Covid-Free? We’ll Tell You Next Week

I got a swab stuck up my nose for 15 seconds at Day Street Park — and didn’t find out until a week later that I was negative for Covid-19.

The Fairfield County doctor in charge of the operation billed my insurance company over $1,900 for the ​“visit.”

My experience is not unique among New Haveners who have received a Covid-19 test at one of the local sites run by the Greenwich-based doctors group, Murphy Medical Associates.

Since late April, the Fairfield County-based outfit, led by Steven Murphy, has partnered with the city to provide free, walk-up coronavirus testing in Dwight, on the Green, and at pop-ups in Newhallville, the Hill, and elsewhere.

His business is booming. He has 100 workers at three related companies doing Covid-19 testing-related work in Stratford, Stamford, Greenwich, Darien, Bridgeport, and Bedford Hills, N.Y., in addition to New Haven. He recently hired 25 more people after receiving a contract with New York City’s housing authority.

Patients can show up with no appointment and no symptoms at his New Haven sites, and get tested within a matter of minutes — no insurance or out-of-pocket payments required.

The city has encouraged people to make use of the service, especially as businesses reopen.

But while the service is reaping the doctor big billings, the participants — at least, those who ultimately test negative — often wait so long for results that they have little if any use.

I’ve been tested twice at the Day Street Park site in Dwight: once in early May, and once in late July. Both times, I had to wait at least seven days before learning that my polymerase chain reaction (PCR) nasal swab test — the one that involves a nylon-tipped stick stuck up your nose to find out if you currently have Covid-19 — had come back negative.

By the time the results came, I had no idea whether I had contracted the virus since the test. And in between, I didn’t have an answer that would have let me know whether to quarantine or whether it was relatively safe to be out in the community.

The first time around, my insurance company was billed $1,906 for the visit, and wound up paying Murphy Medical $833.

After this most recent nose-stick test, my insurance company has gotten a bill for $364 so far — with much more likely on the way. My insurance company also got billed $84.26 for an antibody test, which I had not gotten in May but went for in July.

Four New Haveners who spoke with the Independent for this story all described experiences similar to my own: Getting swabbed. Not hearing back from Murphy Medical for at least a week. And then receiving an ​“explanation of benefits” from their insurance companies outlining a wide range of claims, worth between $76 to well over $1,800, related to the single nose-stick visit.

Everyone interviewed for this article ultimately tested negative for Covid-19, and no one had to pay any amount out of pocket — to Murphy or to their insurance company — to cover the cost of the test.

The long waits are not unique to New Haven. Overwhelmed labs across the country are experiencing delays of five to seven to 10 days at a time in turning around Covid-19 results. That has sparked outrage and confusion about whether to stay quarantined or risk infecting others at work and social gatherings. Patients across the country are also reporting surprisingly high bills submitted by healthcare providers to insurance companies for Covid-19 tests that are being treated on paper like full healthcare visits.

New Haveners interviewed for this story pointed to Murphy Medical as providing similar delays, and frustrations, closer to home.

Medical Care’s Not ​“Chick-Fil‑A”

Murphy told the Independent in phone interviews Thursday afternoon and Friday morning that the insurance claims his company submits are so high because he provides a more comprehensive medical assessment than takes place at most Covid-19 testing sites.

“Covid is not just a test,” he said. ​“I think that’s a very big oversimplification. I think we would be better as healthcare providers explaining that Covid is a disease that needs to be managed, that needs to be checked on.”

He also said he has been reimbursed for only a small fraction of the cost of the 5,286 tests his outfit has conducted in New Haven over the past three-plus months.

He said he has spent hundreds of thousands of dollars on testing supplies, personnel, and his own lab and test processing set up in North Stamford. And he claimed that his tests are accurate more than 90 percent of the time.

As for the delays, Murphy said that his doctor’s group prioritizes getting back to every patient who tests positive within 24 to 36 hours of being tested. That can leave patients who test negative not finding out until three to five business days later — or, in some cases, even longer.

“We’re doing medical care. We’re giving people a medical diagnosis,” Murphy said. ​“Medical care is not Chick-Fil‑A. We evaluate you and make sure you do not need to be sent to the hospital. … We’re not Labcorp or Quest. You’re not going to just get a test,” but rather something closer to a full doctor’s visit.

By contrast, in a Friday morning virtual press conference, top Yale New Haven Health administrators said that results from their in-house tests are turned around to patients within 12 to 24 hours 95 percent of the time.

“A Little Bit Of An Anxiety Attack”

The New Haveners interviewed for this story said that they were not expecting — and did not receive — comprehensive medical care when they went to get a nylon-tipped swab stuck up their nose on the Green or at Day Street Park.

They wanted to know if they had Covid-19. And they had to wait days and days to find out the results.

“If they perhaps needed seven to 14 days for results based on being overwhelmed, then just tell people that,” said one New Havener, who asked to remain anonymous for this story, and who got tested at Day Street Park in mid-May.

