This outrage is yet another symbol of the utter brokenness of our healthcare system 😡 Time to stop playing these money games NOW.
$10,000 for a COVID-19 antibody test. By now, many of you guys have seen this article by, in ProPublica, by a reporter that I know personally, Marshall Allen and I spoke with him about this piece, about a pathologist working at a freestanding ER, in Texas who oversaw their COVID-19 antibody testing.
He was on staff to do that and said, you know what? I might as well get a test too. I had a headache recently, maybe I was exposed. So he thought, okay, I’ll go ahead and get my own test that I administer here. And they’ll comp me for it because I’m an employee.
Well, the staff ended up taking down his information, his insurance information, and they were like, don’t worry. You’re not going to pay a dime, right? So he gets a statement after the fact that says, okay, here are the physician charges of 2,000 and some dollars. And the facility and other expense charges for the test of 8,800 coming up to a total of like almost $11,000. Now his insurance company, Golden Rule Insurance or something, it was a short term plan that he purchased in Texas, that’s not Obamacare compliant. So it’s like one of these, it doesn’t have to cover all the stuff right. Covered his antibody test at that $11,000 price point a 100%, no out of pocket cost. Okay. So let’s unpack this.
And as a physician, it’s crazy to me that other physicians and myself would struggle with this. An average person in the country has no chance, no chance against these kinds of bills. Even though the insurance company paid for it. Here’s the punchline. The doctor was like, wait a minute. This test costs $8 in materials. It’s listed on this company, that it was a free standing emergency department that he was working for in Texas. These are for profit entities in Texas, that operated emergency department levels and bill often out of network to insurance companies. And a lot of times those fees are then passed on to patients, right? But they offer convenience and quality and that sort of stuff. That’s their pitch, anyway.
So this is what ended up happening. He said $8 in materials, on the website of the company it says that the test costs like 75 bucks. Medicare normally pays 42 bucks for this test, right? So how, when did it come to $11,000?
Now this pathologist who was a good person said, wait, this is dumb. Even though I’m not paying this out of pocket, what’s going on here? So he calls up the insurance company and says, hey, this is like fraudulent. First of all, when you look at the charges, it says that it was a, you know, a high complexity emergency department visit, this kind of exam was done. None of that was done. It listed billing for a nasal swab test, which wasn’t done. This was a blood test. And so this is just straight fraudulent. Well, what did the insurance company say? Yeah, well, you know, this stuff happens. What can you do? And nothing was escalated.
Now why? Golden Rule Insurance Company is owned by United Health, the largest insurer in the country. They made $6.6 billion in net profits in quarter two of 2020 during COVID. When doctors and nurses and people are losing their jobs, this insurance company made $6.6 billion. Do you think they care about a fraudulent charge for $11,000? If they deny it, then they look like they’re denying care for COVID, which under the CARES Act is illegal. They’re supposed to cover it at at least the level of what their website was listing. No they don’t care. They are terrified because they see the writing on the wall that these money games that the insurance company says, okay, we’ll pay this much. So the doctors bill this much, and then they haggle and they haggle and they haggle until they get to a price that is not transparent, that nobody knows about. That isn’t public. What chance does a patient have to know what their out of pocket bill is? Zero.
Even though this doctor didn’t get charged, the insurance company paid $11,000 for an $8 antibody test that Medicare would pay $42 for. Where do you think that money is coming from? Our premiums. A $3.2 trillion economy, economic albatross around our neck. Yes, there’s fraud. It’s about 10% healthcare experts suspect fraud on the part of doctors. And these are companies let’s be honest. Most doctors are decent, right? These are corporate entities, these freestanding ERs, other companies that engage in something called upcoding, it’s a game. You just go, well, let’s see what we will keep up putting higher and higher complexity codes to squeeze out as much money as we can, because we know the insurance companies are gonna push back. And when they don’t, like in this case, we got lucky, okay, we got a little chunk of money.
And what do the insurance companies do? They spend time and money denying claims that are higher value that are higher sort of return for them. And putting doctors through the hoops of having to prove that they’re doing the right care. Autonomy’s lost, moral injury’s inflicted, ’cause you want to do the right thing for the patient. But some insurance claims person is saying, no, you can’t do that. And this game goes back and forth and back and forth. And who suffers? The patient. The economy.
We’re spending so much money and here’s the best part of this. Antibody tests aren’t even necessary for most patients. See the video I did on this. They’re a waste of time and money because of false positives, false negatives, and the fact that antibodies wane over time. So now what we have is a healthcare system absorbing $11,000 for a test that wasn’t necessary. And when the doctor even complained about and said, you know, this shouldn’t happen. The insurance company did nothing. The company that build the test is just: we deny all the allegations. I mean, this is the game that we play in healthcare. What chance does a patient have?
You know, my child, my nine year old daughter, okay. Was scheduled to have an MRI. All right. We won’t get into the details. I’ll do another show on that. At a local multi-specialty conglomerate that I used to work at. All right, it’s not Stanford. And I knew that this test, because we have high deductible insurance, I have to pay 6,000 bucks before the insurance will pay anything. So before the MRI even happened, I called this corporation’s billing office and a very nice young lady talked to me and said, okay, I understand. I said, well, what’s the price that you charge for this sort of MRI. And this is what she told me. What’s the CPT code for the test you are getting? And I said, if I were a patient, I would be scratching my head as what, what a, you know, certified procedural thing, whatever the CPT stands for is I happen to know as a doctor, what those codes represent, but I didn’t know the code. Well, luckily she was able to look it up because I said, you know, MR, this part of the body, this the da da da da. And she said, okay, are you sure that’s what it is? Yeah, it is. Okay.
