then go away. Let's drill down
into her son's examination, her son's test, because they up

(05:00):
going back I don't know why they went back to
the same place. Well, they didn't actually go back. So
what happened is it's really interesting. She was so disturbed
by this paperwork that she got and these potential six
figure fees that she wondered how much it would cost.
And then she and her husband realized they had taken
their son to that same facility about a month before,

(05:20):
and so back in June, they took their son there.
He's an eight year old boy, and they had him
to a test and they had submitted it to their
insurance company, but they had never seen a bill, they
had never seen a statement. So they were able to
look up their own insurance records and they were able
to get his records from the freestanding emergency room. And
what that revealed to them is that their plan had

(05:41):
been charged two thousand, four hundred and seventy nine dollars
for that visit. Yeah, in that case, the facility fee
was over seventeen hundred bucks. The physicians fee was four
d eighty six dollars, and there was mistakes in there.
They said that he had gotten an antibody test and
that there was other types of exposure from COVID nine
that they weren't even sure he really was subjected to.

(06:02):
So I mean, it really did seem like they were
marking anything they could do up the price. So I
ran this by a lot of experts, and they pointed out,
first of all, there's a few things in healthcare in
the United States that people need to keep in mind,
and that's the first one, is that the price is
never the price. You know, just because they say they're
going to charge two thousand, four d seventy nine dollars,

(06:22):
that doesn't mean they're going to get that, and it
doesn't mean that you should pay that, although sometimes they
might get paid that, which is why they jack these
prices up just in case they can get paid that much.
But also the billing is incredibly sloppy. I mean, I've
looked at lots of medical records for lots of different patients.
It's very common to have errors than the bills, or

(06:42):
to have things where it looks like they have upcoded
the bill. And by upcoding, I just mean they have
built a higher level of coding, which means they can
charge and get reimbursed for a higher amount of money
than what would be warranted. Like, I ran this bill
by some experts and they said that for this type
of care. It did not warrant the type of billing

(07:04):
code and the type of charge that the family received.
It's a great read and look into this. Obviously, this
isn't I don't think this is happening widespread, especially if
you're going to some free testing sites or whatnot. But
when you're dealing with insurance, when you're dealing with these
freestanding emergency centers emergency rooms, you just got to be
careful with what you can get charged. And men, some

(07:26):
of these people are doing everything they can to charge
your insurance company as much as possible. Yeah, you have
to be very careful. And one thing you can always
do as a patient is make sure that you're in
network with your insurance plan. And then always remember your
insurance doesn't pay for this. The government doesn't pay for this.
At the end of the day, we all pay for this,
and so when our insurance plans get overcharged and pay

(07:48):
more than they should, that always comes back to the
patient in the form of higher premiums and higher costs
over the long haul. So all of us need to
be on the lookout for this. Marshall Allen, healthcare reporter
at Pro PUBLICA. Thank you very much for joining us.
Thank you. Hi'm Oscar Ramirez and this has been reopening America.

(08:09):
Don't forget that. For today's big news stories, you can
check me out on the Daily Dive podcast every Monday
through Friday. So follow us on I Heart Radio or
wherever you get your podcast