I Got Tested for COVID-19. Then I Got Billed.
All it took was an online registration, a drive through nasal swab and a short phone call. Then my insurance company was billed for $1,944.
By Sammy Sussman
I was tested for the coronavirus on May 9. I live in Westchester County, New York, near what was then the country’s coronavirus hotspot. (America’s first major outbreak, in New Rochelle, was around 20 miles from my house.)
In May, our county had regularly seen between 3,000 and 5,000 new cases each day. Ten days earlier, New York state had peaked at about 10,500 new cases. As drive-through testing facilities began opening up around the area, we decided that it was time to get tested.
The specific testing site that we chose was located in the local train station parking lot. It was a collaboration between the town government and a private testing company — the town provided volunteers, free meals, a location and a mild police presence while the testing company took and processed the nasal swabs.
In our town supervisor’s nightly emails, he’d repeatedly advertised this test. “No cost, no pay, no one will be turned away” he proudly wrote. He’d also linked to the testing company’s website, where they bragged that they had “shaped the landscape of testing with the first drive-thru testing on East Coast [sic].”
After reading about the test, we were proud to be tested at this site. We were happy to support our local government and this local testing company — two institutions that we assumed had been hit particularly hard by this pandemic.
And though there had been some red flags while we registered for the test — why were providing detailed health insurance information over a Google form? — we were confident that the town had properly vetted this private testing company. Hadn’t other towns contracted with this company for coronavirus testing?
We’d soon learn the limits of local government in vetting private testing companies. And we’d learn just how easy it was for a testing company to overcharge for a test in the middle of a pandemic. We’d come away from the experience feeling more pessimistic about the state of the American health care industry than ever before.
The drama began soon after we were tested. Though we’d been told to expect results within 48 hours, we’d quickly received an email from what we believed to be the testing company. It had contained a letter advising us to self-quarantine until our results were delivered — after a brief moment of panic, we realized that this did not mean we’d tested positive — and a screenshot of our county department of health’s coronavirus advisory.
Weeks later, I’d speculate that this screenshot allowed the testing company to bill us $234 for “preventive service.” At the time, however, I simply assumed that this was an extra precaution in case we hadn’t already seen this advisory.
My sister was the first person in my family to get the call from the testing company. She had a brief three or four minute conversation with them about the test. They asked her what symptoms she’d been experiencing and why she’d gone to get tested. They’d informed her of her results and hung up.
(This would later be billed to our insurance company as an out-of-network telehealth appointment: $350 for the “office visit” and $130 for another “preventive service.”)
When my mom got the next call, she asked the employee on the other end to tell her all of our results. (She told them that this was to save them time; little did we know that it would also save us two $480 bills.)
Despite the potential privacy violations, the employee agreed to give my mom all of our results. The employee read off the three test results and provided some information about how to stay safe before hanging up the phone.
The conversation couldn’t have lasted more than five minutes. To us, it was a short phone call. To the testing company, it was a telehealth “office visit” with “preventive service.” It was $480 more that our insurance company would be asked to pay for the service that our local government had organized and advertised.
When we got our explanation of benefits statements from our insurance company, we began to get an idea of the scam that we might have just participated in. My dad and I had each been charged $1,464 for the drive-through nasal swab and the test processing. My mom and sister had been charged $1,944; $1,364 for the test and $480 for the phone calls.
Our family’s insurance provider had been charged $6,616. They’d paid for it at a slight discount, as all major insurance providers are apt to do. $5,340.78 was the final cost of this test.
My bill was broken down into three categories: “Office Visit,” “Lab Microbiology” and “Preventive Service.” I’d been billed $234 for the office visit, $1,000 for the lab microbiology and $130 for the preventive service.
My mom’s bill and my sister’s bill were even more expensive. In addition to those costs, they were each billed $480 for the phone call delivering our tests results. (This had broken down into $130 for preventive counseling and $350 for an office visit.)
Our family is privileged to have good health insurance. We paid nothing out-of-pocket for these tests. Had it not been for the explanation of benefits, we’d never have learned of the charges.
Nevertheless, we were upset to learn that the private testing company might be making money off the town’s drive-through testing site.
As a local government official would later write to my mom in an email, “we had an agreement from the outset that no one would be charged anything for the services.”
Why was the town providing this company with volunteers and free meals, we wanted to ask. Why was the town supervisor advertising so heavily for this test in his nightly emails?
Though we didn’t know enough to be confident in our suspicions, something seemed amiss. An article had just been published about other testing companies grossly overcharging for these tests. It seemed as though most tests cost around $100. Why had two of our tests cost $1,944 each?
For the past two years, I’ve been a student reporter at my university’s student newspaper. Though I knew that our local newspapers had faced massive layoffs over the past couple of years, I searched for a reporter that could pursue this story. The potential for a 6,000 word exposé on potential corruption seemed too good to pass up.
Meanwhile, my mom emailed our town supervisor to tell him what we’d experienced with our test. While I waited for reporters to respond to my emails, my mom’s email was forwarded to the head of the testing company. She was the first one to get a response.
“I think it will help when everyone knows exactly how to properly read an explanation of benefits. [sic] Because it appears to me that this is an explanation of benefits,” the head of the testing company wrote, which is “far different than a bill.”
He added another employee to the chain. She assured us that the cost was appropriate.
“The office must pay the staff administering the test (test must be performed by a licensed medical professional),” she wrote. “Also, [they had to pay for] the machine that processes the test, the lab technician who processes the test and the overhead involved for housing the lab where the test is processed. Not to mention the staff that processes the claim to be sent out.”
