Health & Fitness

“It felt like a deception”: an elite hospital in New York charges high fees for Covid tests

Lenox Hill Hospital in Manhattan advertised its “Covid-19 tests” on a large blue and white banner in front of the Greenwich Village emergency room. The banner said nothing about the cost.

However, cost turned out to be the most notable feature of the test. 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, which is about 30 times the typical cost of the test.

“It was shocking to see a number like this when I was previously tested for about $ 135,” said Ana Roa, who was billed for $ 3,358 for a test at Lenox Hill last month.

Ms. Roa’s coronavirus test bill is among 16 the New York Times checked on the website. They show that Lenox Hill is getting its unusually high prices by charging a high fee for the test itself – about six times the typical fee – and billing the encounter as a “moderately complex” emergency doctor visit.

In one case, a family charged $ 39,314 in 12 test fees this winter to meet return to work or school requirements. In another case, an asymptomatic patient came in because she saw the banner outside and wanted a test after traveling. Her insurance was charged $ 2,963.

Federal legislation last year stipulated that coronavirus tests could be free for patients, so people are usually protected. But ultimately, American patients bear the cost of these expensive tests in the form of higher insurance premiums.

Patient bills show that at least one other hospital in Lenox Hill’s parent group, Northwell Health, charged emergency room fees to patients at a mass test site.

“It felt like a sham and an effort to get money that they weren’t entitled to,” said Ute Tabi. She checked her family’s insurance claims and saw a $ 2,793 charge for a drive-through coronavirus test her husband had received at a Northwell hospital in the suburbs of New York, Huntington Hospital on Long Island.

The Times asked readers to submit bills so we could understand the cost of coronavirus testing and treatment. So far, more than 600 patients have participated. Her bills revealed high fees and illegal fees, as well as patients who have significant medical debt for coronavirus treatment. If you have a bill for coronavirus testing or treatment, you can share it here.

Northwell Health, a not-for-profit organization, operates 23 hospitals in the area and received approximately $ 1.2 billion in funding for emergency healthcare providers under federal CARES law last year.

The chain was recently under scrutiny after The Times announced that it sued more than 2,500 patients over medical debt during the pandemic. It has since dropped those cases.

Northwell, appropriately defending its coronavirus testing fees, has since removed the blue signs in the Greenwich Village section promoting the service.

Officials said patients tested in the emergency room received more advanced care than anywhere else. They declined to comment on specific patient cases, but said their protocols include notifying patients that their test will incur emergency room fees. A label with the information is stuck on a plexiglass label at the registration desk.

“I don’t see the emergency room as a testing site,” said Barbara Osborn, vice president of communications at Northwell.

But Lenox Hill in Greenwich Village tested 15,000 patients for coronavirus over the course of the pandemic. Patients interviewed by The Times said they went outside to not seek emergency care because of the banner. They were asymptomatic and looked for tests as a precaution before traveling or socializing.

Ms. Roa discovered the emergency room fee through an unusual circumstance. Her wallet had been stolen and she was checking her bills. She feared her identity had been stolen because she couldn’t remember going to an emergency room.

“I called my insurance company and freaked out and asked who has my identity, what will this bring,” she said. “After maybe 45 minutes, I was transferred to someone who could tell me it was a Covid test.”

Americans performed about 370 million tests during the pandemic. The price of each – as with most services in the American healthcare system – can vary widely from hospital to hospital or from doctor’s office to doctor.

New York state testing sites do not charge any patient fees or collect health insurance information for the Covid nasal swab tests. A study published last year found that a swab test in a hospital can range from $ 20 to $ 850. Some independent labs charged more and billed $ 2,315.

Updated

March 30, 2021, 12:30 p.m. ET

Lenox Hill Greenwich Village Center charges $ 671 for its coronavirus test, six times what big labs like LabCorp and Quest do. The rest of the price difference comes from the emergency room fees.

Doctors and hospitals that charge higher test prices can rely on new federal protections to ensure they get paid. Congress passed a law last year that obliges insurers to fully cover the cost of coronavirus tests and not to impose co-payments or other fees on patients for the service.

Insurers also have to pay for services required for the coronavirus test, such as: B. a doctor’s visit or, in the case of Lenox Hill, an emergency room fee.

