AHIP says COVID-19 test providers are “blown up” insurers


Out-of-network providers who pay more for COVID-19 tests are realizing a larger share of them during this phase of the pandemic, leading to rising costs among health insurance companies, the AHIP business group maintains report published Tuesday.

The number of out-of-network suppliers charging at least 50% more than the commercial average for COVID-19 tests has doubled since the beginning of the pandemic, with 36% of suppliers testing prices above standard rates.

The share of providers who paid at least $ 185 for a coronavirus test went up to 54% in March, compared to 42% last April when the pandemic was new to the United States, according to the trade association insurance industry in Washington.

Out-of-network providers administered 27% of COVID-19 diagnostic tests, antibodies and antigens in March, a 6% increase from last April, AHIP found investigating commercial insurance claims. The average price for a COVID-19 test is $ 130.

These higher prices and the growing demands from out-of-network providers affect insurance companies directly in their portfolios. The Coronavirus Aid, Relief, and Economic Security (CARES) Act requires insurers to cover evidence without sharing costs during a public health emergency. The CARES Act requires insurers to pay out-of-network providers regardless of their listed cash price and prevents them from dealing with them for lower rates.


“As the nation continues to face the pandemic, accessible tests are key to reducing the spread of COVID-19,” said Jeanette Thornton, senior vice president of product, employment and trade policy. press release. “COVID-19 testing explosion prices threatens the progress we are making against this deadly virus, and we urge the administration, Congress and policy makers to take deliberate measures to ensure that evidence is accessible and accessible to all “Americans.”

AHIP wants Congress to set a market-based tariff benchmark for texts transmitted off-network and urges policy makers to accelerate the availability of rapid tests that consumers can use at home.

While the CARES Act requires insurers to waive COVID-19 by testing cost sharing, it does not require them to cover coronavirus treatment. Many commercial and nonprofit insurers have redistributed cost-sharing requirements for COVID-19 patients. Democratic lawmakers have asked insurers to cover these expenses, arguing that they put “profits ahead of the well-being of the people of this country.”

While the number of tests performed by out-of-network providers has grown since last spring, AHIP has found that the share of tests performed on high-cost parameters has declined. The number of coronavirus tests administered in hospitals has decreased 13 percentage points since the beginning of the pandemic, and these sites accounted for only 5% of all service locations in March, AHIP found. The number of autonomous laboratory tests performed increased 3 percentage points to 57% and tests performed in medical and clinical offices increased by 10 percentage points to 27%.

The change in care sites could explain the decline in higher rates, AHIP said. The number of tests that cost at least three times the trading average – $ 390 or more – decreased by 5 percentage points during the same time interval.

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