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 indicate proof of destructive take a look at outcomes to be let into the nation.
The couple made an appointment on the Austin Emergency Heart in Riverside — one of many many freestanding non-public emergency rooms in Texas.
Their checks got here again destructive, clearing the best way for a visit to Machu Picchu, crammed with llama sightings and mountain views. However a letter from their insurance coverage firm rapidly killed their pleasure.
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Austin Emergency Heart claimed the go to for his or her COVID-19 checks value $3,973 altogether, and their insurance coverage firm stated it was the couple’s accountability to pay it.
“Abused — there actually is not any different approach of claiming this,” stated Suli. “Do they take benefit like this? Do they attempt to get as a lot out of every thing they do?”
The costs have been particularly stunning, as a result of COVID-19 testing has largely been accessible without spending a dime all through the pandemic for People. Native governments have completed free testing at public websites and federal legal guidelines have required well being plans to cowl the total prices of coronavirus testing with no deductible or co-payment.
The reason for the excessive prices had extra to do with the place Suli acquired her COVID-19 take a look at. Austin Emergency Heart is made up of six regionally 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, but it surely’s a value insurance coverage suppliers are typically required to cowl underneath the CARES Act. However Austin ER stated 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 acquired 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 might get charged with, and what you’ll be chargeable 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 e mail, Austin Emergency Heart stated that if insurance coverage received’t comply with pay the charges related to the take a look at, it received’t truly invoice the affected person for any of the non-covered expenses.
Texas Affiliation of Well being Plans Communications Director Alicia Pierce stated what occurred to Suli is going on throughout the state in lots of free-standing emergency rooms.
“They’re making an attempt to go alongside these prices to well being plans and insurance coverage firms to see what they will get for it,” stated 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 back in June 2020, exhibiting that her insurance coverage was billed greater than $6,000 after COVID-19 checks at a location of the Austin Emergency Heart.
The Texas Affiliation of Freestanding Emergency Facilities represents many freestanding emergency rooms throughout the state however doesn’t embrace the Austin Emergency Heart. The group stated it “strongly condemns the apply of extreme billing charges for COVID-19 testing” and stated “when there may be an excessive pressure on our well being care system, sufferers should keep in mind freestanding emergency facilities should not testing websites.”
“The Omicron variant, whereas much less extreme, is extra contagious, inflicting a drastic enhance within the variety of sufferers our ERs are treating,” the Texas Affiliation of Freestanding Emergency Facilities stated 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 major care facility quite than visiting an emergency heart.”
Sufferers, most often, won’t ever see an precise invoice within the mail reflecting the fees within the EOB, in accordance with Pierce. However sufferers might be impacted by the excessive expenses from free-standing clinics for COVID-19 testing additional down the street.
“Relying on a variety of components, a few of these prices might come again to them,” stated Pierce. “On a macro degree, it will probably imply larger prices for sufferers ultimately as a result of premiums should 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 stated 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,” stated Suli. “This isn’t like a selection that I had. I didn’t simply go get one thing as a result of I needed to. This was one thing that was required.”
