HOUSTON – As the COVID-19 pandemic continues, health authorities are encouraging everyone to get tested repeatedly to make sure we are not unknowingly spreading the virus.
Now, hundreds of millions of tests later, Channel 2 Investigates discovered doctors gouging patients and insurance companies for tests that are supposed to be free.
Nasal swabs, mouth swabs, rapid tests, and PCRs: There’s more than one way to get tested for COVID-19.
“I paid $100 for me, I paid $100 for my daughter,” said Katie Hillborn.
Hillborn also provided her insurance card at the Clear Creek Emergency Room in League City, in hopes she would be reimbursed when her insurance company paid the claim for the COVID-19 tests for her and her daughter.
“I called ahead, I asked what item fee would be,” said Ruth Kurian.
Kurian thought she asked all the right questions before getting a drive-thru test at the River Oaks Emergency Room on South Shepherd in Houston. She and her husband paid $100 and provided a picture of their insurance card as asked.
“That’s the only reason I provided my insurance. I was looking to get my $100 back,” she explains.
But weeks later, both women felt sick when they opened their explanation of benefits.
“$3520 for me and $3520 for my daughter,” said Hillborn, referring to the amount Clear Creek Emergency Room billed her insurance company on the first claim it sent.
Kurian’s explanation of benefits showed the River Oaks Emergency Room charged her insurance company $8900 each for her and her husband.
Broken down, the claims were $4,200 for emergency service and another $4,700 for ancillary services totaling $17,861 for two drive-thru COVID-19 tests. The entire bill was paid in full by Anthem Blue Cross Blue Shield.
“I was flabbergasted! I never set foot in the building. I spent maybe 5 minutes with a nurse through my car window,” said Kurian.
On top of the $3,250 Hillborn’s insurance was charged for herself and her daughter, there were two more claims for $3,700 each for the doctor’s services.
“Which I never saw a doctor while I was there,” Hillborn told Davis. “They said, ‘Well, you talked to a doctor over the phone when you got here that asked you questions.’”
Who is paying these high COVID test bills?
“It’s outrageous and, frankly, it’s criminal behavior,” said Niall Brennan, CEO of the Healthcare Cost Institute of Washington D.C. He said the CARES Act intended to shield consumers from the costs of COVID testing. But in the end, he says we’ll all pay the costs of the exorbitant claims in higher premiums.
“Unfortunately there is a small group of providers who looked in the CARES Act and found a way to make a quick buck,” said Brennan.
Texas is one of the worst when it comes to surprise COVID test billing, according to Brennan. Most of the egregious charges are from free-standing emergency rooms.
Tracking down someone in charge
When no one with River Oaks Emergency Room or Clear Creek Emergency Room - both owned by Village Emergency Centers - would call us back, consumer expert Amy Davis dropped by and caught up with CEO Dr. Hortencia Luna-Gonzales.
“I’m wondering if you can explain why you would charge almost $9,000 for a covid test,” said reporter Amy Davis.
“We don’t charge $9000,” said Luna-Gonzales.
“This is what you billed the insurance company,” said Amy.
“No comment, I’m gonna go,” Luna-Gonzales said.
The doctor was in a hurry to get away from our crews and the camera.
“Some people say this is illegal what you’re doing. No? It’s not illegal what you’re doing?” said Amy.
“Our prices are posted on our website, so you can look at our website,” Luna-Gonzales said.
We checked. The website actually reads, “No Surprise Billing” and “This facility charges rates comparable to a hospital emergency room and may charge a facility fee.”
When Channel 2 contacted Anthem Blue Cross Blue Shield to ask why it paid the $18,000 claims for a covid test, a representative explained the company had done a thorough review of the case. The claims from River Oaks Emergency Room were for emergency and ancillary services that were not immediately explained, so the company did not know Kurian and her husband had simply received a drive-through COVID-19 test and that they never left their vehicle. After Channel 2 called Village Emergency Centers, a representative contacted Anthem to reimburse the nearly $18,000 the company paid out.
Free testing is available
There are plenty of free COVID testing sites available all over the greater Houston area. Tax dollars are paying for the tests at about $60 - $90 a test. But often people need results faster so they seek out other places to get tested.
The Texas Department of Insurance says unless it’s an emergency you should avoid going to a free-standing emergency room or hospital for COVID testing. If you believe you have been excessively charged, you can file a complaint with the Texas Attorney General.