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CityMD unleashes wave of surprise bills for COVID-19 tests
By
Caroline Lewis
Published Sep 12, 2022
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By
Caroline Lewis
Published Sep 12, 2022
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Over the course of the pandemic, many New Yorkers and New Jerseyans flocked to the nearest CityMD to get a COVID-19 test whenever they started to feel sick or wanted to be safe before visiting family. But some of those who braved the long lines at the urgent care chain earlier in the pandemic are now getting billed hundreds of dollars for a service they thought would be free.
CityMD patients have taken to Twitter this summer to decry the recent charges, some of which are for tests that took place as far back as 2020. Some say they are specifically being billed for an “office visit” associated with a COVID-19 test, rather than the test itself.
It’s unclear how many people are affected by the charges, but CityMD has become ubiquitous in the New York City area, with more than 135 locations across the five boroughs and Long Island as well as in Westchester and Rockland counties and New Jersey.
One of those hit by the “office visit” charge was Paige Perry, an Astoria resident who said she received a $300 bill from CityMD last month.
“At first when I got the email, I was like, ‘Is this a scam?” Perry said. “I didn't know for sure if it was actually from CityMD because I hadn't been in forever.”
Upon closer examination, Perry saw that the bill was for a visit on Dec. 16, 2020, when she remembers getting tested before flying home to Texas to see her family for the holidays. An insurance statement Perry shared with Gothamist shows that CityMD first billed the $300 to her health plan, Independence Blue Cross, but the company declined to pay.
A separate insurance statement shows that Independence had already paid LabCorp $100 for a testing service on the same date. Independence did not respond to inquiries from Gothamist about why it didn’t also pay the office visit fee charged by CityMD.
Other private health care providers are now seeking payments from patients after failing to get the full amount they’re requesting from insurers. The Manhattan-based testing company Medbar, which set up shop in pharmacies and other locations during the pandemic, has also been hitting patients with belated charges for COVID-19 testing that it said the customers’ health plans refused to cover.
Since reporting on the charges in July, Gothamist has received more emails from people who say the company is still sending out bills for tests conducted months prior.
Aren’t tests supposed to be free?
Perry said a representative for Independence Blue Cross, which is based in Pennsylvania, told her she should not be responsible for the unpaid balance – but it’s unclear whether CityMD will agree. She is still in the process of contesting the bill with the urgent care company.
According to Joy Lee-Calio, a spokesperson for CityMD, the company held off on billing patients for services related to COVID-19 between March 2020 and June 2022 “as we worked closely with insurance companies and monitored rapidly changing guidelines.”
Then, on June 23, CityMD said it started releasing COVID bills “based on feedback we received from insurance plans.”
On June 23, CityMD said it started releasing COVID bills “based on feedback we received from insurance plans.”
Early in the pandemic, the federal government sought to make COVID-19 tests free for patients under the Families First Coronavirus Response Act and the CARES Act. The laws required a patient’s insurance to cover the full cost of a test without any copays or other out-of-pocket fees.
But, according to health insurance experts who spoke to Gothamist, if a health plan declines to pay the full amount, the testing provider is not always barred from billing the patient for the difference – a practice known as “balance billing.”
Loren Adler, associate director of the USC-Brookings Schaeffer Initiative for Health Policy, said there are situations “where patients are still getting trapped in the middle” of billing disputes between health care providers and their insurers.
He added that there has been some confusion among health care providers and insurers over compliance with the federal rules around COVID testing coverage.
The rules limiting patient cost sharing remain in place until the federal public health emergency around COVID-19 expires in mid-October — after that, patient fees for tests could become more common.
Getting fees waived
In Perry’s case, her insurance statement on the $300 charge indicates that “no allowance is being made for this service due to an agreement with the provider. Based on this agreement, the member is not responsible for this charge.”
Gothamist reached out to Perry’s insurer, Independence Blue Cross, for clarification on its arrangement with CityMD. Independence did not respond to that question. But Donna Farrell, a spokesperson for the company, said in a statement, “Independence Blue Cross covers the cost for medically appropriate diagnostic and antibody testing of COVID ordered by an authorized health care professional at no cost to the member.”
We are working to ensure Ms. Perry does not get another bill for her December COVID test.
Donna Farrell, Independence Blue Cross spokesperson
Farrell went on to state that patients who have an issue with a charge should contact Independence, and it will reach out to the health care provider to resolve the issue. According to Perry, when she first reached out to Independence they told her to contest the charge with CityMD and did not offer to contact the urgent care chain on her behalf.
After Gothamist reached out to Independence, Perry said another representative got in touch with her and told her they would handle it.
“We are working to ensure Ms. Perry does not get another bill for her December COVID test,” Farrell said.
Some who have received COVID testing bills from CityMD say they were able to get the charges waived. Journalist Nick Pinto tweeted on July 1 that he had received a bill for $400 for two COVID tests.
A week later, he posted a follow-up. “When my insurance finally got CityMD on the phone, it got them to back down on their classification of those COVID tests and to resubmit the bills in such a way that I won't have to pay anything,” Pinto tweeted on July 7.
But CityMD is not making any guarantees when it comes to the cost of future tests.
“Copayments on commercially insured patients for COVID-19-related visits will not be collected at the time of service but depending on their insurance plan and their specific benefits they could receive a balance post discharge,” Lee-Calio said in her statement.
Gothamist learned from multiple patients while reporting on MedBar that the state attorney general’s office was investigating the company’s billing practices, although the attorney general did not confirm that an investigation was underway. The attorney general also did not respond to a request for comment on whether it is investigating the practice of balance-billing by CityMD.
The state Department of Financial Services, which oversees insurance plans, said it is investigating some complaints about charges related to COVID-19 tests.
Tagged
testing
COVID-19
new york city
health care bill
citymd
health care
health
Caroline Lewis
Caroline Lewis is on the health care beat for WNYC and Gothamist. She has covered COVID, a nurses' strike, the overdose crisis and New York’s marijuana legalization effort, and spent a year investigating patients' medical bills. She always wants to hear about how everyday New Yorkers experience the health system. Got a tip? Email [email protected].
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Gothamist is funded by sponsors and member donations
Gothamist is funded by sponsors and member donations
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