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Medical Providers (Still) Charge Astronomical Prices For COVID-19 Tests

posted by Alicia Caramenico

on May 14, 2021

Price gouging in COVID-19 testing and screening continues
as a major problem.

All Americans should be able to get the COVID-19 tests they need for peace of mindDuring the pandemic, health insurance providers have eliminated patient cost-sharing for diagnostic testing and treatment for COVID-19. 

As we enter year two of the pandemic, COVID-19 testing remains “especially lucrative” for hospitals and clinics that charge exorbitant pricesCalifornia Healthline recently reported. “Loose rules on prices” make it impossible for health insurance providers to negotiate more affordable test prices. 

California Healthline shared some egregious examples of COVID-19 test price gouging, including: 

  • Hospitals are charging up to $650 for a simple, molecular covid test that costs $50 or less to run, according to Medicare claims analyzed for KHN by Hospital Pricing Specialists (HPS). Charges by large health systems range from $20 to $1,419 per test, a new national survey by KFF shows. And some free-standing emergency rooms are charging more than $1,000 per test.
     
  • “Insurers and other payers ‘have no bargaining power in this game’ because there is no price cap in some situations, said Ge Bai, an associate professor at Johns Hopkins Bloomberg School of Public Health who has studied test economics. When charges run far beyond the cost of the tests ‘it’s predatory,’ she said. ‘It’s price gouging.’
     
  • “The data shows that covid tests continue to generate high charges from hospitals and clinics despite alarms raised by insurers, anecdotalreports of high prices and pushback from state regulators.
     
  • “The listed charge for a basic PCR covid test at Cedars-Sinai Medical Center in Los Angeles is $480. NewYork-Presbyterian Hospital lists $440 as the gross charge as well as the cash price. Those amounts are far above the $159 national average for the diagnostic test, which predominated during the first year of the pandemic, at more than 3,000 hospitals checked by HPS.
     
  • “Sticker shock from covid tests has gotten bad enough that Medicare set up a hotline for insurance companies to report bad actors, and states across the country are taking action. 

Unfortunately, covid price gouging is not new. AHIP data in July 2020 and October 2020 found out-of-network COVID-19 test costs continued to rise, far exceeding in-network costs and threatening affordability. 

As much as 16% of out-of-network test claims were more than $390—3x the average cost.

It’s clear we need legislative action to protect Americans and stop price gouging in a public health crisis. 

Moving forward, we urge Congress to examine how some diagnostic testing providers are charging exorbitant amounts taking advantage of the requirement that health insurance providers pay the cash price, regardless of the reasonableness of that price. We look forward to collaborating with Congress as we continue the nation’s progress for more expansive and low-cost diagnostic and screening testing for COVID-19.