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$1,944 for a coronavirus test? Readers helped us spot an unusual trend

120 points by prostoalex 6y ago

gok 6y ago
tldr: One doctor is defrauding thousands of people by charging $2000 for a test that costs him nothing, and presumably making millions doing so.
- programmertote 6y ago
  If people think it's just one doctor/one clinic profiting off from this pandemic, they'd be wrong. I know a couple of people who worked at these COVID testing sites in NYC (area near Columbia University), Brooklyn and in New Jersey for $15/hour. If one wants to work there, s/he doesn't even need to have work permit (because these sites hire foreign medical graduates for cheap labor). One just need to be able to draw blood, if necessary and that's the main requirement to work there. All of these clinics are owned by doctors. I'm 100% sure these clinic owners get reimbursed more than $15 per test from the US government. It is a financial windfall for those entrepreneurial doctors and clinic owners who are willing to ignore proper screening in hiring COVID testers at the sites.
  - fragmede 6y ago
    It’s a blood draw, not brain surgery. It sounds like you have problems with a for-profit healthcare system run under capitalism, however.
    - 8bitsrule 6y ago
      Could well be. Many people are saddened by the whole idea of a for-profit healthcare system ... regardless of the politics ... and I'm among them. Health is a Human Right. As for the predatory equity firms that control many of them, I'd be delighted to see them thrown out of the US ... after their owners serve serious jail-time. Edit: While we're at it, how about 1 year of jail time for every US citizen who has died of opioids made by US pharmas. They can divide that time up however their employees decide is fair.
- hammock 6y ago
  Not patients. Insurance. > she was “shocked” to see a drive-through coronavirus testing site bill her insurance $1,944
  - jacurtis 6y ago
    Yes they bill the insurance $1,944. But the insurance isn't going to pay that. Most of the insurance companies have capped COVID testing at $100. That is what they will cover because that is what the CARE Act requires them to cover. So that person probably got a bill for $1,844 from their insurance because the insurance probably paid $100.
    - garmaine 6y ago
      Insurance doesn't bill the patient.
- jacurtis 6y ago
  I recently had COVID, so I have just gone through all of the stuff in this article. You would be surprised how many "COVID Testing Sites" are scams. Pure scams. Many of them are not even able to bill your insurance, probably because Insurance companies would refuse to pay the fees they are charging for. So you will be paying out of pocket for them. I actually did shop this around, trying to find a legit one. Several of the ones I called charged $400 for a "screening visit" which is basically the person that comes to your car window and asks if you have any COVID symptoms. If you say "yes I have a cough" or you list any other symptom of COVID (which is almost anything) then they will determine that you should get a COVID test. This screening visit is laughable. Many of the people screening you aren't even licensed medical professionals in any way. Even more disgusting, half of them are volunteers. They think they are helping the community and have volunteered. They simply listen for a single symptom and when they hear it then they give you the test. This screening cost ranges from $200 - $600 in my area. But the average was $400. Then they administer the test which can be charged $99 - $299. Many of these "drive up testing sites" that you see advertised are legit scams. They want people to see the sign, pull up in their car, get the test without asking any questions, and they will get a surprise bill of $500 - $1000+ in a few months. The other charge that you often get is a test results charge. Some of these testing sites are charging you for the phone call they make to tell you the test results. So be very wary if you are getting COVID tested. THere are a lot of places out there doing COVID testing that are PURE SCAMS! Good news: there are some legit ones. But you need to really do your research ahead of time. I eventually went and got tested at a testing site that is operated by my state. They are authorized to bill the CARE Act which was the emergency bill that allows for free COVID testing and COVID care. They were also authroized to bill your insurance. They bill insurance a flat $99 fee. And if your insurance doesn't cover it then the CARE Act can cover the rest. So please be careful out there. If you are getting COVID testing, make sure to do some research and go to a legit testing site. Call them and see if they can bill the CARE Act. Even if you have insurance, you want to go to these sites because they are the "official ones". If they are doing it legit enough that the CARE Act covers them, then the insurance companies will also cover tests from that same place. Make sure there are no additional costs for screening or delivering results. If they have any of those costs or are NOT covered by the CARE Act, then run. Those places are likely profiting off the pandemic and will surprise you with expensive bills that your insurance will refuse to cover.
teekert 6y ago
Ah, the American Health Care system. I think we are all starting to learn that indeed, capitalism is great, as long as agents have a choice. In healthcare there often isn't (drug or death is not really a choice, iPhone or Galaxy is). Not great to leave such a market free to optimize for profitability.
