The surprise bill that follows

A KRQE News 13 eight month investigation

ALBUQUERQUE, N.M. (KRQE) – Anyone who has ever tried to decipher a medical bill knows the frustration first hand. Whether an invoice came from your doctor, the hospital, or an insurance company, you have entered the incomprehensible world of health care billing.

KRQE Investigates

Take for example one routine procedure: a COVID-19 test. It takes about five minutes, you get results in a day or two, and the cost is picked up by health insurance. The last thing you expect when you get a COVID-19 test is sticker shock. “In any other industry, you might call that fraudulent. But in health care it’s legal,” says Elisabeth Rosenthal, author of a best-selling book on health care.

“I was stunned. I absolutely could not believe what the charges were,” says a retired health care worker who asked that her name not be disclosed. She got her COVID-19 test at a westside facility called Albuquerque ER & Hospital. A technician there checked her vitals, a doctor asked a few questions, and then sent for the nurse.

“So (the nurse) came in and swabbed me and told me it would be about ten minutes before they got the results. And then she came back and gave me the results,” the retired health care worker said.

So what’s the charge for a routine COVID-19 test at the westside facility? $450 for the test, a $2,265 facility fee, and $1,316 for a chat with the doctor. Albuquerque ER hit up the patient’s insurance company $4,031 for a single COVID test. “It was not right,” the retired health care worker says. She tells KRQE News 13 no one at the facility told her in advance about the test charges.

And she is not alone. KRQE News 13’s investigation finds Albuquerque ER & Hospital routinely charges thousands of dollars for each COVID test it administers.

“This is one of the most egregious cases that I’ve ever heard of,” says Ron Liss, President of the American Patient Right’s Association which advocates for fairness in health care. “That’s called predatory medical billing and they’re actually trying to take advantage by attempting to take as much as they can possibly get,” Liss said.

Albuquerque ER and Hospital maintains it is not urgent care but rather a 24/7 fully equipped emergency room. And because it offers emergency room care it charges emergency room fees. Among its advertised services: around-the-clock COVID-19 testing.

KRQE News 13 asked Elisabeth Rosenthal whether it’s simply bogus to charge four grand for a COVID test? “The answer you will often get about these charges is, well, it’s legal. And that is true. It is legal. Is it right? I would say not,” she said. Elisabeth Rosenthal received her MD from Harvard and reported on medical issues for the New York Times. She is currently Editor in Chief for Kaiser Health News.

“What’s going on here is there’s been a proliferation of what we call free-standing ERs. They sometimes call themselves an Emergency Room,” Rosenthal says. “They look like an Urgent Care center so people often think they’re going into a local Urgent Care center. They’re not told about what bills might be generated and they are notorious for high bills,” Rosenthal said.

Albuquerque ER does not accept Medicare or Medicaid. If you have private health insurance, your insurance company will be invoiced. One state regulator who reviewed Albuquerque ERS’s billing practices says no insurance company is going to pay $4000 for a COVID test. He calls the health care facility’s COVID test charges “way out of line.”

“Unfortunately, there’s no laws or regulations restricting the pricing for these tests as far as limits are concerned. So a medical facility like a freestanding E.R. can charge whatever they want,” says American Patient Right’s Association President Ron Liss.

Albuquerque ER CEO Dr. Sanjay Kholwadwala says billing fees are posted on the faculty website. He says Albuquerque ER charges are comparable to regional emergency rooms. Albuquerque area hospitals say their emergency rooms do not provide COVID testing for walk-ins. Dr. Kholwadwala declined our request for an interview.

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