COVID-19 Lab Test Prices Give Some Health Plans ‘Indigestion’

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HEALTH INSURANCE PLANS CONTINUE TO  BE UNHAPPY with the higher prices they are charged for COVID-19 tests by out-of-network clinical laboratories. That is one theme in a report on COVID-19 test prices published by a health insurance trade group. 

In its report issued last month, the America’s Health Insurance Plans (AHIP) wrote, “price gouging in COVID- 19 testing continues as a significant problem.” AHIP’s report is titled “COVID-19 Test Prices: A Look-back on Trends in COVID-19 Testing Prices.” The report can be viewed at www.ahip.org/covid-19- test-prices/. 

12-Month COVID Test Study 

AHIP’s study of COVID-19 test prices looked at the 12-month period of April 2020, through March 2021. During this time, the study determined that the average price for a COVID-19 test in the commercial market was $130. “In contrast, out-of-network test providers charged significantly higher (more than $185) prices for more than half (54%) of COVID-19 tests in March 2021,” the study noted. 

The data used for this study came from a large proportion of the private health insurance industry. AHIP noted that the “the enrollment-weighted survey data includes 17 responses from plans representing 80% of commercial enrollment of AHIP member plans.” 

Out-of-network laboratories have increased their proportion of COVID-19 test claims. In March 2021, AHIP determined that 27% of COVID-19 tests in March 2021 were administered out-of-network. This is a 6% increase since the beginning of the pandemic in early 2020. 

Fewer Hospital, ER Tests 

Interestingly, researchers reported that the share of COVID-19 tests claims submitted from “high-cost locations”— identified as hospitals and emergency departments—declined from 18% in the first three months of the pandemic to only 5% during the first three months of 2021. 

Another point that AHIP emphasized about the “price gouging” of out-of-network clinical labs was that “the share of tests charging 50% to 100% above the average costs has doubled in the same time period (April 2020-March 2021) from 18% to 36%. The overall share of high-priced COVID-19 tests costing more than $185 has increased from 42% to 54% in the same time period. 

AHIP noted in the study that “when health insurers are working with the test providers in their own networks, they can bargain for lower prices.” It then went on to say, “but when an insured patient gets medically-necessary testing from out-of-network providers, the federal Coronavirus, Aid, Relief, and Economic Security (CARES) Act of 2020 requires the insurer to pay the test provider’s full listed cash testing price.” 

Suggestion to Congress 

One recommendation AHIP made in the report was that “throughout the public health emergency, Congress should eliminate the ability for price gouging to occur by setting a reasonable market-based pricing benchmark for tests delivered out of network.” 

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