Emergency Room Overcharges with Coronavirus Test

Santa Clara, CADespite the $2 trillion coronavirus aid package that includes over $100 billion for hospitals and medical needs, and despite a law signed by President Trump on March 18 that supposedly allows Americans to be tested for coronavirus free of charge, some patients now face emergency room overcharges. While the tests may be free, both insured and uninsured patients are still charged the ER visit to get the test.  And keep in mind that insured patients visiting an emergency room during this crisis could face huge ER costs.

For instance, at the beginning of March a patient was instructed by the heads of a hospital emergency room and infectious-disease department to visit the emergency room for newly available coronavirus testing. In an isolation room, Mr. Cencini was put on an IV drip, had a chest x-ray and swabbed for the virus. According to the New York Times, the patient (who helps with computers in a prison for $54K per year and is a volunteer firefighter) was charged $2,000—the bulk of emergency room fees were covered by his insurer.
 

Coronavirus Emergency Room Charges

What emergency room charges does the insurer cover during this pandemic? Laboratories aren’t working for free. A spokesperson for the American Clinical Laboratory Association told the Times (March 30) that labs have completed over 234,000 tests to date, nearly quadrupled their daily test capacity and were “still waiting for reimbursement for tests performed. In many cases, labs are receiving specimens with incomplete or no insurance information, and are burdened with absorbing the cost.”

But emergency rooms are still charging patients, mainly because many in-network emergency rooms are staffed by doctors working for private companies. Mr. Cencini’s doctor works with Team Health, a medical staffing business owned by a private equity firm called Blackstone (In 2016, Blackstone paid $6.1 billion for Team Health.)

The new law that is meant to ensure aid to fight the effects of the pandemic seems to have overlooked ER charges related to coronavirus testing. Out-of-network medical billing has not been taken into consideration. Peterson-KFF, a health system tracker, explains that “surprise medical bills” occur when an insured person inadvertently receives care from an out-of-network provider. Last year, one in six visits to ER had at least at least one out-of-network charge, which increases the risk of patients’ receiving surprise medical bills, and hospitals demanding patient payment. A 2019 study in Texas showed that over 30 percent of ER doctor services were “out-of-network — and most of those services were delivered at in-network hospitals”. 

The last thing patients need to worry about during this pandemic is a huge emergency room charge. Kaiser Health reported – before the pandemic-- that two-thirds of Americans are “very worried” about being able to afford their own or a family member’s unexpected medical bills. Emergency room charges have already seen increases of 176% between 2008 and 2017, according to the Health Care Cost Institute. This increase has led to insurance companies narrowing the number of doctors that are in-network, hoping to pretty much find the doctors and hospitals that charge them the lowest amount. Unfortunately, this has resulted in patients getting slammed with surprise out-of-network costs from consulting physicians, especially in emergency situations such as being quarantined with coronavirus.

If you have a health emergency, and even if you are tested negative for coronavirus, the last place you want to be during this crisis is the emergency room.  Chances are, you would be treated in an unfamiliar, out-of-network hospital because your hospital is too full with Covid-19 patients.