Debt Collector Dogs ​“Free” Covid Testee

Andrew Warshall has been receiving threatening letters for over a month from a North Carolina-based laboratory conglomerate looking to collect $314 for a ​“free” Covid-19 test at a city-sponsored site in Day Street Park.

The city and the Fairfield County doctor in charge of the Dwight testing operation continue to insist that Warshall won’t have to pay a dime, and that the lab bill will ultimately be dropped. Meanwhile, the debt collection letters keep coming.

Warshall is a 39-year-old Edgewood resident and adjunct professor in mathematics at Southern Connecticut State University.

His experience wrestling with the surprise medical bill after getting tested for Covid-19 in late May illuminates how communication breakdowns and differences of medical opinion among healthcare providers, insurance companies, state regulators, lab companies, and local public health officials can manifest themselves in a hefty charge delivered out of the blue to a patient’s mailbox. All because that patient heeded public health advice and decided to get tested during a pandemic.

It also raises questions about whether or not the current patchwork of city, state and federal regulations do indeed ensure that no one in Connecticut should have to pay out of pocket for a Covid test.

Another question: Is Murphy Medical in particular ordering and billing for more than just Covid tests? Past patients have raised that question. Or are insurance companies being far too stingy, controlling, and narrow in their understanding of what qualifies as a medically-valid component of detecting the novel coronavirus?

“I’m Feeling Cheated”

Since Aug. 15, Warshall has received three letters from LCA Collections, an ​“in-house division” of the North Carolina-headquartered laboratory testing company, LabCorp.

Each of those letters states that Warshall owes an ​“immediate payment” of $314 resulting from his May 26 visit to the Day Street Park testing site run by Murphy Medical Associates. During that visit, he received a nasopharyngeal swab test and an antibody test for Covid-19. (Both results came back negative.)

“It is not our wish to have this matter handled as a collection issue,” reads LCA Collections’ most recent letter, dated Sept. 15. ​“However, if this bill is not satisfied immediately, it will be listed as a severely delinquent account and further collection activities will proceed.”

Warshall told the Independent that the surprise medical bill’s dollar amount, while unwelcome, is not in an of itself so distressing to him. He can pay $314 if he needs to.

What has so upset him is that he received the bill at all, considering how the city and Murphy Medical Associates have promoted the Day Street Park testing site since its inception in late April as completely cost-free for patients. Regardless of whether or not they are sick. Regardless of whether or not they have insurance.

Indeed, the city’s contract with Murphy, signed on July 6 and effective March 30, clearly states that ​“no balance invoice or ​‘co-pay’ shall be required of patient” for those tested at Day Street Park or at any of Murphy’s other pop-up Covid-19 testing sites around the city.

Murphy isn’t the only testing option in town. Fair Haven Community Health Care, Cornell Scott Hill Health Center, and Yale New Haven Health all provide Covid tests. Murphy’s is unique because of the doctor’s contract with the city.

“I’m feeling cheated,” Warshall said. ​“Like, it’s dishonest. This was not the way they said it would be.” Although he can afford the bill, he said, there are plenty of people in this city who cannot.

Warshall said he wasn’t feeling sick at the time that he got tested. But he had had a fever in late April, quarantined for two weeks, and decided to visit Murphy’s Day Street Park clinic in late May after hearing from a friend that the city was promoting free tests at that site.

“I certainly have no plans to pay it,” he said about the LabCorp bill. If LCA Collections takes him to small claims court? So be it.

City, Murphy Advice: Don’t Pay

When reached for comment about Warshall’s case, city Health Director Maritza Bond, Greenwich-based Dr. Steven Murphy, and Mayor Justin Elicker all said that Warshall should not and will not have to pay the LabCorp bill.

“Clearly this is not what any of us want to be happening,” Elicker said. ​“We want to make sure that there are no barriers to people getting tested.” That includes no surprise bills from North Carolina labs and subsequent threats of debt collection.

“Dr. Murphy has a responsibility to ensure that he follows through with his commitment. The city is representing to the public, and it is our agreement with Dr. Murphy, that nobody get charged for Covid tests that are given at the site.”