“This is a goldmine for hospitals because they can now charge emergency fees to totally healthy people who just want to be tested,” said Renee Hsia, professor of emergency medicine at the University of California at San Francisco who handles medical billing. “This is what you would expect from a market-driven approach to health care. It is the behavior that our laws have inspired. “

Emergency rooms in the United States typically charge patients what is known as a facility fee, the price of walking in the door and finding care. Fees have risen sharply in recent years and can cost around $ 200 for a simple visit or $ 1,800 for the most complex cases.

Hospitals like Lenox Hill often defend these costs as necessary to comply with federal laws requiring them to care for all patients regardless of solvency.

“When someone is uninsured, we still provide the same level of care as insured people,” said Rich Miller, Northwell’s chief business officer.

Emergency admissions are common in the American system, but rare in the world of coronavirus testing. At the request of the Times, data firm Castlight Health analyzed insurance claims for 1.5 million coronavirus tests.

It has been found that less than 4 percent of coronavirus tests are billed through emergency rooms. The vast majority of these tests come with grand claims that have many charges, suggesting that the nasal swab was associated with a more complex visit.

Only about 5,000 bills out of the sample of 1.5 million – about 0.3 percent – were billed in a manner similar to Lenox Hill’s fees, as the Castlight data shows.

At the Lenox Hill site, Miller explained, there are actually two separate coronavirus testing procedures. Patients arriving with a doctor’s order for a coronavirus test will be directed to a service center that has no emergency room fees.

Patients who enter without this prescription will be sent to the emergency room for evaluation, where they will be charged the facility fee. About 75 percent of coronavirus tests at Lenox Hill Greenwich Village are passed through the emergency room, a practice Mr Miller defended.

“Anyone billed for an emergency room visit would have been assessed to see if there were other things wrong with them,” Miller said. “We believe we are adequately disclosing that this is an emergency room visit and will be billed as an emergency room.”

Lenox Hill was founded in 1857 and has long served a wealthy clientele in its main division on the Upper East Side of Manhattan. Beyoncé was born here in 2012 and is the subject of a Netflix documentary series of the same name that shows the inner workings of the hospital.

In 2010, New York State granted Lenox Hill the right to take over the building in Greenwich Village, which had been vacant due to the closure of St. Vincent’s Hospital. It replaced it with a freestanding emergency room.

It would stay open 24 hours and care for patients regardless of their ability to pay. However, unlike traditional emergency rooms, it is not physically attached to a larger hospital.

Freestanding emergency rooms have increased across the country and in New York City in recent years. Montefiore, Northwell, and NYU-Langone have all opened them up within the last decade.

Supporters have praised them for expanding access to critical care without building an entire hospital, a potential boon for underserved urban and rural areas.

But they have also been criticized for how they handle prices, especially with simple visits. An analysis conducted by health insurer UnitedHealthcare found that the average cost of a visit related to a common condition such as a fever or cough in detached emergency rooms was 19 times higher than in emergency centers.

“Freestanding emergency rooms represent both the best, most innovative side of American healthcare and the pure profit motive,” said Dr. Jeremiah Schuur, chairman of the emergency medicine department at Brown University’s Alpert Medical School.

The awards in Lenox Hill’s detached emergency room caught the attention of local government officials shortly after it opened. The New York Community Board 2, which is responsible for Greenwich Village, held a meeting in 2016 to discuss several cases. One patient was charged $ 1,000 for a bee sting exam and another patient was charged $ 3,000 for a sprained ankle.

Sarah Nathan was not seeking emergency care when she was tested in Lenox Hill Greenwich Village. She only needed one test to get back to work as a kindergarten teacher.

The bill for her visit was $ 3,194 which her insurance company negotiated for $ 2,084. She remembers asking a front desk representative if she would be billed for an emergency room visit. She said she was told she wouldn’t be.

Ms. Nathan is concerned about the impact of these high fees on her premiums.

“My insurance is already so expensive and I am angry that it is increasing the cost for New Yorkers,” she said.

Coronavirus tests were rare at the start of the pandemic, but have grown in number since then, raising questions about why Lenox Hill was promoting tests at this point.

Northwell has an emergency center a 15-minute walk from the Lenox Hill Emergency Room. The emergency center’s fee for a Covid nasal swab test and doctor visit is typically $ 350 – almost 90 percent less.

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