WAUKESHA — On Aug. 3, 2020, Joe Burke of Waukesha had a sore throat and some body aches. Around the same time, one of his good friends who he was around, was sick too and was going to get a COVID test. Burke did the same.
He said he first visited a CVS for a COVID-19 test, but with an upcoming vacation, he wanted results fast. So, he decided to go to urgent care in Oconomowoc.
"Obviously I thought it was important. I have two young daughters," said Burke.
"With my symptoms, they felt it was best to give me the COVID test," he explained.
Burke says medical staff at that Aurora urgent care clinic encouraged him to stay home.
"Quarantine yourself for fourteen days. The test will come back, but until then, you have to be proactive and protect yourself and protect your family. The entire visit was COVID related," Burke continued.
Two days later, his COVID results came back negative. Then, a bill arrived in the mail from Aurora. It was for $267.88 for the urgent care visit.
"I was just about to pay it, but the more I thought about it, I was pretty sure that was covered under the CARES Act," Burke said.
Burke is right. The CARES Act requires health insurance plans cover testing needed to detect or diagnose COVID-19.
Burke learned his provider billed him using the medical codes for "pain unspecified" and for "acute pharyngitis" or a sore throat, even though he says his visit was strictly for a COVID test.
"In my mind, you would think that this is just a common bill. There's a bunch of people going in for these tests. The coding should be pretty repetitive," Burke said.
The I-Team reached out to both Aurora and Burke's insurance company, UnitedHealthcare. Here's Aurora's full statement:
We provide COVID-19 testing to our communities at specific community testing locations with no out-of-pocket cost to the patient. In our urgent care settings, patients are first evaluated by a provider who determines if they need to be tested for COVID-19. Patients’ insurance may be billed for costs associated with that evaluation and visit. Insurance will be billed for the test as well, however, the patient would not get an out of pocket expense associated with the test. We strive to communicate this to patients visiting our urgent care clinics. Patients unsure how their insurance handles claims for office visits should contact their insurance provider. While we cannot comment on the specifics of any patient’s care or billing, it is our practice to work with patients regarding these types of complaints in an attempt to resolve their concerns. -- LeeAnn Betz, Media Relations Manager, Public Affairs & Marketing, Advocate Aurora Health
Here's the full statement we received from UnitedHealthcare:
UnitedHealthcare is waiving cost-share for COVID testing, as we did for Mr. Burke’s July 29 test. He reached out to us on September 1 regarding a subsequent visit to a different medical group. These tests were not coded for COVID. Following that discussion, we reviewed the claim and waived cost share for these tests and office visit, as well. We encourage members to call us if they have questions so we may help resolve their claims.-- Maria Gordon Shydlo, Communications Director, UnitedHealthcare
"Could you have done anything differently or would you have done anything differently?" the I-Team's Kristin Byrne asked Burke.
"No. I don't think so. Like I said it was pretty cut and dry," he said.
"When you get a medical bill, you really expect it to be accurate," Burke said.
If you find yourself in a situation where you get sick and need a COVID test, patient advocates, like Sadie Tuescher with Wisconsin Health Insurance Advocate, LLC provided the I-Team with the below advice:
"The best thing patients can do is 1. Clearly state they think they have COVID and not guess that it might be something else," Tuescher said.
"And 2. When there is such a bill received, check the EOB (explanation of benefits) and make sure the service code looks correct. If it's not, do not agree to pay the bill until it's been corrected," she said.
Consumers who are still struggling to get a COVID medical bill resolved can reach out to Wisconsin Health Insurance Advocate, LLC at 414-797-3408.
Or contact an advocate with Patient Care Partners LLC and ask for a free consult.