In July, I got a bill from CityMD, the storefront urgent-care empire that progressively blanketed New York City over the last several years. Like many other New Yorkers, I was getting squeezed by the private-equity-owned healthcare juggernaut for COVID tests I had been assured I would not have to pay for.

I had visited the CityMD location around the corner from my Brooklyn apartment many times early in the pandemic. I’d been volunteering with several mutual-aid operations, shopping and delivering groceries to people who couldn’t get out, and by the summer of 2020, I was also out in the crowded streets covering the George Floyd uprising. Frequent testing seemed like a responsible thing to do, and my understanding was that, between government funding and private insurance, people who got COVID tests wouldn’t have to pay for them. The Families First Coronavirus Response Act, passed in March of 2020, had explicitly barred insurance companies from charging copays or deductibles for these tests. CityMD, in their own FAQ page, pledged they were not collecting copays for COVID-related visits.

On some of my later visits to CityMD, during my automated check-in I was told that there was a balance on my account. Each time, I asked the receptionists about it, but every time, they told me to ignore it—that sometimes things showed up that way for a while in the system, but that ultimately, since CityMD accepts my insurance, COVID testing wouldn’t cost me anything.

I stopped using CityMD at some point—the city-run testing sites were faster and more reliable—and I never heard from the company again. Until this summer, when CityMD sent me a bill for $400 for visits from May and June of 2020, more than two years prior.

I LOLed. I tagged the Attorney General of the State of New York.

As it turned out, I was hardly alone in getting hit with belated bills for COVID tests that public officials had urged me take and assured me wouldn’t cost me anything. As the replies to my tweet confirmed, and subsequent reporting by Gothamist fleshed out, CityMD is trying to squeeze money out of lots of us New Yorkers who got COVID tests.

After I got the bill, I called CityMD. Whether by design or oversight, CityMD is not excessively solicitous of phone communication. Attempts to reach them generally require nearly an hour on hold. Their hold music is sunny and uplifting, simple piano trills arranged in a mesmerizing sequence of close repetition over a jaunty beat. At the end of this musical interlude, CityMD told me I had to take it up with my health insurance company.

I called Healthfirst, my insurance company. The woman I spoke with there, Marilyn, told me they’d been getting a lot of calls about how CityMD was billing for COVID tests. She said she’d call their billing department, and put me on hold. But CityMD doesn’t pick up the phone any faster for insurance companies than it does for patients, so it wasn’t until later the same evening that Marilyn called me back and told me she’d finally spoken with CityMD and they had agreed to resubmit the bill with a different billing code such that I wouldn’t have to pay anything.  

The episode had cost me several hours of my life waiting on telephones, but I had emerged victorious. I felt good. That’s where I left things on Twitter, and that’s how Gothamist described me in today’s story on CityMD billing.

Unfortunately, that is not the end of the story. A few weeks after my triumphant tweet, I got another bill from CityMD. My LOL died on my lips.

Rueful, grizzled, getting too old for this shit, I saddled up for one last job.

I had, when I first encountered it, dismissed the CityMD hold music as unremarkable. Upon repeated and sustained listening, however, I found that this recording has secrets to reveal. Every 10 or fifteen minutes, perhaps at the end of the loop, the entire track abruptly lurches into a downshifted, murky sludge, as though the tape has gotten tangled in the machine, before dissolving in a crashing surf of static. This moment is followed by a few seconds of silence, after which the cheerful piano returns again, beaming like a perma-grinned corporate mascot, as though nothing has happened. The effect is unsettling the first time you encounter it. With repetition, it begins to conjure a cyclic sense of cosmic order, destruction and rebirth, whole universes exploding into orderly being, slowing, collapsing on themselves.

After forty-five minutes of this hallucinatory journey, Howard picked up. Hasn’t this already been sorted out, I asked him? Howard’s records did not align with what Marilyn had told me. She called, all right, but CityMD didn’t agree to change its billing, and she never called back to resolve it, he said.

The billing statement for each visit contains two items: the test procedure itself, and, separately, an “outpatient visit.” The billing code for this visit, 99212, is generally applied to outpatient consultations by a physician lasting around 10 minutes.

I didn’t ask for a consultation with a physician, I said. I just wanted a test. Howard explained that as a matter of policy, CityMD charges the $300 office fee always.

“Our agreement with the insurance companies,” he told me, “is to bill out as an office visit.” 

I observed that this agreement didn’t seem to be working out, at least to the extent that my insurance company wasn’t agreeing to pay the fee. Could Howard refer me to somewhere I could see that agreement so I could remind my insurance company of their agreement? 

“It’s not written down someplace,” he told me. “That’s an internal contract.” The point, he said, is that the $300 is an automatic and unavoidable charge.

“If you walk into a CityMD office, it’s a $300 flat fee to the insurance company,” he said. “Whether you come in and they spend five minutes with you and they give you a prescription, or maybe you come in with a sprained ankle and they take an x-ray, it’s gonna be the same flat fee of $300.”

I called my insurance company again. Their hold music, while initially more engaging, with guitar and flutes, betrays none of the depths of CityMD’s, but that may be because they tend to answer the phone before the music has a chance to really go off the rails.

Wasn’t there a legal understanding that people who got COVID tests didn’t have to pay for them? I asked Peter, who sounded nice. What’s going on here? The problem, Peter informed me, was that there’s nothing in CityMD’s billing information to confirm that my visit had anything to do with a COVID test.

I called CityMD to put this to them, enduring increasingly pronounced temporal distortions. The great grinding collapse of the theme music seemed now to come as often as the ticking of a clock, the sun a flickering streak across the sky, mountain ranges rising up and crumbling like so much sand.

My insurance is wrong, said the person who finally picked up the phone. An ICD code, Z01.84, attached to the bill makes clear that the $300 outpatient visit fee is related to a COVID test. I am not a medical billing professional. I could only take this information back to my insurance company.

This time, my call was assigned to someone whose English was less than completely fluent. I brought him up to speed, not entirely confident he was following every twist of my tale. Whether he did or not I’m not certain, but he told me I have two options: Have my insurance dispute the charge with CityMD, or appeal my insurance’s decision not to pay the full $300 office-visit fee. Which did he recommend? I asked. He said he’d try both, but after five minutes listening to CityMD’s hold music, he got back on the line to say that he thought it would be better to just forget CityMD and stick with appealing the insurance decision.

I should learn the results of this appeal within 60 days, he said.