A Long Island hospital is coming under fire for sending Covid testing bills as high as $1,931 to multiple members of the community.
Scott Nadboy received bills of $1,720 each for his family of four, both times the family got tested for a ski trip to Maine, at St. Francis Hospital & Heart Center in Roslyn, Long Island.
Manny Gillis, 50, who lives in Port Washington and works in sales, went to get tested in February. He said in a Zoom interview that his bill was $1,545 for the emergency room and $175 for lab charges, though he only had a check of his heart rate, blood pressure and temperature.
A spreadsheet on the pricing transparency page for the hospital lists the cash price for this test at $100. Yet multiple patients were asked to pay 15 times that price.
The bills were first reported by Nina Pineda and 7 On Your Side, at WABC-TV, the New York ABC affiliate.
Billed for $1,931, reduced to $1,910.25
Pam Sorin, another person who went to St. Francis, sent her explanation of benefits (see top screenshot). It shows total charges of $1,931, for an emergency room visit at $1,756, and two charges for “microbiology/bacteriology lab,” one at $75 and one at $100. The “allowed amount” — the figure the insurance company allows for this procedure — is $1,756.
The insurer paid nothing. The explanation of benefits she sent to us from her insurer has a note “ER visit not considered sudden or serious, please submit hospital records.” The hospital then followed up with a bill for $1,910.25 (see lower screenshot).
Sorin, 47, a a food stylist and medical office bookkeeper who lives in Port Washington, wrote in an email: “My insurance didn’t pay it because it’s less than my deductible so that means I am responsible… I am happy to send you a copy of the EOB if you want to see it. Outrageous!”
Most of the patients said the tests were done in an outdoor tent, not in the actual emergency room. Most said they received verbal commitments from the hospital that they would not be charged, or felt that they knew that testing is free of charge from past experiences.
The Families First Act, which was amended by the Coronavirus Aid Relief and Economic Security Act, requires private insurers to pay for Covid testing and related charges without cost to the insured person. This is supposed to include any services during a visit related to Covid testing. This is supposed to be true until the public health emergency ends. President Biden issued an order on Jan. 21 again stating that Covid tests should be covered without payment from the patient. Insurers are not supposed to apply medical screening criteria to impose costs on patients, the guidance says.
The experts: Should be free in most cases. The hospital: Not so much
We asked Niall Brennan, president and CEO of the Health Care Cost Institute, a nonprofit research institute on health costs using data from four health insurance and data companies, if testing is free to the patient. He wrote in an email: “Mostly yes, but there is some ambiguity if the testing is not because the patient thinks they have COVID and is instead to fulfill a return to work protocol. My sense is the vast majority of tests are being covered by insurers but I could be wrong.”
Under current rules, the insurer is supposed to pay only what is listed on its site as the testing cost, right? He wrote, “Yes, although that hasn’t stopped unscrupulous providers from billing 5, 10, 15k for a COVID test.” Has he heard of hospitals adding an emergency room charge to a test charge? “Unfortunately yes – the practice is rampant in TX in particular,” he wrote.
A hospital spokesman sent an email with comments defending the practice that he said could be attributed to Dr. Charles Lucore, president of St. Francis Hospital & Heart Center.
He replied, “According to pandemic legislation, patients should not be responsible for any out-of-pocket expenses for these services. If however, a billing issue arises, we are committed to investigate the charges and will attempt to rectify the issue with the insurance carrier. … We are reviewing our billing practices to avoid any potential confusion in the future.”
We asked how patients could be billed for an emergency room visit if they never see an emergency room.
He replied that the tent where the testing took place is “an extension of the emergency room.” “For infection prevention purposes, we have extended our Emergency Department into an adjacent tent fully staffed with physicians, nurses, and medical equipment,” he said. “This carefully separates those who may have been exposed to COVID or who are presenting with COVID symptoms from other patients.”
We asked what insurers’ responses have been, since the people we talked to said their insurers were not paying. The response: “Some insurance companies have recognized their error in adding this to the patient’s deductible and reversed the charges.”
‘Any patient at the emergency department needs a complete evaluation’
We asked why an emergency visit was necessary. The response: “We are obligated from a quality, safety, regulatory and liability perspective to provide complete evaluations to our emergency department for any services, including COVID related and testing. Any patient that presents to an Emergency Department needs to receive a complete evaluation. We have found patients requesting Covid testing who are having heart attacks, respiratory failure and other ailments that require immediate attention and services.”
We queried again, saying that the patients thought they were going to a Covid testing spot, and that most Covid testing places do not do a full evaluation and charge for it. They hospital did not respond.
Susan Null, medical bill advocate at Systemedic, Inc., in New City, N.Y., wrote in an email interview: “Covid testing and treatment, as long as it is billed correctly, should not have any cost share associated with it for people with fully funded health plans. People who have self-funded plans might have to share in the costs. The employer, who funds the plan, makes the decision about whether or not they are waiving the cost-sharing responsibilities. For people without insurance, there is supposed to be a government fund that providers can submit their charges to, for reimbursement.”
She added that in her understanding, the insurer pays its “allowed amount” or “negotiated amount,” while the cash price on the website is for self-pay patients, that is, those who choose to pay cash.
About high emergency room bills, she wrote: “I’ve heard a lot of controversy over these types of ERs in Texas. Connecticut had some drive-through testing locations and they were charging for all types of add-on services including [personal protective equipment]. Apparently in Texas there is a price gouging law on the books to combat exorbitant billing. I have heard that many complaints have been made to the attorney general’s office but apparently very few cases are investigated. I have only heard this, I don’t know it from experience.” Of course, New York also has a surprise and emergency billing law, but it does not seem to be observed or enforced in some puzzling examples.
