AHIP: Value-gouging will get worse for out-of-network COVID-19 checks


New information from an insurance coverage trade group finds that price-gouging for out-of-network COVID-19 checks has elevated since a July survey and needs Congress to step in.

The information launched Monday from America’s Well being Insurance coverage Plans comes as most suppliers agreed to supply COVID-19 testing and coverings with out cost-sharing. 

AHIP performed a survey of 22 of its members, representing 76% of business enrollment of AHIP member plans.


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On common a COVID-19 check within the business market prices $130 and out-of-network checks price greater than $185.

“Between 9% and 16% of out-of-network check claims charged greater than $390 (thrice the common price),” AHIP’s report mentioned.

RELATED: HHS calls on FDA to hurry up opinions of lab-developed COVID-19 checks after backlog

It discovered that just about 1 / 4 of COVID-19 checks are administered out-of-network, which is a 14% enhance from the same survey of 22 members taken in July.

AHIP discovered that the out-of-network prices have been additionally going up.

“The share of claims for diagnostic and antibody checks for COVID-19 that price greater than 50% of the common price ($185) elevated by virtually 10%,” the group mentioned.

The survey additionally mentioned that many of the high-priced checks got here from standalone labs (58%) and 18% got here from hospital outpatient clinics and 18% at a health care provider’s workplace.

AHIP mentioned that the CARES Act requires insurers to pay the listed money worth for a COVID-19 check if there isn’t a contract with the supplier or lab, “thus eliminating their capacity to barter extra inexpensive check costs.”

The group urged lawmakers to create a “affordable market-based pricing benchmark” for any out-of-network checks.


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