Everything's Bigger in Texas: A $75 COVID Test is Billed at $10,984 by Man's Own Hospital Employer

[TheBlackAdder]

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A Doctor went to his own employer for a COVID-19 antibody test. It cost $10,984.

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About a month later, Golden Rule sent Sussman his explanation of benefits for the physician portion of the bill. The charges came to $2,100. Sussman was surprised by the expense but he said he was familiar with the Physicians Premier high-dollar business model, in which the convenience of a free-standing ER with no wait comes at a cost.
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He said he let the issue slide until a few weeks later when a second explanation of benefits arrived from Golden Rule, for the Physicians Premier facility charges. This time, an entity listed as USA Emergency sought $8,884.16. Again, the insurer said, “Payable at: 100%.”
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For comparison, Medicare lists its payment at $42.13 for COVID-19 antibody tests. That’s because Medicare, the government’s insurance plan for the disabled and people over 65, sets prices.

Complicating matters, Texas is the nation’s epicenter for free-standing emergency rooms that are not connected to hospitals. Vivian Ho, an economist at Rice University who studies the facilities, said their business model is based on “trying to mislead the consumer.” They set up in locations where a high proportion of people have health insurance, but they don’t have contracted rates with the insurers, Ho said. They are designed to look like lower-priced urgent care centers or walk-in clinics, Ho said, but charge much higher emergency room rates. (The centers have defended their practices, saying that they clearly identify as emergency rooms and are equipped to handle serious emergencies, and that patients value the convenience.)
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This is a long article, at the link:
https://www.rawstory.com/2020/09/a-doctor-went-to-his-own-employer-for-a-19-antibody-test-it-cost-10984/

There seems to be a lot of fraud at the hospital side, lack of oversight on the insurance side. I guess the hospital feels that if the patient has no out-of-pocket expenses, they won't complain about what is being billed out to the insurance company.

Man, the more I read about Texas, the more I'm dumbfounded what people give up for 'freedoms.'

It's Florida unbridled.

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[catrose]

1. I called my provider, Aetna, to find a hospital with an emergency room

because I didn't want to go to a doc-in-a-box. (The last time I did, they said, yeah, this is serious. Go to a hospital.)

They gave me the name of a rehab center and several other unrelated medical facilities. Basically, I couldn't stay in network and go to a hospital, though there's one about 3 miles away.

[Indykatie]

2. These Out of Network For Profit Facilities Are Bankrupting The System

They take advantage of the system on patients with Employer insurance where preventive tests are paid at 100% by their Employer's insurance. They assume the patient won't question the bill if their insurance pays an exhorbitant fee. They usually will write off any balance not paid by the insurance.

[dalton99a]

3. Free-standing ERs are scams. Go to a real hospital.