AUSTIN (KXAN) – Earlier than flying to Peru to hike the Inca path, Suli Luque and her husband went to get examined for COVID-19. They wanted to point out proof of adverse take a look at outcomes to be let into the nation.
The couple made an appointment on the Austin Emergency Middle in Riverside — one of many many freestanding non-public emergency rooms in Texas.
Their exams got here again adverse, clearing the best way for a visit to Machu Picchu, stuffed with llama sightings and mountain views. However a letter from their insurance coverage firm rapidly killed their pleasure.
Austin Emergency Middle claimed the go to for his or her COVID-19 exams value $3,973 altogether, and their insurance coverage firm mentioned it was the couple’s accountability to pay it.
“Abused — there actually isn’t any different manner of claiming this,” mentioned Suli. “Do they take benefit like this? Do they attempt to get as a lot out of every part they do?”
The costs have been particularly surprising, as a result of COVID-19 testing has largely been obtainable free of charge all through the pandemic for People. Native governments have achieved free testing at public websites and federal legal guidelines have required well being plans to cowl the complete prices of coronavirus testing with no deductible or co-payment.
The reason for the excessive prices had extra to do with the place Suli bought her COVID-19 take a look at. Austin Emergency Middle is made up of six domestically owned, independently run emergency rooms in Central Texas.
The money value listed on the Austin ER web site for a COVID-19 take a look at is $427, nevertheless it’s a price insurance coverage suppliers are typically required to cowl below the CARES Act. However Austin ER mentioned that when it sends a declare to well being plans, it doesn’t simply cost for the money value of the take a look at — it additionally payments for what they name a “physicians cost,” an ER go to cost and a lab cost.
The letter Suli bought from her insurance coverage company was not a invoice however an evidence of advantages (EOB) from her insurer (suppose a pre-bill explaining what you would get charged with, and what you’d be accountable for).
The letter was basically letting the couple know their insurance coverage wouldn’t be footing the invoice for the opposite expenses Austin ER added to the declare.
However the place does that go away Suli? In an electronic mail, Austin Emergency Middle mentioned that if insurance coverage gained’t comply with pay the charges related to the take a look at, it gained’t truly invoice the affected person for any of the non-covered expenses.
Texas Affiliation of Well being Plans Communications Director Alicia Pierce mentioned what occurred to Suli is going on throughout the state in lots of free-standing emergency rooms.
“They’re attempting to move alongside these prices to well being plans and insurance coverage firms to see what they will get for it,” mentioned Pierce. “There’s tales all through the state, and there’s a sample of behaviors from free-standing ERs.”
Pam LeBlanc was amongst two KXAN viewers who shared their EOB letters again in June 2020, displaying that her insurance coverage was billed greater than $6,000 after COVID-19 exams at a location of the Austin Emergency Middle.
The Texas Affiliation of Freestanding Emergency Facilities represents many freestanding emergency rooms throughout the state however doesn’t embrace the Austin Emergency Middle. The group mentioned it “strongly condemns the observe of extreme billing charges for COVID-19 testing” and mentioned “when there may be an excessive pressure on our well being care system, sufferers should keep in mind freestanding emergency facilities will not be testing websites.”
“The Omicron variant, whereas much less extreme, is extra contagious, inflicting a drastic improve within the variety of sufferers our ERs are treating,” the Texas Affiliation of Freestanding Emergency Facilities mentioned in an announcement. “We suggest those that are solely searching for a take a look at with no signs of sickness to go to a testing website, discover an at-home take a look at, or arrange an appointment with a main care facility relatively than visiting an emergency heart.”
Sufferers, generally, won’t ever see an precise invoice within the mail reflecting the costs within the EOB, in line with Pierce. However sufferers may very well be impacted by the excessive expenses from free-standing clinics for COVID-19 testing additional down the street.
“Relying on plenty of components, a few of these prices may come again to them,” mentioned Pierce. “On a macro stage, it will possibly imply increased prices for sufferers finally as a result of premiums must go as much as cowl these exorbitant prices. But in addition, normally, these are issues that would get handed on as not only a premium, but additionally a co-pay or value along with your deductible.”
Pierce mentioned in instances like Suli’s, sufferers ought to instantly notify their insurance coverage company to flag that the prices don’t match the service they acquired.
“It makes me sick to my abdomen. That’s actually how I really feel,” mentioned Suli. “This isn’t like a selection that I had. I didn’t simply go get one thing as a result of I wished to. This was one thing that was required.”