“The issue is with the coding of these services,” Null wrote. “If a visit or a service is not coded with a Covid-related diagnosis, then the cost-sharing waivers don’t hold. So an ER could bill the primary diagnosis as shortness of breath and the patient would be subject to cost share. If that same visit had been coded with the primary diagnosis of Covid-19, there would have been no cost-share. Apparently a number of hospitals have been hurt by this because a patient will come to the hospital and will be diagnosed with symptoms but not Covid until later on. If Covid isn’t the primary diagnosis, then the hospital will not be made whole by the government plan.”
Pam Sorin said her hospital bill showed that the insurer paid nothing. None of the other people we talked to could tell us what their insurance company had paid. Several said they thought the insurance company should not pay for an emergency room visit, because the Covid test at most locations does not involve emergency-room-type activities.
‘Free of charge’
Janet Mermel described her experiences in an email.
“I brought my entire family to be tested for covid last week. We didn’t have symptoms but were required by my kids’ school to get tested in order for them to return. As we were also traveling the following week (we are currently away), we decided to get tested as an extra safety measure before getting on a plane.
“I called St Francis in advance to ask about their covid testing center. They replied that it was free of charge, usually quick and easy, and located in a tent beside the emergency room. There was no mention of entering the ER, or charging it as an ER visit, nor did they ask me if any of us had Covid symptoms.
“When we arrived, no one was inside either tent. We waited for a while until a nurse directed us into the vestibule just in front of the ER,” she wrote. They were instructed to sit, then a nurse took their temperatures and measured oxygen levels and blood pressure, and gave them bracelets with ID numbers, then sent them to one of the tents, where they were swabbed.
“A few days later my friend told me she hoped I had not gone to St Francis for testing. Why, I asked. She said that there was a very long thread on FB of parents complaining that they had received ER bills for their “free” covid test.
“I called St Francis to alert them that I won’t be paying such arbitrary bills. First two representatives in medical billing simply hung up on me. I begged the third not to hang up, then explained the situation. She calmly listened and told me that this was, in fact, an ER visit. I again explained that it was a covid test with zero symptoms, and directing us to ER nurses is using up resources that should only be available to patients with acute symptoms. She said, ‘perfectly healthy people walk into the ER everyday.’ I was stunned. She told me there was nothing she could do as it was perfectly reasonable to bill our visit as an ER visit and that our insurance would probably take care of it.
“I am so disgusted with the opportunistic way that St Francis is misappropriating their emergency room resources and abusing the necessity for covid testing. They are taking advantage of innocent people and insurance companies to cash in on a pandemic.”
‘A way to up the charge’
Gillis said in a phone interview that he’d gone in for the test without his insurance card, but was told it didn’t matter. “They always take your vitals for some reason,” he said. “I feel like all these places, are doing it as a way to up the charge that they’re sending to the insurance company. They take your heart rate, your blood pressure and your temperature. I can’t imagine what your blood pressure and your heart rate has to do with COVID — maybe the temperature check but otherwise? And they did give me the bracelet, as if I was a patient, which I was surprised about. So that stood out to me a little bit.
“So just recently, I got the bill. I opened it. And I was like, ‘You’ve got to be kidding me.’ So I called them up. And I gave him my insurance information. And I haven’t heard back from them.”
He said he was not satisfied with the hospital’s explanation, as reported on WABC, that the bill was not for him, but for his insurance company.
“Even if I’m not paying for it, I felt like my insurance company shouldn’t be paying for it either,” he said. “I could have gone to the urgent care locally — it just happened to be the place we chose to go.”
Heather Gillis, Manny’s wife, said the reason they went to St. Francis was because no appointment was necessary. She also said the local Port Washington Facebook page was in flames about the topic of St. Francis Covid test billing. She quoted a conversation there where another woman described the bill as “exorbitant.” “The hospital saw an opportunity to monetize a situation and figured that people wouldn’t care if they said was only billing their insurance,” she said.
Manny Gillis said he had spoken with a representative from his insurance company, Fidelis Care, and they said they would look into the matter as “potential fraud.”
St. Francis not alone
Other hospitals, too, are adding emergency room charges. Lenox Hill Hospital in New York City, part of the Northwell system, charged as much as $3,358, according to an article in The New York Times.
“Lenox Hill, one of the city’s oldest and best-known hospitals, repeatedly billed patients more than $3,000 for the routine nasal swab test, about 30 times the test’s typical cost,” Sarah Kliff, the reporter, wrote.
“’It was shocking to see a number like that, when I’ve gotten tested before for about $135,’ said Ana Roa, who was billed $3,358 for a test at Lenox Hill last month.
“Ms. Roa’s coronavirus test bill is among 16 that The New York Times reviewed from the site. They show that Lenox Hill arrives at its unusually high prices by charging a large fee for the test itself — about six times the typical charge — and by billing the encounter as a ‘moderately complex’ emergency room visit.”
‘They were so pleasant and convenient’
Referring to St. Francis, Scott Nadboy said, “They were so pleasant and so convenient and so easy about it. We went Jan. 4. And then we went back again in February, because there’s such a pleasant experience. And now I feel like a total fool, obviously, because of the billing situation.”
He called the hospital, he said, and “The lady on the phone with St. Francis Catholic services, whatever, just basically said, don’t worry about it, we’ll work it out with the insurance company.”
He said, “I know it affects my premiums in the end. Are the insurance companies actually paying this? Or are they fighting? And also, how many people have just paid because they get a bill and they pay it — they don’t even look at it?
“I’ve been down this route before, and the whole thing is just Pandora’s box. Honestly, it’s no surprise that they’re charging astronomical sums. So the insurance companies can justify their astronomical premiums and their astronomical profit. It’s like a never-ending cycle. ”