Murphy, who runs the Day Street Park site as well as Covid-19 testing sites in Stratford, Stamford, Greenwich, Darien, Bridgeport, and Bedford Hills, N.Y., slammed Warshall’s insurance company, Connecticare, for refusing to cover the full cost of the lab work his clinic ordered as part of Warshall’s antibody test. He also said that LabCorp, which Murphy’s clinic often sends patient blood samples to for processing, should not have sent the bill to Warshall.

He committed to speaking directly with a LabCorp vice president about dropping the charge.

“Mr. Warshall will have no costs, that’s a guarantee on my part,” he said. ​“One thing is for certain: Mr. Warshall shall not pay anything whatsoever.”

Murphy later told the Independent that he had spoken with senior management at LabCorp and that ​“the claim is under reprocessing with the insurance company, and I’m certain the resolution will turn in Mr. Warshall’s favor.”

Bond agreed that Warshall should not have to pay any of the LabCorp bill. She said that her advice to Warshall — and to any other New Haveners who receive surprise medical bills after getting tested for Covid-19 by Murphy Medical Associates — is to reach out to Murphy’s customer care rep so his clinic can rectify the charges.

“You can’t control if a third party sends a bill,” Bond said about LabCorp. What the city and Murphy can and must do, she said, is improve its communication to the public so that if someone receives a bill related to getting tested for Covid-19 at Murphy’s clinic, that patient should not pay it and should instead work with Murphy to make sure the bill disappears.

Bond said that the city is also no longer actively promoting cost-free antibody tests at Murphy’s local testing site, because insurance companies appear to cover less of the associated lab work.

She said the city is still encouraging residents to go to the Day Street Park site to get cost-free PCR tests — that is, the nasal swab that lets patients know if they currently have and are infectious with Covid-19. Antibody tests let a patient know if they have had Covid-19 at some point in the past several months.

While Murphy and Bond expressed that Warshall’s bill will ultimately be dropped, a spokesperson from LabCorp — the company seeking to collect the debt in the first place — offered a different take.

LabCorp’s Kelly Smith Aceituno said that the outstanding balance that was not covered by Connecticare and that is owed by Warshall following his visit to Murphy Medical is not related to a Covid test.

“The COVID-19 tests were fully covered by the patient’s insurance,” she wrote. ​“On the same day, another test was ordered and performed in addition to the COVID-19 tests, and insurance coverage was declined for that test.”

To Test Or Not To Test … For Procalcitonin

So how much did Warshall’s insurance cover? For what services?

And why was ​“another test,” purportedly unrelated to Warshall’s intention to get tested for Covid-19 at Day Street Park, ordered by Murphy Medical Associates that day?

According to the explanation of benefits that Connecticare sent to Warshall following his May 26 visit, Murphy and LabCorp billed the insurance company a total of $1,244 across seven different claims associated with the nasal swab test and the antibody test.

Connecticare paid a total of $218.30 of of what was billed, including parts of six of the seven different claims. The insurance company refused to pay any part of one of those claims — a $314 claim submitted by LabCorp.

A June 30 bill sent by LabCorp to Warshall clarified that that un-covered $314 claim is for Murphy’s test for something call procalcitonin, ​“a 116-amino acid residue” used as a ​“biomarker” to detect systemic, severe bacterial infections.

A Connecticare spokesperson, Kim Kann, told the Independent that the insurance company does cover all Covid-19 testing and related office or telehealth visits at no cost to their members.

“The medical efficacy of Procalcitonin (PCT) laboratory testing is not proven for most conditions,” she wrote. ​“We encourage our members to take advantage of the appeal rights they have as ConnectiCare members.”

(On Thursday morning, Warshall told the Independent that someone from Connecticare had just called him directly and offered to put in an appeal of the denial on his behalf.)

In a Wednesday afternoon interview with the Independent, Murphy said that testing for procalcitonin is a well-established approach for looking for ​“bacterial superinfections,” and is a useful and medically sound means of predicting the relative severity of Covid-19 cases.

He said Connecticare should have covered that blood work the first time around, and that he’s confident they will ultimately pay it upon appeal.

Murphy said the reason he sends blood samples taken at Day Street Park to LabCorp at all rather than using his own lab that he’s set up in North Stamford is that Connecticare has a ​“physician office laboratory exclusion. They won’t pay for services rendered by physicians that include laboratories.”