- Nbox9 6y ago
  The healthcare system is not a free market. 1. It’s very hard to shop around to find better prices or better service. 2. People often make choices like “Do you want this expensive life saving procedure or not?” 3. The average person isn’t informed enough to understand what their medical treatment needs are. Patients ask doctors what their recommendation is. Doctors often have an incentive to sell the most healthcare they reasonably can. 4. My ability to pay for healthcare is directly tied to my employer. There simply are less jobs that provide good healthcare than people that would like them. My ability to change positions in society is limited by my desire to continue to have access to affordable healthcare. This is practically a freedom limiting mechanism. 5. I’m limited in my choice of which healthcare to purchase based on my Insurance policy. My choice in insurance policy is similar to a suburbanite’s choice in an ISP. I have very few choices.
  - throwaway0a5e 6y ago
    >The average person isn’t informed enough to understand what their medical treatment needs are. The average person isn't informed about anything other than however they make money from 9-5 Consumer ignorance is not an excuse for a crappy market.
    - toomuchtodo 6y ago
      It is the job of regulators to coerce the market, through regulation, into one that is less harmful to consumers. It is unreasonable to expect every consumer to be an expert in every commerce transaction that takes place in their daily lives.
      - 6y ago
alextheparrot 6y ago
> He said the use of the larger test was appropriate because it could catch a wider range of diseases, particularly for those who were symptomatic. [0] Cant’t believe this isn’t an ethics violation, it is like going into the car dealership to change my oil and them charging me to take apart the engine because “It could catch a wider range of issues”. I know what service I want and would consent to, this “Technically correct but costs 50x as much” is harmful. [0] This is the doctor’s response when asked why he is testing for ~20 other respiratory diseases in the drive-through coronavirus line.
- peeters 6y ago
  Yeah that's straight up malpractice. If there's a 99% chance it's Covid and not something else, you do the Covid test first and if that comes back negative, then you test for the "something else" (if symptoms are severe enough).
  - arcticfox 6y ago
    It's even worse than that, he was testing asymptomatic patients with a full panel. That part takes it from probably unethical to full-blown fraud for me. > But in interviews, asymptomatic patients said they had also received the more expensive test.
    - vharuck 6y ago
      For asymptomatic patients, doing those tests could easily cause net harm from follow-up to false positives. So, even if the tests had been free, it's probably unethical. This is why organizations like the United States Preventative Services Task Force exist. They review studies and recommend best practices for medical screening. They do recommend against asymptomatic screening for a lot of tests.
- throwaway0a5e 6y ago
  >it is like going into the car dealership to change my oil and them charging me to take apart the engine because “It could catch a wider range of issues”. This kind of stuff is pretty par for the course. They try and up-sell. If you agree then you're on the hook for the bill. That's just how the industry works. But businesses that make a habit of being sleazy don't survive long because the bill must be agreed upon beforehand and customer is free to go elsewhere with little friction and there isn't all sorts of gatekeeping and regulatory capture constraining supply.
criddell 6y ago
There was a similar story last September. Here's the lede: > Physicians Premier ER charged Dr. Zachary Sussman's insurance $10,984 for his COVID-19 antibody test even though Sussman worked for the chain and knows the testing materials only cost about $8. Even more surprising: The insurer paid in full. https://www.texastribune.org/2020/09/05/austin-texas-coronavirus-test-insurance-emergency-room/ https://www.texastribune.org/2020/09/05/austin-texas-coronav...
- hammock 6y ago
  Do you think we should add some laws or something to protect insurance companies' profits, which are suffering from this type of fraud?
  - gabereiser 6y ago
    Any laws introduced would only tangle the mess called Healthcare even further. Government doesn't know how to administer healthcare (at least in the US) so it defers it to the private sector. Putting caps in place was already done, the issue is pricing transparency is not a thing. The insurance company pill just pay it and amortize it on the claimants group (or however they account for losses). I wish we could fix this broken system. The only way to fix it now is open-heart surgery while driving.
    - fragmede 6y ago
      If the issue is pricing transparency, and that it’s “not a thing”, we could maybe make laws requiring pricing transparency?
      - gabereiser 6y ago
        My memory of ACA may be hazy but I do remember talks of having that as part of the ACA law. Not sure if it made it in (probably not due to lobbyists). I think if insurance carriers had the ability to verify the charges before paying we would see naturalized reform from sheer market power. No one will pay for a $5k thing if the site says it's $350.
ExcavateGrandMa 6y ago
The great WorldWide Hold Up :D "Democracies dies in darkness"
EamonnMR 6y ago
