LEILA FADEL, HOST:
Coronavirus tests are usually free to patients in the U.S., but how much should an insurance company pay for these tests? That's the question at the heart of our latest medical bill of the month. Dr. Elisabeth Rosenthal is the editor-in-chief of our partner, Kaiser Health News, and she's brought us this bill. Welcome back.
ELISABETH ROSENTHAL: Good to be here again.
FADEL: So who are we meeting today?
ROSENTHAL: We're meeting Travis Warner. He's a 36-year-old IT professional from Dallas, Texas, and he wrote to us about what happened after he got a COVID test early in the pandemic.
FADEL: OK. Kaiser Health News reporter Aneri Pattani spoke with Travis. Let's listen.
ANERI PATTANI: Travis Warner runs his own company in Dallas, setting up internet, video and other systems in homes and offices. In the early days of the pandemic, they were busy.
TRAVIS WARNER: Obviously, there was a lot of service calls at the time because everybody's on the internet. Everybody's wanting more TVs. OK, we're not going into the office, so I need a better home office setup.
PATTANI: He and his employees were careful about COVID, but they were in people's homes constantly. In June 2020, Travis got a call that one of his employees tested positive. That sent Travis and his wife on the hunt for a test.
WARNER: That time was not very easy to find a place to get COVID tests. It was a scary time because it was just so much unknown.
PATTANI: They ended up driving about 30 minutes to a free-standing emergency room. That's basically an ER that's not attached to a hospital.
WARNER: It was a little doc-in-a-box, as people call them.
PATTANI: This one was owned by SignatureCare, which has more than a dozen facilities across Texas.
WARNER: They tell us, you know, there's different tests that we should do. We should do two different tests. One's quick. One's long term.
PATTANI: So they got the rapid test and the more extensive PCR one with the long swab.
WARNER: It's where they tickle your brain and everything. And it was fine. We - the rapid tests came back within 15 minutes. And they said it was a negative, and we felt relieved.
PATTANI: Eventually, everything came back negative, so Travis went back to work. And he didn't think about that ER visit until a month later.
WARNER: Well, the first thing that happened was my wife has great health insurance. She got her bill well before me. We saw some pricing on there that was, like, $2,000.
PATTANI: Travis remembers thinking...
WARNER: Wow, that was pretty pricey for a test.
PATTANI: And then Travis got his own bill.
WARNER: There's a lot of numbers and a lot of stuff on there, a lot of jargon and a lot of things that are like, I don't know what this is, but it said $54,000.
PATTANI: Yes, more than 50 grand for a COVID test.
WARNER: I was like, OK, well, somebody, I felt like, should have questioned that. And then what also blew my mind was insurance paid it all. They sent them the money. They paid.
PATTANI: His insurer settled the claim for about $17,000. Travis didn't have to pay anything.
WARNER: But it bothered me that there was a $54,000 charge for something that was a COVID test. I just couldn't believe it.
PATTANI: Travis called his insurance company. They reviewed the charge and said it was an error. So they took back most of the 17 grand. Travis still owed nothing, which is great, he says. But how did no one else catch the mistake?
WARNER: And then my question is, are they doing that to a lot of people? Are they sending these codes out, getting paid, nobody caring, nobody really doing questioning, oversight?
FADEL: So that was Travis Warner speaking with Kaiser Health News reporter Aneri Pattani. Dr. Elisabeth Rosenthal is still here with us to talk this through. Fifty-four thousand dollars for a COVID test - I can't even get my head around that number. So let's get to his big question. How often is this happening? Do we even know?
ROSENTHAL: Yeah. Like, wow. And the short answer is we don't know how often or how much this is happening. There's a law saying that patients should get these tests without copays during the pandemic, but there's nothing in the law that says how much can be charged. And that's weirdly enabled some really eye-popping bills because when patients hear you don't have to pay anything out of pocket, most patients don't even really question these huge bills.
FADEL: I mean, yeah, I mean, I rarely look at my - if I'm not paying it, I don't look at what I'm being charged (laughter).
ROSENTHAL: Yeah. Of course.
FADEL: What should insurers be paying for a COVID test? What's a reasonable amount?
ROSENTHAL: Well, Medicare pays about $100 for that gold-standard PCR test, the swab way up the nose. Many walk-in clinics will charge a couple of hundred because getting a test includes a medical visit. But researchers have looked at this, and 1 in 5 prices for a COVID test is more than $300. And that makes a good profit. But 17 grand that the insurer paid, that's just absurd.
PATTANI: So what if the patient hadn't said, wait a minute, so that the insurer could get that money back? What would have happened if he didn't ask a follow-up question?
ROSENTHAL: Well, that's why I like active patients. The stand-alone ER might well have just kept the $17,000. It would take a deeper investigation to see if this was truly a fluke or a pattern for this particular provider. And that's really the question - is this a mistake or an attempt to see if a provider can get away with a really high charge? The company says it has a low rate of billing errors and has a robust audit process, but, you know, this was a really big bill.
FADEL: So what should patients be aware of? What should they do if they need a coronavirus test?
ROSENTHAL: First of all, note that you shouldn't be charged as long as we're in a public health emergency. And, as always, try to avoid an ER, even these so-called free-standing ERS. It may look like an urgent care center, but if there's ER in the name, it most likely means big bills. Your local health department might be a better option, a city-run testing program or a pharmacy chain's minute clinics. Those will be kind of reasonable. And you can ask the price beforehand, and wherever you go, check your bill. Check your insurance statement. You might just catch a really crazy charge, too, like Travis did.
FADEL: Dr. Elisabeth Rosenthal, editor-in-chief of our partner, Kaiser Health News, thanks for being here.
ROSENTHAL: Thanks for having me.
FADEL: And if you have a bill that's confusing or eye-popping, please send it to us. Go to NPR's Shots blog and tell us what's going on.
(SOUNDBITE OF EL TEN ELEVEN'S "FANSHAWE")
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