AUSTIN (KXAN) — Before flying to Peru to hike the Inca trail, Suli Luque and her husband went to get tested for COVID-19. They needed to show proof of negative test results to be let into the country.
The couple made an appointment at the Austin Emergency Center in Riverside – one of the many freestanding private emergency rooms in Texas.
Their tests came back negative, clearing the way for a trip to Machu Pichu filled with Llama sightings and mountain views — but a letter from their insurance company quickly killed the high they experienced from a week away.
Austin Emergency Center claimed the visit for their COVID-19 tests cost $3,973 altogether, and their insurance company said it was the couple’s responsibility to pay it.
“Abused — there really is no other way of saying this,” said Suli. “Do they take advantage like this? Do they try to get as much out of everything they do?”
The prices were especially shocking, because COVID-19 tests have largely been available for free throughout the pandemic for Americans.
Throughout the pandemic, local governments have done free testing at public sites and federal laws have required health plans to cover the full costs of coronavirus testing without a deductible or co-payment.
The explanation for the high costs has more to do with where Suli got her COVID-19 test. Austin Emergency Center is made up of six locally owned, independently run emergency rooms in Central Texas.
The cash price listed on the Austin ER website for a COVID-19 test is $427. It’s cost insurance providers are generally required to cover under the CARES Act. But Austin ER said when it sends a claim to health plans, it doesn’t just charge for the cash price of the test, it also bills what they call a ‘physicians charge,’ ER visit charge and lab charge.
The letter Suli got from her insurance agency was not a bill but an explanation of benefits from her insurer (think a pre-bill explaining what you could get charged and what you would be responsible for).
The letter was essentially letting the couple know their insurance would not be footing the bill for the other charges Austin ER added to the claim.
But where does that leave Suli? In an email, Austin Emergency Center said if the insurance won’t agree to pay the fees associated with the test, it won’t actually bill the patient for any of the non-covered charges.
Texas Association of Health Plans Communications Director Alicia Pierce said what happened to Suli is happening across the state in many free-standing emergency rooms.
“They’re trying to pass along these costs to health plans and insurance companies to see what they can get for it,” said Pierce. “There’s stories throughout the state, and there’s a pattern of behaviors from free-standing ERs.”
Pam LeBlanc was among two KXAN viewers who shared explanation of benefit letters back in June 2020 totaling more than $6,000 after COVID-19 tests at the Austin Emergency Center on Mueller.
The Texas Association of Freestanding Emergency Centers represents many freestanding emergency rooms across the state but does not include the Austin Emergency Center. The group said it “strongly condemns the practice of excessive billing fees for COVID-19 testing” and said “when there is an extreme strain on our healthcare system, patients must remember freestanding emergency centers are not testing sites.”
“The Omicron variant, while less severe, is more contagious, causing a drastic increase in the number of patients our ERs are treating. We recommend those who are only seeking a test with no symptoms of illness to go to a testing site, find an at-home test, or set up an appointment with a primary care facility rather than visiting an emergency center. “ the Texas Association of Freestanding Emergency Centers said in a statement.
Patients, in most cases, will never see an actual bill in the mail reflecting the charges in the explanation of benefits, according to Pierce.
But patients could further down the road be impacted by the high charges from free-standing clinics for COVID-19 testing.
“Depending on a number of factors, some of those costs could come back to them,” said Pierce. “On a macro level, it can mean higher costs for patients eventually because premiums will have to go up to cover those exorbitant costs. But also, usually, those are things that could get passed on as not just a premium, but also a co-pay or cost with your deductible.”
Pierce said in cases like Suli’s, patients should immediately notify their insurance agency to flag the costs don’t match the service they received.
“It makes me sick to my stomach. That’s really how I feel,” said Suli. “This is not like a choice that I had. I didn’t just go get something, because I wanted to. This was something that was required.”