Insurers are caught with the massive payments from Lenox Hill, however the public finally pays by increased premiums.

Sarah Kliff


The Lenox Hill Greenwich Village emergency department, where patients have been charged extraordinarily high prices for coronavirus tests. This photo was taken in mid-March; the blue parts of the signs advertising coronavirus testing have since been removed.
Credit…Steven Molina Contreras for The New York Times

Lenox Hill Hospital in Manhattan marketed its “Covid-19 Testing” on a big blue and white banner outdoors its Greenwich Village division’s emergency room. The banner mentioned nothing about price.

But price turned out to be the testing’s most noteworthy function. Lenox Hill, one of many metropolis’s oldest and best-known hospitals, repeatedly billed sufferers greater than $3,000 for the routine nasal swab check, about 30 instances the check’s typical price.

“It was shocking to see a number like that, when I’ve gotten tested before for about $135,” mentioned Ana Roa, who was billed $3,358 for a check at Lenox Hill final month.

Ms. Roa’s coronavirus check invoice is amongst 16 that The New York Times reviewed from the positioning. They present that Lenox Hill arrives at its unusually excessive costs by charging a big price for the check itself — about six instances the standard cost — and by billing the encounter as a “moderately complex” emergency room go to.

In one case, a household accrued $39,314 in expenses for 12 checks this winter, all taken to meet necessities for returning to work or college. In one other, an asymptomatic affected person walked in as a result of she noticed the banner outdoors and wished a check after touring. Her insurance coverage was charged $2,963.

Federal laws final yr mandated that coronavirus testing be free for sufferers, so people are sometimes protected. None of the sufferers examined on the Lenox Hill emergency room have been billed immediately for the service. But ultimately, American sufferers bear the prices of those costly checks within the type of increased insurance coverage premiums.

Patient payments present that at the very least one extra hospital owned by Lenox Hill’s mother or father group, Northwell Health, has charged emergency room charges to sufferers at a mass testing website.

“It felt like deception, and an effort to try and get money that they are not entitled to,” mentioned Ute Tabi. She was reviewing her household’s insurance coverage claims and noticed a $2,793 cost for a drive-through coronavirus check her husband acquired at a Northwell hospital within the New York suburbs, Huntington Hospital on Long Island. The hospital pursued the household for a share of the invoice, which Ms. Tabi has thus far refused to pay.

The Times has been asking readers to submit payments in order that we are able to perceive the prices of coronavirus testing and remedy. So far, greater than 600 sufferers have participated. Their payments have revealed excessive expenses and unlawful charges, in addition to sufferers who face substantial medical debt for coronavirus remedy. If you’ve gotten a invoice for coronavirus testing or remedy, you possibly can share it right here.

Northwell Health, a nonprofit, operates 23 hospitals within the area, and acquired about $1.2 billion in emergency well being supplier funding within the federal CARES Act final yr.

The chain not too long ago got here underneath scrutiny after The Times revealed it had sued greater than 2,500 sufferers for medical debt through the pandemic. It has since dropped these circumstances.

Northwell, which defended its coronavirus testing expenses as acceptable, has since eliminated the blue indicators on the Greenwich Village division promoting the service.

Officials mentioned sufferers examined on the emergency room acquired extra superior care than they might elsewhere. They declined to touch upon particular affected person circumstances however mentioned their protocols contain notifying sufferers that their check will include emergency room charges. An indication with the knowledge is taped to a plexiglass defend on the registration desk.

“I don’t think of the emergency room as a testing site,” mentioned Barbara Osborn, Northwell’s vp for communications.

But the Lenox Hill in Greenwich Village has examined 15,000 sufferers for coronavirus over the course of the pandemic. Patients interviewed by The Times mentioned they went there due to the banner outdoors, to not search emergency care. They have been asymptomatic and looking for checks as a precaution earlier than touring or socializing.

Ms. Roa noticed the emergency room price by an uncommon circumstance. Her pockets had been stolen, and she or he was checking her payments. She feared her id had been stolen as a result of she had no reminiscence of visiting an emergency room.

“I called my insurance and was freaking out, asking who has my identity, what will this bring,” she mentioned. “After maybe 45 minutes, I got transferred to someone who was able to tell me that this was all about a Covid test.”

Americans have taken about 370 million checks through the pandemic. The worth of every — as with most providers within the American well being system — can differ broadly from one hospital or physician’s workplace to a different.

State-run testing websites in New York don’t cost sufferers or acquire medical health insurance info for the coronavirus nasal swab checks. A research revealed final yr discovered {that a} swab check at a hospital can run from $20 to $850. Some impartial laboratories have charged extra, billing $2,315.

The Lenox Hill Greenwich Village heart payments $671 for its coronavirus check, six instances what main labs similar to LabCorp and Quest cost. The remainder of the worth discrepancy comes from the emergency room charges.

Doctors and hospitals that invoice increased costs for testing can depend on new federal protections to make sure they’re paid. Congress handed a regulation final yr that requires insurers to completely cowl coronavirus testing prices and never apply any affected person co-payments or different charges to the service.