He said he didn’t receive his results for a week and a half. ​“I am not sick currently but if I was, I would be so stressed out,” he told the Independent at the time. ​“I was sick in February and just want the peace of mind knowing I’m not positive.”

“What’s the point of a test if you’re walking around not knowing what the results of the test are?” asked a downtown business owner, who also asked to remain anonymous for this story.

He got tested at Day Street Park in late April. He said he didn’t find out he was negative until nearly two weeks later.

“The fact that the mayor is encouraging more testing as an epidemiological benefit I think is really great. I just wish that the response time was faster. The partnership with Murphy Medical Associates, I wish that that was a better outfit.”

He said he ultimately went to an urgent care clinic in Hamden for a follow-up test in July. He said it took only 38 minutes from when he arrived to when he got his results. 

East Shore resident Dorian Rahamim agreed.

He got tested on the Green in early July. He said he never heard back from Murphy Medical at all about his results.

“I start to get a little bit of an anxiety attack,” Rahamim recalled. Rahamim’s young daughter goes to summer camp. He said he and his wife were hoping to get tested every two weeks just to make sure that they weren’t exposing their daughter to the coronavirus — and that she wasn’t inadvertently bringing it home.

“They said they were gonna give me a call. I swear someone said they were gonna give me a call. But I never got a call,” Rahamim said.

Murphy told the Independent that his office called Rahimim three times, with the first call made five days after his test was conducted. He said they were never able to reach Rahamim, and could not leave a voicemail because they did not want to deliver medically sensitive information to an inbox that other people may have access to. Rahamim said he never got those calls from Murphy’s office. Instead, he said, he tried calling Murphy’s office multiple times, and spoke with a doctor about a week and a half after his test. She said she would look into his results, and then never got back to him, Rahamim said.

“I think the city should end its relationship with Murphy Medical,” said Rahamim’s wife, who also asked to not share her name for this story and also had to wait a week to get her results after being tested on the Green in early July.

“If it’s more than [a week], people who test positive are still out in the world, potentially affecting other people.”

She said she ultimately got tested at a Fair Haven Community Health Care pop-up at Westville Synagogue. The experience was so smooth, and she got her results in such a timely fashion, that she recommended Rahamim go to Fair Haven’s Grand Avenue site for a follow up test, which he did.

Rahamim and his wife said that Murphy Medical billed their insurance company $1,846 twice, once for each of their tests.

The downtown business owner said his insurance company got billed over $1,500 for his. The fourth person interviewed said his insurance company got billed only $76 for his test.

Mayor Justin Elicker said that he has gotten a few questions from city employees who have been tested by Murphy and seen the relatively large claims submitted by the Greenwich doctor group.

Elicker stressed that no one should be — and, to his knowledge and this reporter’s knowledge, no one has been — charged out of pocket by Murphy’s group for getting a test.

“We of course want to make sure everything is being done appropriately,” Elicker said. He said he has asked the city’s insurer, Anthem, to look into the charges and to let him know if everything looks ok.

“Overall, Murphy Medical has been incredibly flexible as far as the testing goes,” he said. ​“We’ve received no complaints about the actual medical treatment.”

As for the delayed turnaround of results, Elicker noted that Murphy’s group had a ​“technical glitch” earlier this spring. Before it was fixed, the glitch led to delayed communication among Quest Diagnostics, Murphy’s group, and patients.

The mayor said he and city Health Director Maritza Bond will look into any continued delays in test result turnaround with Murphy’s outfit.

“I think it’s critical for people to know as soon as possible because we need to identify outbreaks. Also, for people to be able to protect themselves and others, it’s important that people are notified as soon as possible of their test results.”

Bond agreed. She said that Murphy’s communication with patients has become much better as of late with the advent of Murphy Medical’s online portal, which is designed to provide HIPPA-secure notifications as to test results even before a doctor reaches out by phone three to five business days after the test is complete. (This reporter never received an update via the online portal as to the results of my latest PCR test. Instead, I got a phone call — and an apology for the delay — from a Murphy Medical doctor seven days after my visit.)

The city health director said that Murphy Medical has been quite prompt in notifying people who test positive for the virus.

If there is another surge in cases this summer and fall, Bond said, groups like Murphy Medical likely won’t be able to make phone calls to every patient who tests negative. Instead, they will prioritize immediate phone calls for those who test positive, and lean on electronic updates for those who test negative.

“We want to make sure that these portals are working and working effectively so that people have access to their results,” Bond said.

“Apples To Oranges”

In phone interviews with the Independent, Murphy said that the claims his clinic submits to insurers are so relatively high because his local sites are not testing only for the novel coronavirus that causes Covid-19.

He said patients who visit his testing sites receive a full respiratory panel that looks for Covid-19, pertussis, influenzas A and B, parainfluenza viruses, and a range of other viral pathogens.

