ST. LOUIS (KMOV.com) -- Testing for COVID-19 remains a critical tool in fighting against it but now some local doctors' offices are facing a difficult choice: whether to turn down testing for some patients because of the insurance card in their wallet.

At A to Z Pediatrics in the Metro East, they conduct drive-up COVID-19 tests for dozens of sick kids every single day.

“They should be making it easier for medical professionals right now, to save everyone else from the pandemic,” said Dr. Jean Wagner. But instead, Wagner says one insurance company hasn't been playing fair. “I am really upset, I am upset for my patients, my families, my staff. I should not have to be that stressed right now about something that small."

Wagner says one COVID test costs them $34.38. That doesn't include the cost of PPE or staff time to administer it. Like every doctor's office, they then submit bills to the patient's insurance, expecting reimbursement.

“Every other insurance company, including Medicaid and TriCare, which is what the military uses, is paying us 51.31 cents, for every test that we do,” Wagner said.

But Wagner says there's only one exception: United Healthcare.

“When we were getting our bills back from UHC, we were only getting $30.59,” she said. That means that on every single test they give, they're actually losing money. “So we eat it,” she said.

It’s a difference of only about four dollars, but Wagner says at a small practice like theirs, the lost revenue is adding up by the thousands.

“We are not looking to make a profit, we just need to get the cost covered of every test so we don't lose money,” said Wagner.

“When we get paid less than what I even paid for a test, that's quite a big hit, every dollar counts,” said Dr. Joe Cangas, who has practices in both Missouri and Illinois. He, too, is feeling the pinch. “I am sure they are looking for any way they can to save a dollar and it just effects the little guy like me."

While most insurance plans, he says, are reimbursing full costs of the test and then some for supplies and staff, UHC is not. An article in the New York Times earlier this month also detailed accounts from doctors all over the country dealing with the same issue.

"We spend hours on hold and switch to different people and they say someone is going to call back and its not much of a response," said Cangas. Both doctors say they have gotten few answers from the insurance company.

Wagner says she was told simply to tell her patients to go elsewhere.

“Which we found completely unacceptable to us and to our patients. All that is doing is putting up a barrier between my kid and getting back to school or sports or whatever it is they need to do," Wagner said.

Federal coronavirus regulations prohibit the doctors from passing on the extra costs to their patients, something they say they don't want to do anyway. One doctor in the St. Louis area told News 4 because of this situation, they just simply stopped offering tests altogether for patients carrying United Healthcare insurance cards.

“I want to see them adapt more quickly when they are in a situation like this, talk to the providers see what the tests cost and help us pay our bills,” Cangas said.

News 4 put in a request to speak with a representative from United Healthcare on-camera. Instead, we received a statement from a spokesperson:

“The rates we pay for rapid COVID tests follow applicable requirements of the CAREs Act and what others in the market are paying, with average rates in the $40-$50 range. When paying new codes, including those created for the testing or treatment of COVID, we honor our provider contracts, which generally refer to industry sources to set an appropriate market price. Of course, we work hard to make sure every member has access to testing. We encourage any providers with payment questions to contact us.”

But doctors, overwhelmed with treating sick patients, say they just wanted United Healthcare to live up to its name and work with them to fight COVID-19. A spokesperson for UHC said they would reach out to those doctors directly. United Healthcare has reported increased profits, earning $15.4 billion in profit in 2020, compared to $13.8 billion in 2019. Part of that, they say, is from people delaying elective procedures due to the pandemic.

Have an issue you want us to dig into? Email us at Investigates@kmov.com.

Copyright 2021 KMOV (Meredith Corporation). All rights reserved

Locations

Recommended for you

(0) comments

Welcome to the discussion.

Keep it Clean. Please avoid obscene, vulgar, lewd, racist or sexually-oriented language.
PLEASE TURN OFF YOUR CAPS LOCK.
Don't Threaten. Threats of harming another person will not be tolerated.
Be Truthful. Don't knowingly lie about anyone or anything.
Be Nice. No racism, sexism or any sort of -ism that is degrading to another person.
Be Proactive. Use the 'Report' link on each comment to let us know of abusive posts.
Share with Us. We'd love to hear eyewitness accounts, the history behind an article.