Before a camping and kayaking trip along the Texas coast, Pam LeBlanc and Jimmy Harvey decided to test for coronavirus. They wanted a little more peace of mind before spending 13 days indoors with three friends.
The two had test drives at the Austin Emergency Center in Austin. The center announces a “minimally invasive” testing experience in a state that is now battling one of the worst coronavirus outbreaks in the country. Texas recorded 5,799 new cases on Sunday and recently reversed some if its reopening policies.
They both remembered how uncomfortable it was for the nose to run up the long nasal swab. LeBlanc’s eyes began to cry; Harvey felt as if the swab “was in my brain.”
His tests returned with the same negative result, which allowed the trip to continue, but the accompanying invoices were quite different.
The emergency room charged Harvey $ 199 in cash. LeBlanc, who paid with insurance, charged him $ 6,408.
“I assumed, as an idiot, that it would be cheaper to use my insurance than to pay cash right there,” LeBlanc said. “This is 32 times the cost of what my friend paid for exactly the same.”
LeBlanc’s health insurer negotiated the total bill up to $ 1,128. The plan said that she was responsible for $ 928 of that.
During the pandemic, there has been wide variation between what providers bill for the same basic diagnostic test, with some charging $ 27, others $ 2,315. It turns out that there is also a significant variation in how much a test can cost two patients at the same location.
Harvey and LeBlanc were among the four New York Times readers who shared the bills they received from the same chain of emergency rooms in Austin. Their experiences offer a rare window into the unpredictable way in which health prices vary for patients who receive apparently identical care.
Three paid with insurance and one in cash. Even after negotiations between insurers and the emergency room, the total that patients and their insurers ended up paying varied by 2,700%.
Such discrepancies stem from a fundamental fact about the health care system in the United States: the government does not regulate health care prices.
Some academic research confirms that prices can vary within the same hospital. A 2015 article found substantial differences in hospital prices for basic procedures, such as MRI imaging, according to the health insurer.
The researchers say these differences have nothing to do with quality. In all probability, expensive MRIs and cheap MRIs are done on the same machine. Instead, they reflect the market influence of different insurers. A large insurer with many members may demand lower prices, while small insurers have less negotiating influence.
Because healthcare prices in the United States are so opaque, some researchers have turned to their own medical bills to understand this type of price variation. Two health researchers who gave birth in the same hospital with the same insurance compared notes later. They found that one received a surprise $ 1,600 bill while the other did not.
The difference? A woman gave birth while an out-of-network anesthesiologist was attending the maternity ward; the other received her epidural from an in-network provider.
“The additional out-of-pocket charge in addition to the other costs of labor and delivery was left entirely to chance,” co-authors Erin Taylor and Layla Parast wrote in a blog post summarizing the experience. Parast, who received the surprise bill, eventually reversed it, but not until her baby was almost 1 year old.
The Trump administration has taken steps to limit patients’ out-of-pocket costs for coronavirus testing and treatment, using aid funds to reimburse providers for uninsured patient bills. Insurers must cover patient coronavirus testing without cost sharing or copays. Alex Azar, secretary of human and health services, reiterated that commitment in a Sunday interview on CNN and said: “If you don’t have insurance, we will cover it.”
The Texas group’s testing experience suggests that it doesn’t always work that way. Some emergency rooms charge cash prices and add trial fees that insurers are not required to cover.
In this case, the patient who paid in cash obtained the best treatment. Harvey has health insurance, but felt it would be a “pain” to use it for the coronavirus test. He then paid for his test with two $ 100 bills after receiving the nasal swab and was on his way.
LeBlanc let the emergency room take a picture of his insurance card. He ended up with $ 6,408 in charges, primarily from an outside laboratory called the Genesis Laboratory that handled his tests. You received Explanation of Benefits statements suggesting you owed more than $ 1,000.
Jay Lenner, who also received a test drive from the same provider, used his insurance and received a similarly long list of charges. Remember a vendor said he would be screened only for coronaviruses, but invoice records show he was also screened for Legionnaires’ disease, herpes, and enterovirus, among other things.
The emergency room also charged him $ 1,684 to use his facilities and $ 634 to see one of his doctors. In total, he ended up with $ 5,649 in bills, of which his insurance plan paid $ 4,914. Lenner didn’t end up on the hook for any of that, but he’s still frustrated. “Ultimately, we pay this in higher premiums,” he said.
Michelle Tribble, a spokeswoman for the Austin Emergency Center, said she needed to charge high prices because insurers often pay only a small part of their fees.
“For emergency room visits, the reimbursement from insurance companies is usually a fifth or a third of the total charges,” he said. “If an insurance company billed a patient for an out-of-network visit to our emergency room, our billing company would go to that patient and appeal on their behalf.”
The Austin Emergency Center and the Genesis Laboratory had different explanations for why patients like Lenner were screened for so many conditions. Tribble said “the laboratory makes the determination” of what to test. Laboratory spokesman Edward Cienki said: “Genesis does not order clinical laboratory tests.”
LeBlanc learned of the discrepancy only because her husband was on the phone with Harvey when a price estimate came in from his insurer in the mail. Harvey said, “I hear Pam in the background saying, ‘What the hell is this?’ “
She also used the information about what her friend had paid to negotiate her charges up to $ 199. And after contacting a local television station, which dedicated a segment to her charges, her health plan began investigating the bill.
On Thursday, after returning from another camping trip, LeBlanc learned that the bill would be removed entirely.
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