I had so many questions about this claim. Why had it been reported that most tests cost $100-$300? What made this specific test so much more expensive?
Then I received a response to my emails. Like many towns around the country, our local newspaper’s newsroom had shrunk precipitously over the past decade. It now consisted of one reporter and one editor; neither could sacrifice the hundreds of hours that would be required to pursue this story.
I began to fear that we’d never get answers to our questions. Medical insurance is extraordinarily difficult to understand in America, almost by design. And without a local government to vet these testing companies or a local reporter to hold the local government to account, it seemed inevitable that overly costly coronavirus tests would slip through the cracks.
My mom and I began doing our own research on the payments. She continued to write the head of the testing company with questions about his billing; I began my own email chain with this doctor, writing to him as an “investigative reporter” “working on a story” about his testing practices.
To my mom, the head of the testing company wrote that, “I realize this is a very stressful and confusing time full of misinformation. It has led reasonable people to mistake good work for manipulation and misdeeds. Frankly, there is a little too much of that in this world.”
To me, he wrote that he’d “seen [my] work and would love to help … with [my] story.”
My mom responded first, asking about the charges for the phone call. She still couldn’t understand how he could justify $480 for a few minutes on the phone.
“We subsidize all these tests and bill no patient ever, we provide medical care for these less fortunate than us,” the head of the testing company responded. “I assure you, our efforts are pure, our intentions good. We are doctors dedicated to care for our communities and the patients we serve.”
But because the testing company was a private entity, my mom and I had no way of knowing if he was telling the truth. Unlike a local government, the public could get no access to his records under the Freedom of Information Act. Without investigative reporters or a vigilant local government, we had to take the head of the testing company at his word.
The head of the testing company had also emailed my mom to explain that his test price was comparable to the pre-pandemic CPT (current procedural terminology) code 87633 test.
“The lowest charge in the 501c3 hospitals systems for [a 87633 test] is around 1500 USD,” he’d claimed.
Eager for something to research, I grabbed onto this claim. According to the CPT Assistant, an 87633 test is a “nucleic acid assays that detect multiple respiratory viruses in a multiplex reaction.” This was the old code — the pre-pandemic code — for a test to detect specific viral respiratory illnesses.
My research indicated that as of March 13, 2020, tests for SARS-CoV-2 (the novel coronavirus) were supposed to be filed under a different code: 87635. “Use of code 87635 will help to efficiently report and track testing services related to SARS-CoV-2,” the CPT Assistant had noted, “and will streamline the reporting and reimbursement for this test in the United States.”
Though I was no expert in medical insurance pricing, my assumption was that these two codes were incomparable. Wouldn’t the comparably low demand for pre-pandemic viral respiratory illness tests naturally make the 87633 prices much higher? Had the testing company’s use of the 87633 code been nefarious?
I decided to email the head of the testing company to question this. He wrote back that “several machines that test 87635 have very large false negative rates.” He administered the 87633 test because it is “an excellent test selected by the Department of Defense for it’s [sic] accuracy and rapid TAT With [sic] a very low false negative rate.”
It seemed that I’d misunderstood the documents I’d been researching. These were two different tests, not two codes that could be applied to the same test. If I doubted the head of the testing company and I doubted the results of my own research, who could I trust?
I’d continued to doubt the head of the testing company because he’d also pointed me to an article about testing costs. It was by Mira, an affordable healthcare company. (A section near the bottom advertised Mira’s own testing services.)
He’d pointed my attention to the statement that “when an individual has mild symptoms and seeks a visit with a primary care provider in New York City, the out-of-pocket costs average $994.” Did he think that this would reassure me? It left me with so many more questions.
Why had he billed for almost double this average? Why was he comparing his test to a primary care visit and lab test? Why had we been charged for an “office visit” and “preventive service” if we’d just driven through in a car and had a stick poked up both nostrils?
When my mom called our insurance company, we began to get some answers to our questions. We were unable to file any sort of fraud charges against the testing company because they’d listed the drive through test as a “mobile” office visit. (How our car had functioned as their office is beyond me.)
They’d also listed the phone calls as “telehealth” office visits. Their prices were thus comparable to a primary care visit and lab test, despite how disingenuous this might feel to my family.
As we both tried to continue questioning the testing company over email, the head of the company became increasingly sarcastic in his responses.
“What would be acceptable as payment,” he wrote in one email, “to put your life at risk daily with exposure to a virus seven days a week? In Snow? [sic] In lightning? In rain? In oppressive heat? What would be a fair rate to pay someone who has spent millions on machines and staff to care for the patients?”
He also tried to claim that he was losing money on these tests. “I’m funding this [drive-through testing] effort with my credit cards,” he wrote. If only there was any way that we could determine if this was true.
And in one of his last emails to my mom, the head of the testing company tried to put this price in perspective.
“Today, I am in the field, testing patients who could have novel coronavirus,” he wrote. “I am very glad [you do] not. Sometimes value is determined most when we are ill and need services.”
I wanted to respond by citing the many hospitals and medical practices that have lost tremendous amounts of money because of this global pandemic. Why should the testing company be allowed to make so much money from this emergency?
Instead, I brought this experience up while visiting my general practitioner for my annual physical. What should the price have been, I asked my doctor, for a standard coronavirus PCR test?
“Probably $200 or $300,” he said.
I said that we’d been charged $6,616 for four tests. I explained that we’d gone to the testing site because it was set up by our local government, that we hadn’t understood the price going in.
The doctor seemed much less surprised than I was. He seemed much less angry.
“I’m sorry, dude,” he said. “That sucks.”◆