AHIP accuses out-of-network providers of price gouging in the cost of COVID-19 tests
Legislation could permit insurers to base payment for COVID-19 tests administered out-of-network on their median in-network rate, AHIP says.
Photo: Morsa Images/Getty Images
AHIP claims that federal mandates for insurers to pay for COVID-19 tests have resulted in price gouging on the part of some out-of-network providers.
Out-of-network providers charge significantly higher prices, AHIP said in a Feb. 2 statement submitted to the House Committee Energy and Commerce Subcommittee on Consumer Protection and Commerce. More than half charge more than $185, when the average is $130, AHIP said.
AHIP wants Congress to take action by eliminating the federal requirement that insurers pay the "cash price" for COVID-19 tests delivered out-of-network, according to the statement for the hearing on "Pandemic Profiteers: Legislation to Stop Corporate Price Gouging."
Implementing legislative action would protect patients from balance billing charges by permitting insurers to base payment for COVID-19 tests administered out-of-network on their median in-network rate, AHIP said.
The insurer association also wants Congress to instruct the Centers for Disease Control and Prevention to release guidance permitting the use of the ICD-10 COVID-19 screening test code. This would allow insurers to implement testing policies and more precise coding, AHIP said.
In addition, AHIP wants the Centers for Medicare and Medicaid Services to create Healthcare Common Procedure Coding System, or HCPCS, billing codes to create a system for tracking over-the-counter tests to be able to monitor the supply chain and reconcile against quantity limits to keep track of fraud and abuse.
The organization said it supports continued federal funding for broad-based access to over-the-counter COVID-19 tests that offer an alternative to higher-priced provider- or lab-administered tests.
WHY THIS MATTERS
Price gouging in COVID-19 testing remains a significant problem, AHIP said.
"In 2021, AHIP conducted a survey of health insurance providers in the commercial market to gather information on prices charged by out-of-network providers for COVID-19 tests," the statement said. "The results found that out-of-network providers charged significantly higher prices (more than $185 when the average is $130) for more than half (54%) of COVID-19 tests. The data show that the problem has gotten worse – not better – since the beginning of the pandemic."
THE LARGER TREND
In March 2020, when Congress passed the Coronavirus Aid, Relief and Economic Security or CARES Act, it required insurers to pay the listed cash price the provider posted on a public website for tests to diagnose COVID-19, barring any contract in place.
"In doing so, Congress effectively eliminated the ability of health insurance providers to negotiate more affordable COVID-19 testing prices," the statement said. "Moreover, the statute precludes medical management tools that health insurance providers could use to encourage consumers to use in-network providers and labs."
Insurers are also required to cover the cost of at-home COVID-19 tests.
Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com
