Out-of-Network COVID-19 Test Cost is higher than the commercial price

Out-of-Network COVID-19 Test Cost is higher than the commercial price

According to a new report provider prices for out-of-network COVID-19 tests are higher than the average cost of in-network tests. America’s Health Insurance Plans (AHIP) is calling on the government to stop price gouging after finding provider prices for out-of-network COVID-19 tests far exceeded the average cost of in-network tests.

In a report released late last week, AHIP stated that out-of-network test providers charged more than $185 for nearly 40 percent of diagnostic tests and 25 percent of antibody tests even though the average price of a COVID-19 test in the commercial market is $130. In a small number of cases, out-of-network providers charged over $390 for the COVID-19 tests.

The survey of health insurance providers in the commercial market also found that almost a tenth (9.4 percent) of all claims for COVID-19 tests were from out-of-network providers.

“The Administration should take steps to prevent price gouging for COVID-19 testing, including enforcing the requirement that test providers publicly post their cash price in an easy-to-find online location,” the industry group said in the report.

The Coronavirus Aid, Relief, and Economic Security (CARES) Act passed in late March 2020 requires health insurance providers to give beneficiaries access to medically necessary COVID-19 testing without cost-sharing.

The law also requires the providers to pay providers the listed cash price for the tests in the absence of a contract.

The requirement, however, eliminates a health insurance provider’s ability to negotiate a more affordable price for COVID-19 tests, AHIP stated in the report.

Patients are protected from the prices providers have set for COVID-19 tests thanks to the CARES Act and subsequent pandemic-related legislation, which not only requires health insurers to pick up the tab for medically necessary COVID-19 tests, but also prohibits providers from balance billing patients for the tests and related care.

How Can We Stop Price Gouging of Americans?

Everyone should be able to get the COVID-19 tests they need, whether they have health insurance coverage or not. To stop price gouging:

  • The Administration should take steps to prevent price gouging for COVID-19 testing, including enforcing the requirement that test providers publicly post their cash price in an easy-to-find online location.
  • Congress and the Administration should make the financial investment needed to ensure that Americans have access to all necessary COVID-19 testing.
  • Policymakers and health care delivery system stakeholders should support and accelerate the development of alternative forms of accurate and low-cost testing such as those using saliva and/or test strips.

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