New data from America’s Health Insurance Plans (AHIP) show that out-of-network providers charge significantly higher prices for COVID-19 tests than in-network providers.
On average, a COVID-19 test in the commercial market costs $130, according to AHIP. The new data demonstrates that the share of tests charging 50% to 100% above the average costs has doubled (from 18% to 36%) between early in the pandemic and more recently during the current public health emergency.
The Centers for Medicare & Medicaid Services (CMS) pays much less. The agency pays $100 for COVID-19 tests run on high-throughput analyzers if labs meets two conditions: a) complete the test in two calendar days or less, and b) complete the majority of their COVID-19 diagnostic tests that use high-throughput technology in two calendar days or less for all of their patients (not just their Medicare patients) in the previous month.
The AHIP data come from a survey of health insurance providers in the commercial market conducted between May and June of 2021. The survey, which builds upon results from previous research, gathered information on prices charged by out-of-network providers for diagnostic, antibody, and antigen tests for COVID-19.
Key results from the survey include:
· Out-of-network test providers charged significantly higher (more than $185) prices, compared with the average price, for more than half (54%) of COVID-19 tests in March 2021 — a 12% increase since the beginning of the pandemic. However, the share of highest charges (more than $390) decreased from 12% to 7% during the same period.
· More than a quarter (27%) of COVID-19 tests in March 2021 were administered out-of-network — a 6% increase since the beginning of pandemic.
