Before trekking and kayaking along the Texas coast, Pam Leblanc and Jimmy Harvey decided to take coronavirus tests. They wanted a little more peace before spending 13 days in close circle with three friends.
The two underwent end-to-end tests at the Austin Emergency Center. The center advertises a “minimally invasive” state testing experience that is currently struggling with one of the worst outbreaks of coronavirus in the country. There were 5,799 new cases registered on Sunday in Texas, and recently some of them were canceled if it was reopened.
They both remembered how uncomfortable it was when a long nasal swab pushed their noses. LeBlanc’s eyes began to cry; Harvey felt as if a smear “was in my brain.”
Their tests returned with the same result – negative, which allowed the trip to go forward – but the companion accounts were completely different.
At the emergency room, Harvey paid $ 199 in cash. LeBlanc, who paid with insurance, was charged $ 6,408.
“I assumed, as an idiot, it would be cheaper to use my insurance than to pay in cash right here,” said Leblanc. “This is 32 times what my friend paid for the same.”
LeBlanc Health Insurance agreed on a total of up to $ 1,128. The plan says that she is responsible for $ 928.
During the pandemic, there were big differences between which providers billed for the same basic diagnostic test: some charge $ 27, others charge $ 2,315. It turns out that there are also significant differences in how much a test can cost for two patients in one place.
Harvey and LeBlanc were among the four New York Times readers who shared the bills they received from the same emergency department network in Austin. Their experience offers a rare window into the unpredictable change in healthcare prices for patients who receive seemingly identical care.
Three paid insurance and one in cash. Even after negotiations between insurers and the emergency department, the total amount that patients and their insurers paid in the end varied by 2700%.
Such discrepancies arise from a fundamental fact about the US health care system: the government does not regulate health care prices.
Some scientific studies confirm that prices can vary within the same hospital. In one document for 2015, significant nosocomial differences were found in the prices of basic procedures, such as MRI, depending on the health insurer.
Researchers say these differences are not in quality. In all likelihood, expensive MRI and cheap MRI are done on the same machine. Instead, they reflect the market influence of various insurers. A large insurer with many participants may require lower prices, while smaller insurers have less leverage.
Because healthcare prices in the United States are so opaque, some researchers turned to their own medical bills to understand this type of price change. Two health researchers who gave birth in the same hospital with the same insurance compared records later. They found that one received an unexpected bill of $ 1,600, and the other did not.
Differences? One woman gave birth when an anesthetist working offline was in the maternity ward; another received its epidural anesthesia from a network provider.
“The additional pocket expenses, in addition to other labor and delivery costs, were left entirely to chance,” co-authors Erin Taylor and Leyla Parast wrote in a blog post summarizing the experience. The parast, who received the bill for the surprise, finally changed him, but only when her child was almost a year old.
The Trump administration has taken steps to limit patients’ personal expenses for testing and treating coronavirus, using assistance tools to compensate providers for uninsured patient bills. Insurers are required to cover patients’ coronavirus tests at no cost or surcharge. Alex Hazard, the Minister of Health and Human Services, confirmed this commitment in a Sunday interview on CNN, saying: “If you are not insured, it will be covered by us.”
The testing experience of the Texas group shows that this does not always work out that way. Some emergency rooms charge cash prices and test fees, which insurers are not required to cover.
In this case, the patient who paid in cash actually received the best offer. Harvey has health insurance, but he decided that using it for a coronavirus test would not be easy. Thus, he received two tests for $ 100 after he received a nasal swab and hit the road.
LeBlanc allowed the emergency department to photograph his insurance card. In the end, she received $ 6,408, mainly from an external lab called Genesis Laboratory, which was testing it. She received explanations about the benefits, which stated that she owed more than $ 1,000.
Jay Lenner, who also underwent a test drive from the same provider, used his insurance and received an equally long list of charges. He recalls how the provider said that he would only be tested for coronavirus, but the billing records show that he was also tested for legionnaire’s disease, herpes and enterovirus, among other things.
The emergency department also charged $ 1,684 for using his facility and $ 634 for visiting one of the doctors. As a result, he received $ 5,649 in bills, of which his insurance plan paid $ 4,914. Lenner didn’t get hooked for any of this, but he is still disappointed. “In the end, we pay higher premiums for this,” he said.
Michelle Tribble, an Emergencies Ministry spokeswoman for Austin, said high prices must be charged, as insurers often pay only a small portion of their fees.
“When visiting an emergency department, insurance companies usually pay us a fifth or a third of the total cost,” she said. “If the insurance company billed the patient for visiting our emergency department outside the network, our billing company would go for that patient and file an appeal.”
There were various explanations at the Austin Emergency Center and Genesis Laboratory for why patients like Lenner were examined for so many conditions. Tribble said the “lab decides” what to check. Edward Sienki, a spokeswoman for the laboratory, said: “Genesis does not order clinical laboratory tests.”
LeBlanc found out about the discrepancy only because her husband accidentally spoke on the phone with Harvey when a price estimate from her insurer arrived in the mail. Harvey said, “I hear Pam in the background saying,“ What the hell is this? “
She used information that her friend had paid to negotiate her charges also up to $ 199. And after she turned to the local television channel, which devoted part of her charges, her health plan began an investigation of the bill.
On Thursday, returning from another campaign, LeBlanc found out that the account will be withdrawn completely.
This article originally appeared in New York Times,
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