ProPublica recently reported how a $175 COVID-19 test resulted in charges of $2,479 at a for profit free-standing ER. The cost of surviving the Trump Virus is ridiculous. Once again, ProPublica has exposed another injustice. The article uses Dr. Zachary Sussman as an example.
Sussman went to his employer for a COVID-19 antibody test. He thought it would be free since he worked there as a doctor. However, the facility charged his insurance company $10,984 for the visit. Clearly fraudulent. What’s worse? His health insurer paid the bill in full! Sussman knew something was wrong. He knew the materials for each test amounted to only $8. The test gets read on the spot. He said there was no physical examination.
“Never laid a hand on me,” he said. The facility checked vitals, and drew blood. He tested negative. The whole encounter took 30 minutes.
The bill left him so dismayed he quit his job. But now, the insurer is investigating the case which could lead to repayment or a referral to law enforcement. The case shows how providers charge exorbitant prices for simple and inexpensive COVID-19 tests.
Trump allowed profiteering when the CARES Act passed. The legislation required health insurers to pay for out-of-network testing at the cash price a facility posts on its website, or less. No questions asked.
Fraud or Incompetence?
Health experts say high prices is the reason why Americans pay so much for health care. Shelley Safian is a Florida health care coding expert. She wrote four books on medical coding.
Safian reviewed Sussman’s medical records and claims. She concluded that the records do not justify the bills used to code the visit. Safian described the charges as “obscene.” She was shocked the insurer paid them in full. “This is the exact opposite of an employee discount,” she said. “Obviously nobody is minding the store.”
The charges for a test visit are “ridiculous,” said Niall Brennan. Brennan is president and CEO of the Health Care Cost Institute. The Institute is a nonprofit organization that studies health care prices. “But this whole pandemic, combined with the CARES Act provision, seems designed for unscrupulous medical providers to exploit.”
Unfortunately, many providers are exploiting the situation. Some are inappropriately or even fraudulently billing.