Tuesday, June 30, 2020

Two Friends in Texas Were Tested for Coronavirus. One Bill Was $199. The Other? $6,408.


By Sarah Kliff
June 29, 2020


The two got drive-through tests at Austin Emergency Center in Austin. The center advertises a “minimally invasive” testing experience in a state now battling one of the country’s worst coronavirus outbreaks. Texas recorded 5,799 new cases Sunday, and recently reversed some if its reopening policies.


The emergency room charged Mr. Harvey $199 in cash. Ms. LeBlanc, who paid with insurance, was charged $6,408.

“I assumed, like an idiot, it would be cheaper to use my insurance than pay cash right there,” Ms. LeBlanc said. “This is 32 times the cost of what my friend paid for the exact same thing.”

Ms. LeBlanc’s health insurer negotiated the total bill down to $1,128. The plan said she was responsible for $928 of that.

During the pandemic, there has been wide variation between what providers bill for the same basic diagnostic test, with some charging $27, others $2,315. It turns out there is also significant variation in how much a test can cost two patients at the same location.


Some academic research confirms that prices can vary within the same hospital. One 2015 paper found substantial within-hospital price differences for basic procedures, such as M.R.I. scans, depending on the health insurer.

The researchers say these differences aren’t about quality. In all likelihood, the expensive M.R.I.s and the cheap M.R.I.s are done on the same machine. Instead, they reflect different insurers’ market clout. A large insurer with many members can demand lower prices, while small insurers have less negotiating leverage.


The Trump administration has taken steps to limit patients’ out-of-pocket costs for coronavirus testing and treatment, using relief funds to reimburse providers for uninsured patients’ bills. Insurers are required to cover patients’ coronavirus tests with no cost-sharing or co-payments. Alex Azar, the health and human services secretary, reiterated that commitment in a Sunday interview on CNN, saying, “If you are uninsured, it will be covered by us.”

The testing experience of the Texas group suggests that it doesn’t always work out that way. Some emergency rooms charge cash prices and tack on testing fees that insurers are not required to cover. In this case, the patient who paid cash actually got the best deal. Mr. Harvey has health insurance but felt it would be a “hassle” to use it for the coronavirus test. So he paid for his test with two $100 bills after receiving the nasal swab, and was on his way.


Jay Lenner, who also got a drive-through test from the same provider, used his insurance and received a similarly long list of charges. He recalls a provider saying he’d be tested only for coronavirus, but bill records show he was also screened for Legionnaires’ disease, herpes and enterovirus, among other things.


She used the information about what her friend had paid to negotiate her charges down to $199 as well. And after she reached out to a local television station, which devoted a segment to her charges, her health plan began investigating the bill.

Last Thursday, after returning from another camping trip, Ms. LeBlanc learned the bill would be dropped entirely.

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