It was nine days before Thanksgiving, and I received the dreaded phone call saying that some of my immediate family members had been in close contact with a person who was COVID-19 positive.  My mind began to race thinking about the people we may have been indirectly exposed to the virus based on where we had been the past three days (school, extracurricular activities, the car repair shop).  Then I started worrying that we would all be really sick in a few days.  The nurse at my children’s school provided us with testing cards to have the kids tested free of charge through the county.  We were lucky that the lines were not too bad and we were fortunate to receive our negative test results within a few days.  

Then the day before Thanksgiving, my youngest two children began showing multiple symptoms of COVID-19.  I called their pediatrician, an in-network provider, who suggested they come and be checked out.  After an initial evaluation, it was determined it would be best to test them for both COVID-19 and Streptococcus.  I was told it would be about 24 hours and we would know the results.  Thankfully, again we tested negative for both COVID-19 and Streptococcus, we just had a “regular virus”.  We finished out our quarantine, and the kids were able to return to school after the Thanksgiving weekend.

Just this week, I received two letters in the mail from the laboratory company that processed my children’s COVID-19 test administered by the pediatrician.  It read that payment was not sent to them directly, and I needed to send them the Explanation of Benefits (EOB) provided by my insurance company.  Now to start the detective work….I hadn’t received the EOB yet.  I got online to look up to see what I could find under our account.  Sure enough - I found the lab EOBs.  It showed something I hadn’t seen before, a scanned check for $100 per child written out to my husband, and then it showed that we would owe the lab a total of $250 per test.  At first I was really confused because we had already met our family deductible so we should have been covered for the lab work.  When I did some more research, what I realized was that our IN-NETWORK provider sent the lab work out to an OUT-OF-NETWORK lab.  It now left us with a $250 bill for each test (a total of $500), with an insurance reimbursement of $100 each (a total of $200).  Suddenly these “free COVID” tests are $300 out of pocket.  Only two out of the six of our family were tested that day, but this would have easily been a $900 bill without being any the wiser.  

I had fallen into the “surprise medical bill” trap that was discussed extensively during this last election.  Every other lab test we had previously taken at our pediatrician’s office had been to an in-network lab and this had never been a problem.  To be honest, I didn’t think twice about getting the tests done there because I knew we had met our deductible, and frankly my kids were running fevers after an exposure to the COVID-19 pandemic virus...an out-of-network lab was not on my radar that day.  

It should have been on the provider's mind though.  In this day and age, my account in their system includes all of my insurance information.  I don’t understand 1) how they could not have already known about this problem; 2) when they are inputting the test into their system, why it doesn’t alert them to an out-of-network laboratory; and 3) why they didn’t provide me with that information, so I could decide whether or not to go ahead with the tests.  At least, I could have made an informed decision to either pay for the convenience of doing the tests there; or I could have chosen to “shop around” until I could find something that would have been covered.

I don’t understand why the healthcare industry is exempt from being transparent on how much the costs of their services are going to be.  I understand that until they evaluate a patient it is near impossible to tell exactly what the patient is going to need (and an emergency situation you may not have the time).  However, the same can be said of a home renovation.  The difference is in a home renovation an estimate is still given and usually you are quoted a contingent amount in case they uncover something unexpected.  You generally aren’t just left to rip open your home with absolutely no clue how much it may cost.   The same approach could be done in healthcare.  A fee for the evaluation, and then an explanation of how much they think each service will cost that they are suggesting (tests, vaccinations, procedure, etc).  

It is time to expect more from our health care industry.

The Future is Bright,

Amy