So she looks up the CPT code. Okay. That’s $1,600 is what we charge. Okay. So I said, cool. So do you offer a cash discount if I just pay it in cash? ‘Cause I’m going to be paying it to the insurance company anyways, or paying it to you because insurance isn’t going to cover it, it’s under my deductible, right? And she goes, sure. We’ll give you a 30% discount. And I said, oh, that’s a lot. Okay. So how do I go about that? She goes, well, you need to tell us BEFORE the test. And by the way, we don’t 100% know what that test is gonna cost, ’cause they may throw in other stuff at the last minute and it may not be accurate. Oh. And I said, well, okay. I said, well, what if I don’t do that? Well, then we bill your insurance and you have to go through that and you have to, and then there’s no discount. Okay, well then what if I pay now and agree to do it now? Okay, you’ll get a 30% discount, but you can’t use, that money does not go towards your insurance deductible now. So later on, you’re gonna end up paying for it with another procedure. If you get another procedure or something. And I’m like, so this is completely stupid. Is what you’re telling me. Even as a doctor with a high level of critical thinking and working in the industry, I have no idea what to do in that situation.
So I said, let’s just get the test and bill the insurance because I, she couldn’t tell me what the negotiated rate with the insurance company was. For all I know, the insurance company would have sent me a bill that was quite a bit less because of their negotiated rates. But I wouldn’t know that in advance, in no other sector of our economy, do we allow this kind of moronic price gouging nonsense to occur, but we do it in the sector of the economy that’s most sensitive to the human condition, which is healthcare.
How have we allowed this? These money games that spend time and overhead and bureaucracy and red tape? Why do you think there are so many healthcare administrators to every single doctor? Because someone’s got to do this nonsense game. We’ve created an overclass of bureaucrats to administer stuff that has no business being administered to pay for tests that aren’t even necessary. And by the way, that MRI wasn’t really even necessary. I did it because I didn’t want to expose my child to x-rays and know as a doctor, I knew it wasn’t something that I would even advocate for my patients, but I said, I’m willing to pay for this out of pocket for peace of mind. But I knew up front what I was doing. I was like, this is what I want to do.
Do you think patients have that luxury to be able to make those kinds of high level decisions? I barely have it. This is a crime and we sit by complicit. We just sit here and let it happen. And then, and then we wonder why we’re no longer economically competitive. Why we have such a high rate of uninsured and we can’t afford this.
And then people say, well, then the answer is single-payer. If we just have the government pay for it, it’ll solve the problem. How? So that instead of playing money games with an insurer and a for profit motive, the same providers are paying, playing money games with the one insurer, the government and the government is still paying for stuff that doesn’t work or isn’t necessary. You’re codifying with public money, the commons, a broken corrupt non-evidence based system. Why would you do that?
This is what we should do, all right? Prices should be listed on the website of every single health care company. And it should be compared right there with what the Medicare rate is so that you can see, you should know in advance, what you’re gonna pay, or even what the, the highest amount you could pay could be so that you can make decisions. Entities should compete on price, quality, and convenience, and you should cover every single person in the United States with affordable coverage. Whether that’s a government plan competing with private plans, whether it’s private plans, competing for government funds to administer it, I don’t care. But cut out all these bureaucrats, simplify it, make it totally transparent to the patient and do it now. Or what will happen is we’ll have a single payer plan that codifies this mess in amber forever. Because once the bureaucrats get ahold of it, it’s over.
Do it correctly. And it’s gonna require us to stand up and demand it. That’s what this $10,000 COVID antibody test thing really is about. All right. So I want to thank Marshall Allen for the piece that he did. He is really fighting for people’s frontline rights. He’s done pieces on how frontline healthcare workers have been screwed during this pandemic, by the very people that were there to protect them. By the way insurance company, you had one job to make sure you’re administering correct benefits that make sense for patients. And you failed, United. $6.6 billion. That’s what, that’s how you’re rewarded for failure. All right, anyways.
So full transparency. We’re doing full price transparency. How do you think I am get, how do you think I get paid? Do I get paid by for patient care? No, never again. I stopped doing that a little while ago because I didn’t want that conflict of interest. Now I see patients for free as teaching faculty at UNLV. Okay. How do we get funded? We get funded by you. We’re in your pocket. Supporters who subscribe to the show on Facebook, YouTube who pay us via paypal.me/zdoggmd who buy our funny merchandise at supportertribe4lyfe.com or zdoggmd.com click the shop tab. That’s how we’re supported. Now you know. I’m fully transparent with you. We do occasional sponsored shows too. We have ads on our videos, so you know where I’m coming from. Why can’t we be that transparent in medicine? All right guys, share this video. Tell your friends about this, write to your Congress person. Stand up if you’re a healthcare professional and say enough, I’m not spending my time billing and coding. I’m spending my time taking care of patients and we out.