So in order to increase the likelihood of reimbursement for Covid-19-related blood sample testing, he outsources that work to LabCorp. He criticized the practice as ​“insurance companies directing healthcare.”

Murphy added that the types of surprise bill that Warshall received from LabCorp are unfortunately all too common in American healthcare today. If a patient goes to a hospital for treatment, he said, that patient sometimes receives separate bills from the hospital, the physician, and an independent lab.

Murphy said that LabCorp sending Warshall a $314 bill for a test ordered by his Day Street Park site is not in and of itself a direct violation of his agreement with the city. That’s because Murphy Medical Associates, which is a signatory to the agreement, didn’t send the bill. LabCorp did — even though it was for work ordered by Murphy. ​“Murpy Medical did not send that bill. Murphy Medical will never send that bill,” he said.

Contract parsing aside, Murphy said he would personally intervene to make sure Warshall doesn’t have to pay.

“No one should be sending bills to these patients,” he said. ​“If you get a bill, don’t pay it.” Appeal it to the insurance company instead, and reach out to Murphy’s office.

Murphy said he’s been reimbursed for only around 10 percent of the total claims he’s sent to insurance companies related to Covid-19 tests his clinic has done in New Haven. Bond said that Murphy’s clinic has also conducted around 1,000 tests for local uninsured patients — tests that Murphy, per the contract with the city, cannot collect any money on.

The Fairfield County doctor said that his reading of the governor’s executive orders during the pandemic leads him to believe that no patient should have to pay anything out of pocket for Covid-19 test-related costs that are not covered by insurance. Those protections alone, he said, should ensure that Warshall and other patients who received surprise bills like the one from LabCorp should not have to pay.

Test Coverage For All?

Should anyone have to pay any amount to get tested for Covid-19?

According to the state Insurance Department’s reading of federal law, the answer to that last question is: No. Kind of.

In response to a series of questions submitted by email for this article, state Insurance Department Life & Health Division Director Paul Lombardo is quoted as saying in an email response that the Federal Families First Coronavirus Response Act, or FFCRA, requires self-funded health plans ​“to cover COVID-19 testing with no out-of-pocket costs.”

And yet, a bill to a patient may arise, as evidenced by the procalcitonin debate outlined above, when a medical provider and/or lab company disagree with an insurance company as to whether or not a particular medical intervention appropriately falls under the header of ​“Covid-19 testing.” 

“The Department has not received many complaints on COVID testing claims not being covered,” Lombardo continued. ​“We ask all policyholders to check with their insurance companies first to confirm covered benefits and for assistance in finding COVID testing centers.”

He also said that the state Insurance Department’s March 9 Bulletin No. IC-39 is still in effect. That bulletin, which can be read in full here, calls on all health insurance companies and health care centers authorized to conduct business in Connecticut to waive cost-sharing for Covid-19 testing.

“In order to ensure that cost-sharing is not a barrier to testing for COVID-19, health insurers and health care centers are encouraged to waive any cost-sharing related to COVID-19 laboratory tests,” the bulletin reads.

Lombardo said that the Department has received a total of two Covid-related complaints from Connecticare members over the course of the pandemic. One was ​“a coding error and has been resolved,” he said. The other is still under review.

When asked if Connecticare abides by this state directive, the insurance company’s spokesperson said that it does, and directed the Independent to a Covid-19 FAQ. That online document tells Connecticare members, for the duration of the public health emergency, ​“Your test and visit to diagnose COVID-19 (whether in-person or a virtual telehealth visit) will be covered by your plan. There will be no cost-sharing, including copays, coinsurance, or deductibles.”

Sue Halpin, a lobbyist on behalf of the state’s health insurance industry, said that Connecticut’s carriers routinely cover Covid testing without any cost sharing or co-pays passed along to patients.

“Since the inception of the pandemic, health plans have covered millions of COVID services across the country without question,” she wrote by email.

“However, some services being provided at testing sites are unrelated to the diagnosis of COVID and seemingly inappropriate. From a public policy perspective, it’s important that carriers assure that care being provided is necessary and not simply an attempt to maximize provider reimbursement. Carriers will continue to review claims accordingly.”