It would be really interesting to see a crowdsourced index of real cost and insurer-paid cost for procedures across the US. Maybe a service that pays patients some nominal sum to share the data, then aggregates it and presents it to patients, journalists, etc.
- threwaway4392 6y ago
  Here is another incentive: When users share their bills and EOB, provide them with an automated analysis of their bills: what seems weird, which billed items were far above average prices, etc. This information can be precious when negotiating with the doctor's office, when Yelp/google-maps reviews, or when contacting your politicians about the absurdity of health care costs.
  - dizzant 6y ago
    This is an excellent idea. Also, sell aggregated data on cost of care in local areas to doctors and insurance companies, so they can make clear business decision on how to compete against the local market.
    - deleted 6y ago
      [deleted]
  - EamonnMR 6y ago
    Though that creates an incentive for the company to not share its own data.
- alexrson 6y ago
  The author of this article, Sara Kliff basically did a smaller version of that for ER visits when she was a reporter at Vox. The reporting did end up affecting policy.
meee 6y ago
This article is confusing. I was excited to see someone using research to bubble up a story. Then the writer puts a doctor on the hot seat with no conclusion in the article for him to refute. Is this a teaser for an article to come? I think a good article would tell us how the insurance providers felt about the charges. Do they disagree with the doctor's assesment? Does this represent fraud? Is he taking advantage of ill defined rules?
- tylerchilds 6y ago
  I enabled JavaScript because I thought the rest of the article needed to load, but it just ends abruptly.
  - mandevil 6y ago
    This is a special behind-the-scenes article describing how the journalist did her work. If you read the article with JS turned on, you would see a link to the original article this is the backstory for: https://www.nytimes.com/2020/11/10/upshot/covid-testing-doctor-fees.html https://www.nytimes.com/2020/11/10/upshot/covid-testing-doct... Published back in November.
    - tylerchilds 6y ago
      this makes so much more sense now, thanks!
- istjohn 6y ago
  > Times Insider explains who we are and what we do, and delivers behind-the-scenes insights into how our journalism comes together. The actual article is: https://www.nytimes.com/2020/11/10/upshot/covid-testing-doctor-fees.html https://www.nytimes.com/2020/11/10/upshot/covid-testing-doct...
  - trulyme 6y ago
    Thank you! The link should be changed, this article actually makes sense.
6gvONxR4sf7o 6y ago
This is a story about a story. Readers sent her bills and she got a story about it. https://www.nytimes.com/2020/11/10/upshot/covid-testing-doctor-fees.html https://www.nytimes.com/2020/11/10/upshot/covid-testing-doct... <—-This is the actual story she wrote.
- arcticfox 6y ago
  Incredible, especially the part about testing asymptomatic patients with a full panel. That's...insane.
- jacurtis 6y ago
  Thank you! I was very confused while reading this because the author never actually got to anything interesting. Just talks about their routine of sorting through other people's medical bills.
IndrekR 6y ago
Just as a reference, in Estonia COVID antibody test costs 13.21€ for the state (14.40€ if you are private person) and PCR test costs 51.81€ for the state (58€ private). This includes PE, sampling and analysis. Most tests are paid for by the state. You may want to take privately funded one if you have no symptoms and want to travel; or are returning from affected area and want to shorten the 10 day isolation requirement to 6 with two sequential negative tests.
- ed25519FUUU 6y ago
  The tests are actually free in the USA. The contention here is about how much these testing sites are charging insurers.
  - ed25519FUUU 6y ago
    I'm not sure why I'm being downvoted. In the United States Covid 19 testing is free with or without insurance. Nobody needs to pay anything for a covid 19 test in the USA, regardless of their residency or insurance status. > The Families First Coronavirus Response Act ensures that COVID-19 testing is free to anyone in the U.S., including the uninsured. https://www.hhs.gov/coronavirus/community-based-testing-sites/index.html https://www.hhs.gov/coronavirus/community-based-testing-site... The issue here is these testing sites were performing more than a covid 19 test and then billing for those tests without a person's consent. > Dr. Murphy wasn’t just billing for coronavirus tests, as his patients thought. He was billing for 20 other respiratory pathogens, too.
    - peytn 6y ago
      As somebody who pays taxes, pays insurance premiums, and owns dollars, I contend that unnecessary medical services are not free.
- mrkwse 6y ago
  Not sure about LFT, but in the UK private PCR tests (required for travelling, professional elite sport etc.) cost between £80-130.
Chromozon 6y ago
Another related issue posted today: https://www.kut.org/covid-19/2021-02-04/covid-19-testing-has-become-a-cash-cow-for-freestanding-ers-in-texas-experts-say-and-its-getting-out-of-control https://www.kut.org/covid-19/2021-02-04/covid-19-testing-has...
legitster 6y ago
