When Jaden Janak learned he had been exposed toshortly after his 75-year-old grandmother died from the virus last year, he knew what he had to do. He went to the hospital for a rapid test that he thought would be free.
He was wrong. Several months later, the Texas resident received two bills totaling over $4,000.
“I felt very angry. I felt deceived,” Janak told CBS News’ consumer investigative correspondent Anna Werner.
Janak is not alone. Althoughare supposed to be covered under most circumstances, some people have been getting large and confusing bills, including some for hundreds or even thousands of dollars.
The first bill Janak received was for about $2,700, covering the emergency room and lab fees. He later received a doctor’s bill for some $1,300.
His insurance provider, BlueCross BlueShield of Texas, told him not to worry because it would send him a check for those bills, he said. It eventually did send him a check that he used to pay the Tulsa ER & Hospital, Janak said.
But unbeknownst to him, a second check the insurer sent him never arrived, he said, leaving him fighting the hospital’s bill and getting collection calls for nearly a year. BlueCross BlueShield of Texas said they sent it to the address they had on file but it was returned to them because Janak had moved.
The hospital told CBS News it will accept whatever money Janak’s insurance company sends him and that once they get it, he won’t owe anything more.
“What if this happens to someone else and they do truly believe that they are personally liable for these charges? How are they going to be able to make ends meet given where the economy is?” Janak said.
Barry and Jaime Constanzo of Myrtle Beach, South Carolina, had a similar experience in September. They were planning to visit their grandchildren when they developed what they thought might be coronavirus symptoms and went to the only location they say had rapid tests available that day: Conway Medical Center. Their results were negative, but they did get the bills — totaling some $570 after their insurance paid.
“They tell you you’re negative, then they ask you why you’re here, and then they look in your ears, nose and mouth, and the next thing you know, you get a bill, non-COVID related,” Barry Constanzo said.
Conway Medical Center told CBS News the Costanzos went to the wrong place — to the hospital’s “emergency department triage tent” — and that if they wanted a free COVID-19 test, they should have gone to “the free drive-through testing.”
Since they were technically at the emergency room, Conway Medical Center said it was “legally bound to medically evaluate, treat, and discharge” them. In this case, it was for allergies — treatment the couple said they didn’t ask for.
“Why would I go to a hospital or to any testing site for COVID if I was there for allergies?” Jaime Constanzo said.
Examples like those are cropping up even though a law passed last year requires insurance companies to cover tests and any associated treatments, said professor Sabrina Corlette, founder and co-director of the Center on Health Insurance Reforms at Georgetown University.
“Part of it is because our health care system is very complicated and confusing,” she said.
Corlette saidare supposed to be covered 100% by insurance companies, but she has been hearing of some providers tacking on certain fees, sometimes called “facility fees” or “emergency room fees.”
“If you get a physical exam or they say, ‘Well, let’s test you for flu or other things as well,’ all of that visit is supposed to be covered by the insurer,” she said.
It turns out that’s exactly what happened to the Costanzos. They were each charged $771 for an emergency room fee, which their insurer would not pay in full, leaving them jointly with bills of about $570.
The Costanzos are appealing their bill.
They now have some advice to anyone seeking to get tested for coronavirus.
“If at all possible, don’t go to the hospital. Go to the pharmacy,” Jaime Constanzo said.
The couple’s insurance company, BlueChoice HealthPlan of South Carolina, did not respond to repeated requests for comment.
Janak’s insurance, BlueCross BlueShield of Texas, said it’s reissuing the second check he needs. Officials at Tulsa ER & Hospital told CBS News they’ve since changed their processes with BlueCross BlueShield to take patients out of the middle, and payments now go directly to the hospital. They say they follow “all pertaining laws and regulations.”
The Contanzos gave their permission for Conway Medical Center to discuss their care with CBS News. The center shared the following statement about the case:
“Conway Medical Center has free COVID-19 drive-through testing offered 7 days a week from 8am – 4pm. If a patient comes to our Emergency Department requesting just COVID-19 testing, they are referred to the free drive-through testing. If the patient presents with symptoms requesting and/or requiring other care, as was the case for the Costanzos, we are legally bound to medically evaluate, treat, and discharge that patient in our Emergency Department. They are seen by a provider in the Emergency Department and are billed accordingly.”
“The day the Costanzos were seen in the Emergency Department, CMC provided 358 free COVID-19 tests in our drive-through testing. Since we started this testing option on August 23, 2021, CMC has provided more than 15,000 free COVID-19 tests.”
Tulsa ER & Hospital also issued a statement:
“Tulsa ER & Hospital […], along with all emergency rooms in America, are required by the U.S. Emergency Medical Treatment and Active Labor Act (EMTALA) to provide a medical screening exam (MSE) on patients to determine if an emergency medical condition exists. If a condition is determined to exist, we are also required to treat and stabilize the patient. The MSE, treatment, and stabilization are provided regardless of a patient’s financial ability to pay. When a patient has insurance, Tulsa ER & Hospital […] (is) legally required to bill the visit as an emergency room visit, and insurance companies are required to pay, at a minimum, the in-network rate.”
“Up until April 1st 2021, the largest payer in the region (BlueCross BlueShield), provided payment directly to patients for care in our independent, physician-owned ERs and micro-hospitals. We prefer a dynamic where we negotiate directly with insurance providers, to take the burden off the patient. This has been corrected.”
“…Tulsa ER & Hospital… do not balance bill — meaning they will not bill the patient for charges above the adjusted rates set by insurance policies.”
This story is part of the “CBS Mornings” series “Medical Price Roulette,” in collaboration with the journalism transparency company ClearHealthCosts.