Labs can charge thousands for COVID tests. See which states have the most expensive
Some U.S. labs are charging thousands of dollars for COVID-19 tests ― but are they allowed?
Technically yes, according to a new study that looks at average testing costs in each state.
Health insurers that haven’t negotiated testing prices with labs are obligated under the federal Coronavirus Aid, Relief, and Economic Security (CARES) Act to pay whatever rate those providers choose, according to a study published in the Journal of General Internal Medicine.
Insurers can then pass down some of the cost to consumers, researchers said. And for the uninsured, the risk is even higher.
“Providers that have tested uninsured patients can choose to either seek reimbursement from the Department of Health and Human Services or bill uninsured patients at a self-determined price, which equals the charge unless the provider offers a discount,” researchers said.
The study looked at more than 182,000 claims for COVID-19 diagnostic and antibody tests from more than 2,300 testing facilities.
The costs to determine whether a person was positive for the virus ranged from as low as one cent to, in at least one instance, $14,750, researchers found.
Testing costs by state
When broken down, outpatient care testing costs averaged nearly $168, independent laboratory testing stood at a little over $140, and testing during a doctor’s visit cost almost $121.
Those prices were much higher than the Medicare reimbursement rate of $51.31 for diagnostic testing and a little over $42 for antibody testing.
When broken down by state, the prices greatly varied.
Tests in Utah, for example, were the cheapest ― averaging almost $65. Labs in Washington, D.C. were the most expensive ― averaging nearly $506 per test.
New York had the lowest antibody testing rate at nearly $46 while New Mexico had the highest at a little over $195, researchers said.
Arkansas, Louisiana, Montana and New Mexico “had high average charges for both tests.” Georgia, Kansas, Massachusetts, Maryland, North Carolina, Nevada, and Oklahoma had the lowest.
The researchers found no correlation between the costs of testing and the state’s testing, infection or death rates.
Labs accused of price gouging
Even though insurers are protesting the cost of COVID-19 tests, they don’t have any power under the CARES Act to refer patients to less costly in-network testing providers. Not having a set cost also gives labs the ability to charge exorbitant amounts for a single test.
As of now, federal law prevents insurers from charging out-of-pocket costs for coronavirus testing, but that doesn’t mean health insurers can’t eventually pass some of those costs to employers and patients, according to the study.
“Eventually, the money will come from individual patients in higher premiums,” Ge Bai, a Johns Hopkins University professor of accounting and health policy and management and author of the study, told USA Today.
Now trade association America’s Health Insurance Plans (AHIP), which includes Aetna, Anthem and Humana, are accusing out-of-network test providers of price gouging.
Their Oct. 2020 survey found that half of out-of-market labs who provided COVID-19 tests were charging $185 or more. The average cost charged by in-network labs stands at $130.
The industry group is asking Congress “to set a market-based pricing benchmark for out-of-network tests and provide money to ensure Americans can access COVID-19 tests,” Med Tech Dive reported.
Since the start of the pandemic, nearly 560 million laboratory tests for COVID-19 have been performed, according to the CDC. In the last 7 days, about 8% of those have been positive.
This story was originally published September 21, 2021 at 2:26 PM with the headline "Labs can charge thousands for COVID tests. See which states have the most expensive."
.png)