AUSTIN (KXAN) – Before flying to Peru to travel the Inca Trail, Suli Luque and her husband went to be tested for COVID-19. They had to prove that the test results were negative to be allowed to enter the country.
The couple made an appointment at the Austin Emergency Center in Riverside, one of several free-standing private emergency rooms in Texas.
Their tests came back negative, paving the way for a trip to Machu Picchu, filled with llamas sightings and mountain views. But a letter from their insurance company quickly killed their excitement.
The Austin emergency center claimed the visit for their COVID-19 tests cost a total of $ 3,973, and their insurance company said it was the couple’s responsibility to pay for it.
âAbused – there’s really no other way to tell,â Suli said. “Are they taking advantage like this?” Are they trying to get the most out of everything they do? “
The prices were particularly shocking, as COVID-19 tests have been widely available for free throughout the pandemic for Americans. Local governments have performed free testing on public sites and federal laws have required health plans to cover the full costs of coronavirus testing with no deductible or co-payments.
The explanation for the high costs had more to do with where Suli got his COVID-19 test. The Austin Emergency Center is made up of six independently operated, locally owned emergency rooms in central Texas.
The cash price listed on the Austin ER website for a COVID-19 test is $ 427, but it’s a cost that insurance providers are generally required to cover under the CARES Act. But Austin ER said that when he submits a claim to health plans, he doesn’t just charge the cash price of the test – he also charges what they call a “doctor’s fee,” an emergency room visit fee. and laboratory costs.
The letter Suli received from her insurance agency was not an invoice but an Explanation of Benefits (EOB) from her insurer (think of a pre-invoice explaining what you might be billed for and what you would be responsible for) .
The letter essentially informed the couple that their insurance would not foot the bill for any other charges Austin ER added to the claim.
But where does that leave Suli? In an email, the Austin Emergency Center said that if the insurance does not agree to pay the costs associated with the test, it will in fact not charge the patient for any uncovered costs.
Texas Health Plans Association communications director Alicia Pierce said what happened to Suli is happening statewide in numerous self-contained emergency rooms.
âThey’re trying to pass those costs on to health plans and insurance companies to see what they can get out of it,â Pierce said. “There are stories all over the state, and there is a pattern of behavior for independent emergencies.”
Pam LeBlanc was one of two viewers of KXAN who shared their EOB letters in June 2020, showing that his insurance was billed over $ 6,000 after COVID-19 testing at an Austin emergency center location.
The Texas Association of Self-Contained Emergency Centers represents many self-contained emergency rooms across the state, but does not include the Austin Emergency Center. The group said it “strongly condemns the practice of excessive billing fees for COVID-19 tests” and said that “when there is extreme pressure on our healthcare system, patients should remember that stand-alone emergency centers are not test sites “.
âThe Omicron variant, while less serious, is more contagious, causing a drastic increase in the number of patients our emergency rooms treat,â the Texas Association of Freestanding Emergency Centers said in a statement. âWe recommend that those who are only looking for a test without symptoms of disease to go to a testing site, find a home test, or make an appointment with a primary care facility rather than going to a clinic. ’emergency.”
Patients, in most cases, will never see an actual bill in the mail reflecting the charges in the EOB, according to Pierce. But patients could be affected by the high fees from independent clinics for COVID-19 testing later on the road.
âDepending on a number of factors, some of these costs could come back to them,â Pierce said. âAt a macro level, this can potentially mean higher costs for patients, as premiums will have to increase to cover these sky-high costs. But also, generally, these are things that could be passed on not only as a premium, but also as a copayment or cost with your deductible. “
Pierce said that in cases like Suli’s, patients should immediately notify their insurance agency to report that the costs do not match the service they received.
âIt hurts my stomach. This is really how I feel, âSuli said. âIt’s not like a choice I had. I didn’t go looking for something because I wanted it. It was something that was needed.
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