December 23, 2020

The $7,000 Covid test: Why states are stepping in to shield consumers

One national insurer was billed $6,946 for a coronavirus test in Texas, according to claims data reviewed by POLITICO.

“Insurance regulators from Tennessee to Washington state have stepped up efforts to protect patients from unexpected bills for coronavirus tests, concerned the federal government has failed to shield people from thousands of dollars in out-of-pocket expenses.

Washington’s insurance commissioner, Mike Kreidler, this week issued an emergency order banning labs for billing insured patients for doctor-ordered Covid-19 diagnostic tests. That followed moves in Tennessee, North Dakota, Oklahoma and Georgia to cap costs or more narrowly define what insurers should pay for as the number of tests processed daily surges to 465,000 as of June 4.

The state-by-state guidance and rules come after Congress and the Trump administration this spring assured Americans that coronavirus testing and any necessary trips to doctors and hospitals would be free. But lawmakers didn’t limit charges if the testing is done out of network — or prohibit labs or hospitals from billing patients if insurers refuse to pay their posted charges.

Employers and health plans have complained this could lead to staggering costs. One national insurer was billed $6,946 for a coronavirus test in Texas, according to claims data reviewed by POLITICO. In Oklahoma, health plans received 175 out-of-network claims for coronavirus tests over a single week that ranged from $153 to $2,315 per test, said Laura Fleet, executive director of the Oklahoma Association of Health Plans.

Elizabeth Mitchell, CEO of the Pacific Business Group on Health, which represents large employers, said out-of-network bills compose only 3 percent of her member companies’ total claims but 16 percent of testing costs in this Politico article.

Read the full Politico article here

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