TAHP Notes Test Price Gouging is a Dangerous New Trend

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By: TAHP | Thursday, July 30, 2020

By: Jeremy Rogalski

HOUSTON — Some consumers who thought they were getting a simple COVID-19 test instead got a surprise bill charging their insurance company thousands of dollars. The Texas Association of Health Plans called it a dangerous new trend from a small number of providers.

“No Texas patient deserves to be price gouged,” said TAHP CEO Jamie Dudensing.

The industry association represents two dozen health insurance companies in the state covering nearly all of the commercial market. The group said freestanding emergency rooms are often behind the high billings, which include additional fees beyond the test itself.

“They’re charging for the test, for a physician fee of $500 to $1,000 and a facility fee for anywhere from $2,000 to $5,000, just for a cotton swab test for COVID-19,” she said.

Complaints of high fees are part of an inquiry by the U.S. House of Representatives Committee on Energy and Commerce. In a letter to the National Associate of Freestanding Emergency Centers, Chairman Frank Pallone Jr. (D-New Jersey), called the surprise billings “unconscionable and clearly excessive.”

But the Texas Association of Freestanding Emergency Centers said they are bound by state rules that govern what medical services they can provide.

“The state law only currently allows us to provide emergency services in our facility,” said Rhonda Sandel, CEO of Texas Emergency Care in Houston and a board member of the National Association of Freestanding Emergency Centers.

“Although it’s a higher level of care, a much higher level, it’s also much more costly care,” Sandel said.

It’s why freestanding ER’s are seeking rule changes from the Texas Health and Human Services Commission. They have sent a letter to Chief Deputy Executive Commissioner Cecile Young requesting a temporary waiver for the ability to provide non-emergent care during the public health crisis. Those outpatient services are coded at much lower rates.

“If freestandings were allowed to offer COVID testing at outpatient rates, I think it’s a win-win for everybody,” said Dr. Eric McLaughlin with Patients Emergency Room in Baytown.

“We haven’t had an alternate model to bill patients for lower level testing such as we’re seeing now with COVID-19,” he said.

Under the federal CARES Act, freestanding emergency centers must post a list of prices online or provide them in person. If patients do receive a surprise bill after a routine COVID-91 test they did not require any treatment, there should be no out-of-pocket costs. Deductibles and co-pays are waived under the new federal law.

But Dudensing warned that if the trend in billing continues, Texans and Texas employees could be on the hook for more expensive health insurance premiums.

“Just because the health plan is covering the cost right then doesn’t mean that you’re not going to see the cost of total health care go up.”

The Texas Department of Insurance offers tips to avoid unnecessary COVID-19 testing charges here.

To view KHOU-11’s full article, click here.

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