pricey testing8 Jun 2020 12:46
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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.
The issue could get more attention as New York City and other communities move to make Covid-19 diagnostic testing available to all residents, regardless of whether they are showing symptoms — with the pressure on private insurers to pay.
“Historically, it’s always been a problem for the feds to have as much clout as we’d like,” Kreidler said. He characterized his emergency order as preemptive, adding Washington state will “explore every avenue” to keep prices in check and transparent.
Tennessee's assistant commissioner of insurance, Rachel Jrade-Rice, said some health providers have backed down and issued refunds after state regulators flagged their warnings about excessive bills.
The state regulations apply only to Obamacare markets and other individual coverage, not to most workplace plans that still cover the majority of the nation's privately insured. Likewise, the states can’t dictate how labs bill for the tests.
But their actions underscore the potential for price gouging and other abuses that the Trump administration and Congress didn't fully address as they rushed to boost testing capacity in the early weeks of the pandemic.
The Trump administration issued a transparency rule that required labs and hospitals to post the cash prices for their Covid-19 tests — a move that, in theory, would limit what insurers have to pay out-of-network providers. But industry officials say the administration hasn't rigorously enforced the requirement, which carries fines, and that some hospitals and la
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