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Health Insurers See More COVID-19 Test Mini Gouging

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What You Need to Know

  • AHIP says the average cost of a COVID-19 test in the commercial market is $130.
  • The percentage of tests costing more than $390 has fallen to 7%, from 12%.
  • The percentage of tests costing less than $185 has also fallen.

U.S. COVID-19 testers are sending health insurers fewer shockingly high bills but more very high bills, according to America’s Health Insurance Plans.

The health insurer group looks at COVID-19 testing price trends in an analysis based on commercial market  claims data from 17 AHIP member companies.

In Network v. Out of Network

When health insurers are working with the test providers in their own networks, they can bargain for lower prices.

But when an insured patient gets medically necessary testing from out-of-network providers, the federal Coronavirus, Aid, Relief and Economic Security Act of 2020 requires the insurer to pay the test provider’s full listed cash testing price.

Commercially insured patients tested during the first quarter of this year — from January through March — used out-of-network providers for 27% of those tests, AHIP reports. Earlier in the pandemic, during the second quarter of 2020 , out-of-network providers accounted for just 21% of commercially insured patients’ COVID-19 tests.


AHIP found that the average cost for a COVID-19 test in the commercial market is about $130.

When looking for signs of price gouging, or excessively high prices, AHIP breaks down test claim costs into four pricing categories: under $185; $185 to $259; $260 to $389; and $390 and over.

Here’s what happened to the percentage of out-of-network tests in those four price categories between the second quarter of 2020 and the first quarter of this year:

  • Under $185: 46% (down from 58%)
  • $185-$259: 36% (up from 58%)
  • $260-$389: 11% (down from 12%)
  • $390 and Over: 7% (down from 12%)

AHIP notes that the biggest concern right now is bills for tests that cost $185 to $259, or 50% to 100% more than the average cost of a commercial COVID-19 test, rather than the $390-and-up tests, which cost more than three times as much as the average test.

Instead of requiring insurers to pay the full listed price for all medically necessary COVID-19 tests, “Congress should eliminate the ability for price gouging to occur by setting a reasonable market-based pricing benchmark for tests delivered out of network,” AHIP says.

AHIP says policymakers should also work to increase the availability of consumer-friendly, rapid, and accurate tests, to lower costs and ease testing supply constraints.

(Image: Adobe Stock)


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