Coronavirus diagnostic test pricing is relatively tame
Anecdotes of labs charging thousands of dollars for coronavirus diagnostic tests are the exception rather than the rule, according to data provided to Axios by a national health insurer.
Yes, but: Some labs that don’t contract with the insurer charged rates that are multiple times higher than what Medicare pays for the diagnostic tests, and in some scenarios, patients may be at risk of receiving surprise bills.
The big picture: Axios received data from the insurer on the coronavirus diagnostic test claims it received in April from professional labs. The data doesn’t include two of the five billing codes for coronavirus diagnostic testing, including for high-throughput tests, as they weren’t widely used that month.
- Some labs have negotiated payment rates with insurers. For those that haven’t, Congress earlier this year required insurers to pay the labs’ posted cash price, which some experts worried could essentially give labs a blank check.
By the numbers: In-network labs constituted the vast majority — 89% — of the 63,378 claims. These labs charged, on average, $163.91 per test, but the insurer actually paid a negotiated rate of $51.31 for each test, which is what Medicare pays.
- Labs that were out-of-network but had posted their cash price charged, on average, $124.96 (244% of Medicare) per test, and made up 9% of claims. For claims above 200% of the Medicare price, the insurer attempted to negotiate the price.
- “The labs have been willing to negotiate given the potential volume of services and the potential goodwill that they establish, with the possibility of working with us more formally down the road,” a source who works for the insurer told me.
- Labs that were out-of-network and didn’t post their cash price charged, on average, $176.96 (or 345% of Medicare) per test, and were only 2% of total claims. The insurer source said that the insurer paid these labs the Medicare rate.
Yes, but: The labs that didn’t post their cash prices and aren’t reimbursed for the full amount that they charged may turn around and bill patients for the rest, said Loren Adler of the USC-Brookings Schaeffer Initiative for Health Policy.
Details: Some out-of-network labs that didn’t post their cash price charged much higher than the average rate.
- Lenco Diagnostic Labs, which has labs throughout New York City and Long Island, submitted 138 claims with an average charge of $450 per test. Lenco did not respond to a request for comment.
- Genesis Reference Laboratories, located in Orlando, FL, submitted 23 claims with an average charge of $153.99. It did not return a request for comment.
- Chemisys Laboratories, located in Fair Lawn, NJ, submitted 9 claims at $359.31 per test. The company said in a phone call that its cash price today is $100.
- Alliance Laboratories, which has two locations in New York, submitted 8 claims with an average charge of $740.90. Richard Abrazi, chief operating officer of Alliance Labs, said that he didn’t realize that insurers were required to pay the posted cash price, and said that the higher charge is a negotiating tactic with insurance companies.
The bottom line: The vast majority of coronavirus diagnostic tests in April cost what Medicare has deemed they’re worth. But a minority cost more than that, which we all could end up paying for through our premiums.