"You're never as careful when spending other people's money." I briefly worked in healthcare at a tech startup. The thing you quickly learn is that the market for healthcare is fundamentally broken. You could invent something that saves a patient $10,000 and they will never know. The hospital and doctors won't care about saving money. And the insurance company has no leverage to make them. And it will never make it onto the patient bill in a way that they understand. And as much as doctors and hospitals love to paint insurance as the bad guy, the only reason things like prior authorization is a pain in the ass is because doctors don't actually put in any effort into prescribing generics or really learn how much anything costs. This is highly unusual in most professions: Imagine if your roofer grabbed whatever shingles they liked best and billed you for it after they were up. Now imagine every roofer worked the same way.
- foepys 6y ago
  I'm from Germany and here it's exactly the other way around. Public health insurences (there are over 100, but they are all organized in an umbrella organization) give out licences to doctors to be allowed to practice on publicly insured patients. The doctors get some amount of money they can spent on patient-specific prescriptions, but in general the doctors only prescribe the active ingredient. When the patient goes to the pharmacy to get their prescription, the pharmacy looks up the insurence and hands the patient the medicine that the insurence dictates. A doctor can prescribe a specific medicine but has to pay for it themselves (mostly from the money the insurences previously provided, see above). Insurences check about 10% of all hospital bills and just don't pay what they deem unnecessary. Hospitals are therefore careful not to do things the insurences didn't approve of. There is an open catalog of therapies that the public insurences will definitely pay and how much it may cost, so it's not a secret. They will also push for modern treatments if they reduce recovery time and have less risks. There is a lot more to the system but that's the gist.
  - gumby 6y ago
    Ironically despite the lower cost, the German medical system also provides a wider range of services than are provided in the US. For example my mother in law had an unusual cancer and after her treatments she had a rest spa paid for; once the treatments could no longer help she had in home care. In the US, good luck.
leoedin 6y ago
The full article (https://www.nytimes.com/2020/11/10/upshot/covid-testing-doctor-fees.html https://www.nytimes.com/2020/11/10/upshot/covid-testing-doct...) suggests that this doctor alone has run 60,000 covid tests. Billing $2k a pop. That's $120 million (ok, maybe revenue, but you don't need to skim much off $120 million to be very wealthy). Complete madness.
IG_Semmelweiss 6y ago
for anyone wondering how US healthcare got to where it is today, this is a succinct historical summary in the form of a podcast, by a historian. https://www.econtalk.org/christy-ford-chapin-on-the-evolution-of-the-american-health-care-system/ https://www.econtalk.org/christy-ford-chapin-on-the-evolutio...
aussieguy1234 6y ago
If a solution to this can't be found then rich and poor alike will suffer. Widespread testing is how we got the virus situation in Australia under control. Especially if this situation follows through to the vaccine rollout. Here in Australia both tests are free and the vaccine will also be free
rishabhd 6y ago
This is how much the complete insurance covered hospitalisation & surgery costed for my late father (RF tumour ablation) including tests and medicines. Key thing here in India is that there is no objection in use of generics - in one case, I was looking for a medicine which would cost me around 10 USD for a blister pack, the chemist looked at me and gave a generic one which costed around 2 USD. Hospitals tend to consider tests done at outside labs which may be done at lower cost (case to case basis). Surgeries conducted/ consultations provided on daily basis per doctor vastly outnumber as compared to US. Price breakups are clearly provided (and can be compared easily) and you pay for exact tests or consumables as prescribed. From where I live currently, thanks to the government capping, COVID-19 test costs between 10 USD to 35 USD, you are free to pick where you want it to be conducted and get the same results. edit : added more details
cmollis 6y ago
this is the real reason healthcare costs so much in the US. Clear anti-competitive and monopolistic practices by the hospital/health insurance complex. Obamacare did absolutely nothing about this one issue, other than essentially shifting the cost structures around. The billing is so ridiculous, it's comical. It literally makes no sense.. My son spent 10 days in the hospital a few months ago: total hospital bill 78K. I paid the max out-of-pocket for my Marketplace plan (about 6K). There is no way that the cost was actually 78K.. if it were, then there would be no hospitals, nor would there be any insurance companies. The economics wouldn't allow it. The only other explanation must be a concerted effort by these institutions to shield the actual costs so no one reviews all of the money changing hands behind the scenes. It also explains why these groups fought the Trump administration when it tried to mandate hospital pricing (I was no fan of Trump, but at least he, and the republicans tried). The market will never be able squeeze out these inefficiencies without government intervention.. there are too many moats already in place. It should be noted that specific hospitals/doctors will tell you how much something costs if you ask (and especially if you tell them that you have no health care). I spent a year without health care to discover this and it wasn't because I couldn't pay for it. It was just obvious to me that this was the most egregious example of state-sponsored fleecing of American citizens that I had ever seen.

