AHIP: Price gouging gets worse for out-of-network COVID-19 tests

New data from an insurance industry group find price gouging for out-of-network COVID-19 tests has increased since a July survey, and insurers want Congress to step in.

The data (PDF), released Monday from America’s Health Insurance Plans (AHIP), comes as most providers agreed to offer COVID-19 testing and treatments without cost-sharing. 

AHIP conducted a survey of 22 of its members, representing 76% of commercial enrollment of AHIP member plans.

On average, a COVID-19 test in the commercial market costs $130, and out-of-network tests cost more than $185.

“Between 9% and 16% of out-of-network test claims charged more than $390 (three times the average cost),” AHIP’s report said.

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It found that nearly a quarter of COVID-19 tests are administered out of network, which is a 14% increase from a similar survey of 22 members taken in July.

AHIP found that the out-of-network costs were also going up.

“The share of claims for diagnostic and antibody tests for COVID-19 that cost more than 50% of the average cost ($185) increased by almost 10%,” the group said.

The survey also said that most of the high-priced tests came from standalone labs (58%), 18% came from hospital outpatient clinics and 18% at a doctor’s office.

AHIP said that the CARES Act requires insurers to pay the listed cash price for a COVID-19 test if there isn’t a contract with the provider or lab, “thus eliminating their ability to negotiate more affordable test prices.”

The group urged lawmakers to create a “reasonable market-based pricing benchmark” for any out-of-network tests.