December 10, 2023

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AHIP accuses out-of-network providers of price gouging in the cost of COVID-19 tests

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AHIP statements that federal mandates for insurers to spend for COVID-19 tests have resulted in price tag gouging on the component of some out-of-community suppliers.

Out-of-network providers charge substantially larger price ranges, AHIP explained in a February 2 statement submitted to the Dwelling Committee Electrical power and Commerce Subcommittee on Customer Safety and Commerce. Far more than 50 percent charge additional than $185, when the normal is $130, AHIP claimed. 

AHIP desires Congress to consider action by removing the federal necessity that insurers shell out the “cash price tag” for COVID-19 checks delivered out-of-network, according to the statement for the listening to on “Pandemic Profiteers: Laws to Prevent Company Selling price Gouging.” 

Employing legislative action would guard patients from stability billing prices by permitting insurers to foundation payment for COVID-19 exams administered out-of-network on their median in-community level, AHIP claimed.

The insurer association also wishes Congress to instruct the Facilities for Ailment Manage and Avoidance to launch assistance allowing the use of the ICD-10 COVID-19 screening take a look at code. This would permit insurers to carry out tests guidelines and extra precise coding, AHIP claimed.

In addition, AHIP would like the Facilities for Medicare and Medicaid Companies to develop HCPCS billing codes to build a process for tracking over-the-counter tests to be equipped to observe the offer chain and reconcile in opposition to quantity limits to hold keep track of of fraud and abuse.

The corporation reported it supports ongoing federal funding for broad-dependent access to above-the-counter COVID-19 exams that offer you an option to increased-priced, company or lab administered assessments. 

WHY THIS Matters

Price tag gouging in COVID-19 screening continues as a major trouble, AHIP mentioned.
“In 2021, AHIP executed a study of health and fitness insurance vendors in the professional industry to assemble information and facts on costs charged by out-of-community companies for COVID-19 checks,” the statement reported. “The results discovered that out-of-community suppliers billed substantially higher costs (much more than $185 when the normal is $130) for far more than 50 percent (54%) of COVID-19 exams. The information clearly show that the difficulty has gotten even worse – not far better – due to the fact the starting of the pandemic.”
THE Much larger TREND 

In March 2020, when Congress passed the Coronavirus Aid, Reduction and Economic Safety or CARES Act, it needed insurers to pay out the stated cash price the supplier posted on a community website for assessments to diagnose COVID-19, barring any agreement in location.

“In accomplishing so, Congress proficiently removed the skill of health insurance policies providers to negotiate far more very affordable COVID-19 screening selling prices,” the assertion explained. “Moreover, the statute precludes health care administration applications that wellbeing insurance companies could use to persuade shoppers to use in-network companies and labs.”

Insurers are also expected to go over the cost of at-residence COVID-19 tests.

Twitter: @SusanJMorse
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