Are clinics cashing in on COVID-19 testing with upfront fees?

While staying in Naples for the winter, Margaret Sheahan and her mother Mary Beth found themselves in a dilemma all too common during 2020: they were exposed to COVID-19 and needed a test before potentially exposing more members of their family.

When they showed up at Well-Being Medical Center they were asked to pay $150 each, upfront, for a test.

“I had asked the woman and she said, Well, we’re having trouble with insurance. So we just charge upfront. And as long as the insurance pays, we refund your money,” Sheahan said.

But she said that’s not what happened.

Documents show that Medicare paid the clinic just $68 of that $150, so that is what Mary Beth was refunded. Margaret Shehan’s insurance documents show a charge of $48 to the clinic, but then she was never refunded any money.

“That’s a warning sign. If you’re being asked to pay for COVID testing. I got red flag, red flag, coming to my mind because you shouldn’t have to,” said WINK News Health Care Hacker Jon Hess with Athos Health.

Hess said this is an example of balance billing and it’s not permitted for COVID testing with Medicare or private insurance.

“Laboratories enrolled in the Medicare program must accept the COVID-19 testing assignment, cannot balance bill the beneficiary and there is no cost-sharing for it,” wrote Carolina Garcia, with the Centers for Medicaid and Medicare Services Press office.

According to Hess, providers that have contracts as an “in-network” provider with insurance companies would be violating their contract by balance billing for a COVI19 test.

“I would file a complaint with your insurance company if this happens to you,” said Hess.

Shehan filed a complaint with Medicare and ended up contacting her bank to reverse the charges when she didn’t receive a refund.

In May, WINK News contacted Well-Being Medical Center to inquire about testing services.  By phone, a representative said they are no longer billing insurance for COVID-19 testing and charging everyone a $70 flat fee which includes patients on Medicare.

Dr. Ricardo Martinez, who owns and operates the clinic, told the Sheahan’s by email that he would not be refunding any money.

After several emails and unreturned phone calls from WINK News, he wrote:

“I am a very busy guy, do not have time for this, I instructed my staff to tell you about this. I do not have to answer any questions, but I will make an exception this time. What they are telling you is just a bunch of lies. 

“They were here vacationing and needing a NEG test to go back home to IL. Faking they were exposed to COVID, when in fact both tests came back NEG. I refunded their insurance companies because testing was NOT medically necessary and both Mary and Margaret are fully financially responsible for services provided by my practice.  Please, do not contact me about this issue anymore.  I hope you have your answer.” 

Margaret Sheahan disputes the claims that the tests were performed for travel purposes. She said her insurance company is in communication with Martinez regarding the situation.

Mary Beth said she has an ongoing complaint with Medicare regarding the situation.

You can schedule a no-cost COVID-19 test if you have commercial insurance or Medicare at most CVS and Walgreen’s locations.  If you are not insured, you can find a state-run test site here or by contacting the Florida Department of Health.

Reporter:Lauren Sweeney
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