120 points by prostoalex 6y ago

gok 6y ago

tldr: One doctor is defrauding thousands of people by charging $2000 for a test that costs him nothing, and presumably making millions doing so.

programmertote 6y ago
If people think it's just one doctor/one clinic profiting off from this pandemic, they'd be wrong. I know a couple of people who worked at these COVID testing sites in NYC (area near Columbia University), Brooklyn and in New Jersey for $15/hour. If one wants to work there, s/he doesn't even need to have work permit (because these sites hire foreign medical graduates for cheap labor). One just need to be able to draw blood, if necessary and that's the main requirement to work there. All of these clinics are owned by doctors. I'm 100% sure these clinic owners get reimbursed more than $15 per test from the US government. It is a financial windfall for those entrepreneurial doctors and clinic owners who are willing to ignore proper screening in hiring COVID testers at the sites.
- fragmede 6y ago
  It’s a blood draw, not brain surgery. It sounds like you have problems with a for-profit healthcare system run under capitalism, however.
  - 8bitsrule 6y ago
    Could well be. Many people are saddened by the whole idea of a for-profit healthcare system ... regardless of the politics ... and I'm among them. Health is a Human Right. As for the predatory equity firms that control many of them, I'd be delighted to see them thrown out of the US ... after their owners serve serious jail-time. Edit: While we're at it, how about 1 year of jail time for every US citizen who has died of opioids made by US pharmas. They can divide that time up however their employees decide is fair.
hammock 6y ago
Not patients. Insurance. > she was “shocked” to see a drive-through coronavirus testing site bill her insurance $1,944
- jacurtis 6y ago
  Yes they bill the insurance $1,944. But the insurance isn't going to pay that. Most of the insurance companies have capped COVID testing at $100. That is what they will cover because that is what the CARE Act requires them to cover. So that person probably got a bill for $1,844 from their insurance because the insurance probably paid $100.
  - garmaine 6y ago
    Insurance doesn't bill the patient.
jacurtis 6y ago
I recently had COVID, so I have just gone through all of the stuff in this article. You would be surprised how many "COVID Testing Sites" are scams. Pure scams. Many of them are not even able to bill your insurance, probably because Insurance companies would refuse to pay the fees they are charging for. So you will be paying out of pocket for them. I actually did shop this around, trying to find a legit one. Several of the ones I called charged $400 for a "screening visit" which is basically the person that comes to your car window and asks if you have any COVID symptoms. If you say "yes I have a cough" or you list any other symptom of COVID (which is almost anything) then they will determine that you should get a COVID test. This screening visit is laughable. Many of the people screening you aren't even licensed medical professionals in any way. Even more disgusting, half of them are volunteers. They think they are helping the community and have volunteered. They simply listen for a single symptom and when they hear it then they give you the test. This screening cost ranges from $200 - $600 in my area. But the average was $400. Then they administer the test which can be charged $99 - $299. Many of these "drive up testing sites" that you see advertised are legit scams. They want people to see the sign, pull up in their car, get the test without asking any questions, and they will get a surprise bill of $500 - $1000+ in a few months. The other charge that you often get is a test results charge. Some of these testing sites are charging you for the phone call they make to tell you the test results. So be very wary if you are getting COVID tested. THere are a lot of places out there doing COVID testing that are PURE SCAMS! Good news: there are some legit ones. But you need to really do your research ahead of time. I eventually went and got tested at a testing site that is operated by my state. They are authorized to bill the CARE Act which was the emergency bill that allows for free COVID testing and COVID care. They were also authroized to bill your insurance. They bill insurance a flat $99 fee. And if your insurance doesn't cover it then the CARE Act can cover the rest. So please be careful out there. If you are getting COVID testing, make sure to do some research and go to a legit testing site. Call them and see if they can bill the CARE Act. Even if you have insurance, you want to go to these sites because they are the "official ones". If they are doing it legit enough that the CARE Act covers them, then the insurance companies will also cover tests from that same place. Make sure there are no additional costs for screening or delivering results. If they have any of those costs or are NOT covered by the CARE Act, then run. Those places are likely profiting off the pandemic and will surprise you with expensive bills that your insurance will refuse to cover.

teekert 6y ago

Ah, the American Health Care system. I think we are all starting to learn that indeed, capitalism is great, as long as agents have a choice. In healthcare there often isn't (drug or death is not really a choice, iPhone or Galaxy is). Not great to leave such a market free to optimize for profitability.