Insurers should additionally pay for providers which can be mandatory to acquire the coronavirus check, similar to a physician’s go to or, within the case of Lenox Hill, an emergency room facility price.

“This is such a gold mine for hospitals because now they can charge emergency fees for completely healthy people that just want to be tested,” mentioned Renee Hsia, a professor of emergency medication on the University of California, San Francisco, who researches medical billing. “This is what you’d expect from a market-oriented approach to health care. It’s the behavior our laws have incentivized.”

Emergency rooms within the United States sometimes cost sufferers one thing referred to as a facility price, the worth of strolling by the door and looking for care. The charges have risen sharply lately, and may price about $200 for a easy go to or $1,800 for essentially the most advanced circumstances.

Hospitals like Lenox Hill usually defend these prices as mandatory to meet federal legal guidelines that require them take care of all sufferers no matter their skill to pay.

“If someone does not have insurance, we still provide the same level of care as we would to someone who has insurance,” mentioned Rich Miller, Northwell’s chief enterprise officer.

Emergency room charges are frequent within the American system however uncommon on the earth of coronavirus testing. At The Times’s request, the information agency Castlight Health analyzed insurance coverage claims for 1.5 million coronavirus checks.

It discovered that lower than 4 p.c of coronavirus checks are billed by emergency departments. The overwhelming majority of these checks are related to massive claims which have many expenses, suggesting the nasal swab was incidental to a extra advanced go to.

Only about 5,000 payments out of the pattern of 1.5 million — about 0.3 p.c — have been billed in a method that appeared much like Lenox Hill’s charges, the Castlight knowledge reveals.

At the Lenox Hill website, Mr. Miller defined, there are literally two separate coronavirus testing processes. Patients who arrive with a physician’s order for a coronavirus check are routed to a service heart that doesn’t cost emergency room charges.

Patients who are available with out that prescription are despatched to the emergency room for an analysis, the place they’ll incur the power price expenses. About 75 p.c of coronavirus checks at Lenox Hill Greenwich Village are routed by the emergency room, a observe Mr. Miller defended.

“Anyone who would have been billed for an emergency room visit would have been assessed accordingly to see if other things were wrong with them,” Mr. Miller mentioned. “We believe we’re adequately disclosing that this is an emergency department visit, and will be billed as E.R.”

Founded in 1857, Lenox Hill has lengthy served a rich clientele at its essential division on the Upper East Side of Manhattan. It is the place Beyoncé gave start in 2012, and is the topic of an eponymous Netflix documentary sequence that reveals the hospital’s inside workings.

In 2010, New York State awarded Lenox Hill the rights to take over the Greenwich Village constructing left empty by the closing of St. Vincent’s Hospital. It changed it with a free-standing emergency room.

It would keep open 24 hours and supply care to sufferers no matter their skill to pay. But in contrast to conventional emergency rooms, it isn’t bodily hooked up to a bigger hospital.

Free-standing emergency rooms have proliferated lately, throughout the nation and throughout New York City. Montefiore, Northwell and N.Y.U.-Langone have all opened them inside the final decade.

Supporters have praised them for increasing crucial care entry with out constructing a whole hospital, a possible boon to underserved city and rural areas.

But they’ve additionally confronted criticism for a way they worth care, particularly for easy visits. One evaluation performed by the well being insurer UnitedHealthcare discovered that the typical price for a go to associated to a standard situation like a fever or cough was 19 instances increased in free-standing emergency rooms than in pressing care facilities.

“Free-standing emergency departments simultaneously represent the best, innovative side of American health care and the pure profit motive,” mentioned Dr. Jeremiah Schuur, chair of the emergency medication division at Brown University’s Alpert Medical School.

The costs at Lenox Hill’s free-standing emergency room caught the attention of native authorities officers shortly after it opened. New York City’s Community Board 2, which has jurisdiction over Greenwich Village, held a gathering in 2016 to debate a number of circumstances. One affected person was charged $1,000 to have a bee sting checked out, and one other confronted charges of $3,000 associated to a sprained ankle.

Sarah Nathan was not in search of emergency-level care when she was examined at Lenox Hill Greenwich Village. She simply wanted a check to return to her job as a nursery college instructor.

The invoice for her go to got here to $3,194, which her insurance coverage negotiated all the way down to $2,084. She remembers asking a entrance desk consultant whether or not she can be billed for an emergency room go to. She mentioned she was informed she wouldn’t be.

Ms. Nathan worries concerning the impression these excessive charges might have on her premiums.

“My insurance is so expensive already, and it infuriates me that they’re adding to the cost of that for New Yorkers,” she mentioned.

Coronavirus checks have been scarce firstly of the pandemic, however have since grow to be plentiful, elevating questions on why Lenox Hill marketed testing at this website.

Northwell owns an pressing care heart that could be a 15-minute stroll from the Lenox Hill emergency room. The pressing care heart’s cost for a coronavirus nasal swab check and physician go to normally involves $350 — practically 90 p.c much less.