With the number of coronavirus cases climbing throughout the country as the holidays loom, daily testing trends are expected to continue increasing. (Photo: Shutterstock)
New data from America's Health Insurance Plans (AHIP) indicates that price gouging for COVID-19 testing is on the rise. The association's survey of health insurance providers in the commercial market, conducted in October, found that 23% of all claims for COVID-19 testing came from out-of-network test providers — a 14% increase since July. Moreover, many out-of-network test providers charged prices that far exceeded the average cost of in-network tests.
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On average, a COVID-19 test in the commercial market costs $130. But out-of-network test providers charged more than $185 for nearly half of all diagnostic tests and one-third of all antibody and antigen tests. That's a 10% increase since July, according to AHIP. Additionally, as many as 16% of out-of-network test claims charged more than $390, which is three times the average cost.
AHIP noted that 58% of out-of-network tests with prices exceeding the average cost were administered in a lab setting, with others administered by outpatient hospitals and physician offices and clinics. (In-patient hospitals are not included in this estimate, because they do not charge for laboratory tests separately.)
The Coronavirus Aid, Relief and Economic Security (CARES) Act mandates health insurance providers that offer comprehensive health insurance coverage to provide access to medically necessary COVID-19 testing without cost-sharing. It also requires health insurance providers to pay the listed cash price for COVID-19 tests in the absence of a contract, thus eliminating their ability to negotiate more affordable test prices.
With the number of coronavirus cases climbing throughout the country as the holidays loom, daily testing trends are expected to continue increasing. AHIP suggests the following four actions would help stop price gouging:
1. Congress should make the financial investment needed to ensure that Americans have access to all necessary COVID-19 testing.
2. Congress should eliminate the ability for price gouging to occur by setting a reasonable market-based pricing benchmark for tests delivered out of network.
3. Policymakers should accelerate the availability of consumer-friendly, rapid and accurate tests that lower costs and mitigate the capacity and supply constraints of providers and labs.
4. The Administration should ensure that all available COVID-19 tests, both manufacturer-developed and laboratory-developed, meet appropriate standards for accuracy.
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