Nbox9 6y ago
The healthcare system is not a free market. 1. It’s very hard to shop around to find better prices or better service. 2. People often make choices like “Do you want this expensive life saving procedure or not?” 3. The average person isn’t informed enough to understand what their medical treatment needs are. Patients ask doctors what their recommendation is. Doctors often have an incentive to sell the most healthcare they reasonably can. 4. My ability to pay for healthcare is directly tied to my employer. There simply are less jobs that provide good healthcare than people that would like them. My ability to change positions in society is limited by my desire to continue to have access to affordable healthcare. This is practically a freedom limiting mechanism. 5. I’m limited in my choice of which healthcare to purchase based on my Insurance policy. My choice in insurance policy is similar to a suburbanite’s choice in an ISP. I have very few choices.
- throwaway0a5e 6y ago
  >The average person isn’t informed enough to understand what their medical treatment needs are. The average person isn't informed about anything other than however they make money from 9-5 Consumer ignorance is not an excuse for a crappy market.
  - toomuchtodo 6y ago
    It is the job of regulators to coerce the market, through regulation, into one that is less harmful to consumers. It is unreasonable to expect every consumer to be an expert in every commerce transaction that takes place in their daily lives.
    - 6y ago

alextheparrot 6y ago

> He said the use of the larger test was appropriate because it could catch a wider range of diseases, particularly for those who were symptomatic. [0] Cant’t believe this isn’t an ethics violation, it is like going into the car dealership to change my oil and them charging me to take apart the engine because “It could catch a wider range of issues”. I know what service I want and would consent to, this “Technically correct but costs 50x as much” is harmful. [0] This is the doctor’s response when asked why he is testing for ~20 other respiratory diseases in the drive-through coronavirus line.

peeters 6y ago
Yeah that's straight up malpractice. If there's a 99% chance it's Covid and not something else, you do the Covid test first and if that comes back negative, then you test for the "something else" (if symptoms are severe enough).
- arcticfox 6y ago
  It's even worse than that, he was testing asymptomatic patients with a full panel. That part takes it from probably unethical to full-blown fraud for me. > But in interviews, asymptomatic patients said they had also received the more expensive test.
  - vharuck 6y ago
    For asymptomatic patients, doing those tests could easily cause net harm from follow-up to false positives. So, even if the tests had been free, it's probably unethical. This is why organizations like the United States Preventative Services Task Force exist. They review studies and recommend best practices for medical screening. They do recommend against asymptomatic screening for a lot of tests.
throwaway0a5e 6y ago
>it is like going into the car dealership to change my oil and them charging me to take apart the engine because “It could catch a wider range of issues”. This kind of stuff is pretty par for the course. They try and up-sell. If you agree then you're on the hook for the bill. That's just how the industry works. But businesses that make a habit of being sleazy don't survive long because the bill must be agreed upon beforehand and customer is free to go elsewhere with little friction and there isn't all sorts of gatekeeping and regulatory capture constraining supply.

criddell 6y ago

There was a similar story last September. Here's the lede: > Physicians Premier ER charged Dr. Zachary Sussman's insurance $10,984 for his COVID-19 antibody test even though Sussman worked for the chain and knows the testing materials only cost about $8. Even more surprising: The insurer paid in full. https://www.texastribune.org/2020/09/05/austin-texas-coronavirus-test-insurance-emergency-room/ https://www.texastribune.org/2020/09/05/austin-texas-coronav...

hammock 6y ago
Do you think we should add some laws or something to protect insurance companies' profits, which are suffering from this type of fraud?
- gabereiser 6y ago
  Any laws introduced would only tangle the mess called Healthcare even further. Government doesn't know how to administer healthcare (at least in the US) so it defers it to the private sector. Putting caps in place was already done, the issue is pricing transparency is not a thing. The insurance company pill just pay it and amortize it on the claimants group (or however they account for losses). I wish we could fix this broken system. The only way to fix it now is open-heart surgery while driving.
  - fragmede 6y ago
    If the issue is pricing transparency, and that it’s “not a thing”, we could maybe make laws requiring pricing transparency?
    - gabereiser 6y ago
      My memory of ACA may be hazy but I do remember talks of having that as part of the ACA law. Not sure if it made it in (probably not due to lobbyists). I think if insurance carriers had the ability to verify the charges before paying we would see naturalized reform from sheer market power. No one will pay for a $5k thing if the site says it's $350.

