A laboratory in New Jersey is still profiteering on COVID-19 tests, post pandemic. Three out-of-network claims were submitted for the same patient on three different dates of services, charging $750, $650, and $550, respectively.
Per the CARES Act, health plans must pay an out-of-network provider’s cash price for COVID-19 tests, which the provider must list on their public-facing website. According to a 2020 AHIP (America’s Health Insurance Plans) report, between 9% and 16% of out-of-network test claims charges were greater than $390. Even though charges over $390 fell to 7% in 2021, price gouging and creative billing from providers for out-of-network COVID-19 tests obviously remains a problem.
According to Dr. Richard Stripp PH.D., Chief Scientific and Technical Officer at Cordant Health Solutions, laboratories can “cover all their laboratory and administrative costs with a meaningful profit margin for about $90-$100 per COVID-19 test. $750 is 7 times more expensive than what other labs are charging and 15 times what Medicare pays. There is no way a laboratory can justify these excessive prices.”
Since the laboratory does not list COVID-19 test prices on its website, the reimbursement paid to this out-of-network provider was $100 per test, which Dr. Stripp says, “…is reasonable and fair.”