Out-of-network providers charge significantly more than the commercial price for COVID-19 tests

By | September 1, 2020

Out-of-network providers charged significantly more money for both diagnostic and antibody COVID-19 tests, according to a survey from America’s Health Insurance Plans.

The survey of AHIP member health plans was performed during July to gather information on prices charged by out-of-network providers for diagnostic and antibody tests for COVID-19. It received 22 responses, totaling 67% of commercial enrollment of AHIP member plans.

The respondents indicated that about a tenth (9.4%) of all COVID-19 test claims came from out-of-network providers.

AHIP found that the average price for a COVID-19 test in the commercial market is $ 130.

Among the out-of-network claims, 61% and 75% of respective diagnostic and antibody tests were less than $ 185. However, almost 40% of diagnostic tests cost more than $ 185, with 11% costing more than $ 390. For antibody tests, 25% cost over $ 185 with 9% cost more than $ 390.


In response to what AHIP said was price gouging, the organization has called for policy changes to stop insurers from continuing the practice.

In the survey report, AHIP created a list of recommendations to enable everyone to get the COVID-19 test, regardless of whether they have health insurance or not.

The recommendations include: requiring test providers to publicly post their cash price in an easy-to-find online location; Congress making a financial investment to provide every American COVID-19 testing; supporting the development of alternative forms of accurate and low-cost testing like saliva and/or test strips; ensuring that all COVID-19 tests meet accuracy standards regardless of being manufacturer- or laboratory-developed.


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Congress has passed several acts to make sure uninsured Americans get access to COVID-19 treatment and testing.

The Families First Coronavirus Response Act and the Paycheck Protection Program and Health Care Enhancement Act each established $ 1 billion to reimburse providers for conducting COVID-19 testing for the uninsured. Additionally, a portion of the Provider Relief Fund was designated to the treatment of uninsured individuals with COVID-19.

The Coronavirus Aid, Relief, and Economic Security Act also required that health insurance providers give access to medically necessary COVID-19 testing without cost-sharing.

Despite those initiatives, issues around testing cost and turnaround times have persisted.

Several media outlets have reported on instances where it took test results up to two weeks to be returned. Officials insist that although those instances could be outliers, most test results come back within three days.

In response to high test prices, Abbott released a test for $ 5. The test connects to Abbott’s NAVICA app which keeps track of when a person has a test at their healthcare provider, the result of the test, and the date.

In July, states submitted their testing plans through December to the Centers for Disease Control and Prevention. The states’ plans had to detail how a minimum of 2% of their population will be tested each month, as well as strategies to increase that percentage this fall.

Twitter: @HackettMallory
Email the writer: mhackett@himss.org

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