ExcavateGrandMa 6y ago

The great WorldWide Hold Up :D "Democracies dies in darkness"

EamonnMR 6y ago

It would be really interesting to see a crowdsourced index of real cost and insurer-paid cost for procedures across the US. Maybe a service that pays patients some nominal sum to share the data, then aggregates it and presents it to patients, journalists, etc.

threwaway4392 6y ago
Here is another incentive: When users share their bills and EOB, provide them with an automated analysis of their bills: what seems weird, which billed items were far above average prices, etc. This information can be precious when negotiating with the doctor's office, when Yelp/google-maps reviews, or when contacting your politicians about the absurdity of health care costs.
- dizzant 6y ago
  This is an excellent idea. Also, sell aggregated data on cost of care in local areas to doctors and insurance companies, so they can make clear business decision on how to compete against the local market.
  - deleted 6y ago
    [deleted]
- EamonnMR 6y ago
  Though that creates an incentive for the company to not share its own data.
alexrson 6y ago
The author of this article, Sara Kliff basically did a smaller version of that for ER visits when she was a reporter at Vox. The reporting did end up affecting policy.

meee 6y ago

This article is confusing. I was excited to see someone using research to bubble up a story. Then the writer puts a doctor on the hot seat with no conclusion in the article for him to refute. Is this a teaser for an article to come? I think a good article would tell us how the insurance providers felt about the charges. Do they disagree with the doctor's assesment? Does this represent fraud? Is he taking advantage of ill defined rules?

tylerchilds 6y ago
I enabled JavaScript because I thought the rest of the article needed to load, but it just ends abruptly.
- mandevil 6y ago
  This is a special behind-the-scenes article describing how the journalist did her work. If you read the article with JS turned on, you would see a link to the original article this is the backstory for: https://www.nytimes.com/2020/11/10/upshot/covid-testing-doctor-fees.html https://www.nytimes.com/2020/11/10/upshot/covid-testing-doct... Published back in November.
  - tylerchilds 6y ago
    this makes so much more sense now, thanks!
istjohn 6y ago
> Times Insider explains who we are and what we do, and delivers behind-the-scenes insights into how our journalism comes together. The actual article is: https://www.nytimes.com/2020/11/10/upshot/covid-testing-doctor-fees.html https://www.nytimes.com/2020/11/10/upshot/covid-testing-doct...
- trulyme 6y ago
  Thank you! The link should be changed, this article actually makes sense.

6gvONxR4sf7o 6y ago

This is a story about a story. Readers sent her bills and she got a story about it. https://www.nytimes.com/2020/11/10/upshot/covid-testing-doctor-fees.html https://www.nytimes.com/2020/11/10/upshot/covid-testing-doct... <—-This is the actual story she wrote.

arcticfox 6y ago
Incredible, especially the part about testing asymptomatic patients with a full panel. That's...insane.
jacurtis 6y ago
Thank you! I was very confused while reading this because the author never actually got to anything interesting. Just talks about their routine of sorting through other people's medical bills.

IndrekR 6y ago

Just as a reference, in Estonia COVID antibody test costs 13.21€ for the state (14.40€ if you are private person) and PCR test costs 51.81€ for the state (58€ private). This includes PE, sampling and analysis. Most tests are paid for by the state. You may want to take privately funded one if you have no symptoms and want to travel; or are returning from affected area and want to shorten the 10 day isolation requirement to 6 with two sequential negative tests.

ed25519FUUU 6y ago
The tests are actually free in the USA. The contention here is about how much these testing sites are charging insurers.
- ed25519FUUU 6y ago
  I'm not sure why I'm being downvoted. In the United States Covid 19 testing is free with or without insurance. Nobody needs to pay anything for a covid 19 test in the USA, regardless of their residency or insurance status. > The Families First Coronavirus Response Act ensures that COVID-19 testing is free to anyone in the U.S., including the uninsured. https://www.hhs.gov/coronavirus/community-based-testing-sites/index.html https://www.hhs.gov/coronavirus/community-based-testing-site... The issue here is these testing sites were performing more than a covid 19 test and then billing for those tests without a person's consent. > Dr. Murphy wasn’t just billing for coronavirus tests, as his patients thought. He was billing for 20 other respiratory pathogens, too.
  - peytn 6y ago
    As somebody who pays taxes, pays insurance premiums, and owns dollars, I contend that unnecessary medical services are not free.
mrkwse 6y ago
Not sure about LFT, but in the UK private PCR tests (required for travelling, professional elite sport etc.) cost between £80-130.

