A 45- to 59-minute telehealth urgent care visit from New York City-based Mount Sinai cost one patient $660, raising questions as the price was extremely high for a virtual visit and as the appointment was ruled out of network by an insurer, NPR reported Dec. 19.
In September 2022, Elyse Greenblatt scheduled the virtual visits because she had persistent congestion. During the visit, a physician concluded Ms. Greenblatt was suffering from a sinus infection and prescribed fluticasone — a nasal spray for congestion — and the antibiotic Keflex.
When Ms. Greenblatt received her bill from insurer Empire BlueCross BlueShield, it was $660 and labeled as an out-of-network service. Upon receiving the invoice, Ms. Greenblatt revisited Mount Sinai's app to retrace her actions, and captured a screenshot of a specific section — the details.
The app indicated an estimated wait time of 10 minutes at a cost of $60. It also mentioned, "cost may be less based on insurance," a detail clarified by Mount Sinai spokesperson to NPR as being "for the patient's benefit," with the note that the "cost may differ depending on the patient's insurance."
According to the publication, Ms. Greenblatt's visit was deemed as moderately lengthy, and her physician billed her as a moderate level of care, causing the bill to be higher.
Stephanie DuBois, a representative from Empire BlueCross BlueShield, also told NPR that the insurance provider extends coverage for virtual visits through two services or with in-network physicians. However, the Mount Sinai physician did not meet either of these criteria.
This raised the question of why Mount Sinai would assign Ms. Greenblatt an out-of-network physician, even though the health system is her usual provider.
NPR did a review of the physician's on Mount Sinai's profile page and found that the physician in question does not list any accepted insurance.
A Mount Sinai spokesperson told the publication that the physician did take at least some insurance.
Attempting to unravel the billing complications became a significant challenge for Ms. Greenblatt. Despite being told her case was marked as "urgent" in Mount Sinai's disputes department, there was a lack of response from the physician's office. The bill would then disappear and reappear on her patient portal.
Ms. Greenblatt was then informed that she had consented to the out-of-network charge, but when requesting a copy of the form, the staffer suggested faxing it, which she declined. Despite granting permission to put the form in her patient portal, it never materialized.
According to NPR, KFF Health News questioned Mount Sinai about the case in mid-October. Their spokesperson Lucia Lee forwarded a three-page form, claiming it was part of the check-in process. However, the time stamp indicated the visit concluded before Ms. Greenblatt signed it.
Ms. Lee argued that signing forms after the visit is not standard, suggesting patients could reschedule with an in-network provider if they review the forms first. The timing and clarity of the forms are crucial in light of the No Surprises Act enacted in December 2020. The legislation, designed to address surprise medical bills, requires advance notice and consent, with exceptions for specific healthcare entities. The uncertainty about the entity charging Ms. Greenblatt complicates its status under the No Surprises Act, and Mount Sinai acknowledges the need for further research on whether the billing entity is the hospital or another entity.
Currently, Ms. Greenblatt's bill is unpaid and unresolved.