Providers Price Gouging Out-of-Network COVID-19 Tests, AHIP Says

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.

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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.

Hospitals charge anywhere from $20 to $850 for a COVID-19 diagnostic test, revealed a recent analysis from the Peterson-KFF Health System Tracker.

However, most hospitals charged between $100 and $199 for the test and the median price was $127, according to the analysis of prices listed by the two largest hospitals in each state and the District of Columbia.

For COVID-19 antibody tests, prices ranged from $36 to $300, with 82 percent of posted prices below $150.

Providers must post cash prices for COVID-19 tests on public websites for insurer use, per requirements in the CARES Act. But the law does not regulate the actual pricing of COVID-19 tests or related tests and visits outside of Medicare, giving hospitals the liberty to charge whatever they want for COVID-19 tests, researchers at the Peterson-KFF Health System Tracker pointed out.

Not all providers are posting their cash prices for the tests either, researchers found.

Only 78 of the 102 hospital websites examined for the analysis had pricing information for COVID-19 tests.

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.

However, excessive prices could lead to higher premiums down the line, industry experts have warned.

Enforcement of the CARES Act requirement could prevent providers from charging health insurers excessive prices for COVID-19 tests, AHIP is arguing.

Additionally, the group wants policymakers and healthcare stakeholders to invest in increased access to necessary COVID-19 testing, accelerate the development of alternative forms of accurate, low-cost testing (e.g., salvia or test strips), and increase accuracy of all test types.

“From the beginning, health insurance providers have taken decisive action to ensure Americans get the care they need where and when they need it, including working with providers to assure that cost is not a barrier for diagnosing or treating COVID-19,” AHIP stated on its website.