Chromozon 6y ago

Another related issue posted today: https://www.kut.org/covid-19/2021-02-04/covid-19-testing-has-become-a-cash-cow-for-freestanding-ers-in-texas-experts-say-and-its-getting-out-of-control https://www.kut.org/covid-19/2021-02-04/covid-19-testing-has...

legitster 6y ago

"You're never as careful when spending other people's money." I briefly worked in healthcare at a tech startup. The thing you quickly learn is that the market for healthcare is fundamentally broken. You could invent something that saves a patient $10,000 and they will never know. The hospital and doctors won't care about saving money. And the insurance company has no leverage to make them. And it will never make it onto the patient bill in a way that they understand. And as much as doctors and hospitals love to paint insurance as the bad guy, the only reason things like prior authorization is a pain in the ass is because doctors don't actually put in any effort into prescribing generics or really learn how much anything costs. This is highly unusual in most professions: Imagine if your roofer grabbed whatever shingles they liked best and billed you for it after they were up. Now imagine every roofer worked the same way.

foepys 6y ago
I'm from Germany and here it's exactly the other way around. Public health insurences (there are over 100, but they are all organized in an umbrella organization) give out licences to doctors to be allowed to practice on publicly insured patients. The doctors get some amount of money they can spent on patient-specific prescriptions, but in general the doctors only prescribe the active ingredient. When the patient goes to the pharmacy to get their prescription, the pharmacy looks up the insurence and hands the patient the medicine that the insurence dictates. A doctor can prescribe a specific medicine but has to pay for it themselves (mostly from the money the insurences previously provided, see above). Insurences check about 10% of all hospital bills and just don't pay what they deem unnecessary. Hospitals are therefore careful not to do things the insurences didn't approve of. There is an open catalog of therapies that the public insurences will definitely pay and how much it may cost, so it's not a secret. They will also push for modern treatments if they reduce recovery time and have less risks. There is a lot more to the system but that's the gist.
- gumby 6y ago
  Ironically despite the lower cost, the German medical system also provides a wider range of services than are provided in the US. For example my mother in law had an unusual cancer and after her treatments she had a rest spa paid for; once the treatments could no longer help she had in home care. In the US, good luck.

leoedin 6y ago

The full article (https://www.nytimes.com/2020/11/10/upshot/covid-testing-doctor-fees.html https://www.nytimes.com/2020/11/10/upshot/covid-testing-doct...) suggests that this doctor alone has run 60,000 covid tests. Billing $2k a pop. That's $120 million (ok, maybe revenue, but you don't need to skim much off $120 million to be very wealthy). Complete madness.

IG_Semmelweiss 6y ago

for anyone wondering how US healthcare got to where it is today, this is a succinct historical summary in the form of a podcast, by a historian. https://www.econtalk.org/christy-ford-chapin-on-the-evolution-of-the-american-health-care-system/ https://www.econtalk.org/christy-ford-chapin-on-the-evolutio...

aussieguy1234 6y ago

If a solution to this can't be found then rich and poor alike will suffer. Widespread testing is how we got the virus situation in Australia under control. Especially if this situation follows through to the vaccine rollout. Here in Australia both tests are free and the vaccine will also be free

rishabhd 6y ago

This is how much the complete insurance covered hospitalisation & surgery costed for my late father (RF tumour ablation) including tests and medicines. Key thing here in India is that there is no objection in use of generics - in one case, I was looking for a medicine which would cost me around 10 USD for a blister pack, the chemist looked at me and gave a generic one which costed around 2 USD. Hospitals tend to consider tests done at outside labs which may be done at lower cost (case to case basis). Surgeries conducted/ consultations provided on daily basis per doctor vastly outnumber as compared to US. Price breakups are clearly provided (and can be compared easily) and you pay for exact tests or consumables as prescribed. From where I live currently, thanks to the government capping, COVID-19 test costs between 10 USD to 35 USD, you are free to pick where you want it to be conducted and get the same results. edit : added more details

cmollis 6y ago

this is the real reason healthcare costs so much in the US. Clear anti-competitive and monopolistic practices by the hospital/health insurance complex. Obamacare did absolutely nothing about this one issue, other than essentially shifting the cost structures around. The billing is so ridiculous, it's comical. It literally makes no sense.. My son spent 10 days in the hospital a few months ago: total hospital bill 78K. I paid the max out-of-pocket for my Marketplace plan (about 6K). There is no way that the cost was actually 78K.. if it were, then there would be no hospitals, nor would there be any insurance companies. The economics wouldn't allow it. The only other explanation must be a concerted effort by these institutions to shield the actual costs so no one reviews all of the money changing hands behind the scenes. It also explains why these groups fought the Trump administration when it tried to mandate hospital pricing (I was no fan of Trump, but at least he, and the republicans tried). The market will never be able squeeze out these inefficiencies without government intervention.. there are too many moats already in place. It should be noted that specific hospitals/doctors will tell you how much something costs if you ask (and especially if you tell them that you have no health care). I spent a year without health care to discover this and it wasn't because I couldn't pay for it. It was just obvious to me that this was the most egregious example of state-sponsored fleecing of American citizens that I had ever seen.