covid-19 testing

NBC 5 Responds: How Does a $50 COVID-19 Test Cost Insurance More Than $10,000?

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NBC 5 Responds has been tracking complaints and investigating issues with COVID-19 medical bills and testing costs. 

Several North Texans contacted our team with concerns after they paid $50 for a COVID-19 test after visiting Total Care in Benbrook. A few months later, they each received and explanation of benefits from their insurance provider and discovered Total Care charged more than $10,000 for that visit.

Benbrook resident, Tim Aranki, recovered from a strange cough and said he popped into the Total Care.

“Come June, I thought, as testing became more widely available, I’d go and get the test,” said Aranki.

Aranki said he went for an antibody test but agreed to a diagnostic COVID-19 test as well.

“It's going to be $50 either way. You know, you might as well get both while you're here,” said Aranki.

Aranki tells NBC 5 Responds the entire visit took a few minutes. Which is why he said he couldn’t make sense of the explanation of benefits from his health insurance company.

It shows the facility billed his insurance $10,198.66.

“There was no other examinations done. It was literally two swabs and a pinprick on my finger,” said Aranki.

Premera Blue Cross confirms it paid the claim and Aranki wouldn’t have to pay anything more than the $50 he paid Total Care.

“I had no idea what they were billing the insurance,” said Tricia Sheridan, a resident in Tarrant County.

Sheridan said she was also surprised when she learned Total Care billed Cigna $11,049.16 to test for COVID-19 and antibodies.

NBC 5 responds asked Cigna about the charges and the company replied with this statement, ”People deserve protection and peace of mind when it comes to their health, which is why Cigna works with providers to reduce situations where a person receives an unexpected bill for health services, and our Customer Protection Program ensures customers are protected against surprise billing from out of network providers. Unfortunately, it seems that some clinics are taking advantage of the COVID-19 pandemic by luring patients in for care via deceptive advertising and then charging outrageous amounts of money for COVID-related testing. While we are unable to comment directly on this customer’s case, we are taking appropriate actions with this provider and protecting the customer from cost-sharing.”

“Even if it was covered by insurance, based on principle, in my opinion, I wouldn't go back knowing they were charging that amount for a blood test,” said Sheridan.

And a third patient, who asked us to only share her first name – shared her explanation of benefits, showing the same Total Care in Benbrook billed UnitedHealthcare $10,985.88.

I kind of went to my claims and went, whoa, whoa, whoa, whoa, hold on! What’s going on?” questioned Dorothy.

United said it paid the claim and in an email to NBC 5 wrote its first priority was to ensure members were covered.

While not commenting directly about Total Care, United goes on to say quote “Unfortunately, there continue to be care providers who are trying to take advantage of this situation and are inappropriately or even fraudulently billing. We will continue to investigate this matter and, if appropriate, seek to recoup any overpayment and potentially refer this case to law enforcement.”

“I think that insurance companies find themselves a little bit in between a rock and hard place, said Niall Brennan, President and CEO of the Health Care Cost Institute.

Brennan said the Cares Act created a loophole some providers are using to cash in.

The act said insurance companies must waive cost-sharing payments for COVID-19 testing and many private insurers are waiving payments for related treatment.

“When you have a loophole like that, combined with even a small number of unscrupulous providers, you end up with people getting these very large bills,” said Brennan.

NBC 5 asked a Castlight Health, a healthcare data company, what providers are charging insurance companies for tests.

According to their data that sampled more than 100,000 bills for coronavirus tests, Castlight reported that 82.6% cost $100 dollars or less.

NBC 5 Responds called, sent emails and even Facebook and LinkedIn messages to Total Care Benbrook, but no one responded to our questions.

It’s important to note that stand-alone emergency rooms like Total Care may charge more than your primary care doctor for the convenience of 24-hour and no-appointment-needed care under Texas House Bill 3276.

All the patients in this story told NBC 5 Responds someone took their vitals and each saw an emergency room doctor, briefly.

Even so, Brennan said, these charges are among the most unreasonable he’s seen in the pandemic.

“I think some of the bills that you sent me are certainly contenders for most outlandish,” said Brennan.

The patients we spoke to all said they went to Total Care in Benbrook because it offered a $50 test.

NBC 5 Responds also called the facility and was told the price for a COVID test is $550 if you’re not insured and confirmed they charge $50 if you are.

We asked Gene Besen – an attorney who typically represents insurance providers to weigh in on the charges we were seeing.

“Is it designed to get them in the door so they can then go drive a bunch of extra stuff on top of it? Probably,” said Besen.

He also points out insurance companies are often the first line of defense.

“If this were one or two patients and that were it, maybe that goes unnoticed and just gets paid and so be it. if there's a pattern here, I would be pretty confident the insurance companies will detect it,” said Besen.

Even so, Bensen said sometimes it takes patients who may not owe anything out-of-pocket asking questions because eventually everyone could end up paying.

“That’s what's going to drive insurance rates up for everybody is companies taking advantage of the system like this,” said Aranki.

The Texas Association of Health Plans said it sent a letter to Governor Greg Abbott asking lawmakers to ban what it calls “excessive fees” at free standing emergency rooms.

Specifically calling out fees for asymptomatic testing the kind the patients in this story say they underwent.

If you have a bill you’d like NBC 5 Responds to review, our team is committed to researching your concerns and recovering your money. Our goal is to get you answers and, if possible, solutions and resolution. Call us at 844-5RESPND (844-573-7763) or fill out our Customer Complaint form.

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