He said that his sites are also stationed by doctors, physician assistants, and nurse practitioners who provide a full assessment of a patient’s health.

Unlike with the rapid, self-administered Abbot tests used at sites like the former CVS drive-thru on Long Wharf, Murphy said, the nasopharnygeal tests his clinic administers have an accuracy rate in the high 90 percent range. He said that an independent New York-based study of the Abbot lab tests found that they’re accurate only half of the time — ​“a coin toss,” he said.

Murphy said that trying to compare the tests he performs and bills for to the Covid-19 diagnostic tests performed by major hospitals — which, according to this Kaiser Health study, are often priced $200 or less — is like comparing ​“apples to oranges.”

He said health care providers should not be running tests looking just for the coronavirus that causes Covid-19 ​“during a high virus burden season. That just medically doesn’t make sense.”

He also said that he recently conducted an analysis of tests he has done in New Haven so far, and found that he’s been reimbursed for only around 10 percent of what he’s billed.

“Connecticare has not paid for a single claim at all,” he said. He said he has seen 589 uninsured patients in New Haven, for which he receives no money, per his agreement with the city. He said the Yale Health Plan has not paid his group anything yet, even though it has been billed 748 tests for its insured members.

Anthem requires Murphy’s company to snail mail tests results to California so that they can review before providing reimbursements, he said. And he said Cigna hasn’t paid them at all for three months.

“All in all, just those insurers and uninsured is approximately half of all testing has been paid for by Murphy Medical Associates with the hope insurers don’t break the social contract and will pay us,” he said. ​“We refuse to break our social contract as healers and physicians.”

And as for the delayed delivery of results to patients, Murphy stressed that his clinic prioritizes speedy turnarounds for anyone who tests positive.

His clinic has its own bioMérieux testing machines at a lab in North Stamford. He made that change made after initially relying on Quest labs to do the processing came with its own set of delays thanks to a ​“technical glitch” uncovered in June.

Murphy said nasal swab tests conducted in New Haven on any given afternoon are processed by his lab in Fairfield County that same night. If the results are positive, he personally gets an update and prioritizes reaching out to the patient to talk through their results.

All patients gets an email ​“Quarantine letter” right away after they get tested. That letter includes information about registering to the Murphy Medical online portal and with tips about how to monitor one’s health and identify Covid-related symptoms.

The machine prints out a paper list of all of the results, he said, which his staff then has to scan into the business’s electronic records system.

People who test negative are put on a list of contacts that Murphy Medical doctors seek to reach out to within three to five business days by phone. In theory, the test results are uploaded to the online portal before a health care provider reaches out telephonically.

When I first got tested at the Day Street Park site back on May 6, I didn’t receive a phone call from Murphy Medical informing me of the results — negative — until eight days later. When I went back to Day Street Park to get another nasal swab test on July 20, I got a follow up phone call with my results on July 27.

“We err on the side to notify positives first,” Muprhy said. ​“We are very focused on identifying positives. That way we can begin the contact tracing process as soon as possible.”

“I think the underpromise and the overdeliver mentality makes the most sense here,” Murphy said about the relatively long turnaround time for people who tested negative but don’t know they tested negative until at least a week after the fact.

Murphy said he is currently upgrading his doctors group’s electronic communication system so as to provide speedier results for patients. He said he’s also about to pilot a new text message system that sends an alert to a patient that they are about to be called by a Murphy Medical doctor, so that they don’t dismiss it as spam and not pick up.

Explanation Of Benefits

According to the explanation of benefits for the insurance claims related to my tests with Murphy, the nasal swab test this reporter received at Murphy’s Day Street Park site on May 6 resulted in a bill to my insurer worth a total of $1,906.

The first billing came the day I got tested, when my insurer received claims worth $1,000 for respiratory viral panel testing with 12 – 25 targets, $234 for a new outpatient office visit, $130 for individual preventive counseling, and $62 for an assay of gonadotropin.

The second billing took place on May 14 — around when a doctor from Murphy’s clinic called me to let me know I had tested negative — when my insurer received claims worth $350 for an outpatient office visit and $130 for individual preventive counseling.

Between the two sets of claims for the single May 6 test, my insurer paid a total of $833.22.

Unlike with surprise billing passed along to Covid-19 test patients across the country, I did not and have not had to pay any amount of money out of pocket to Murphy or to my insurance company for the cost of the test. The same was true for everyone interviewed for this article.

A second nasopharyngeal test I took at the Day Street Park site on July 20 has not yet yielded claims as high as in May. For that most recent visit, my insurance company was billed $234 for an outpatient office visit, $130 for preventive counseling, and then $84.26 for a Sars-cov‑2 Covid-19 Antibody test, which I also received that day.

While I received the results of my antibody test online within two days, I didn’t get the results of my nasal test until seven days after I was swabbed, when a doctor from Murphy’s clinic called me, told me I was negative, and apologized for the delay.