March 29, 2020 / RACHEL COHRS
Congress has spent months in stalemate over how best to protect patients from surprise out-of-network medical bills, and lawmakers’ efforts to keep COVID-19 tests affordable for patients could prove an informative test case.
Insurers claim that new laws passed in response to COVID-19 could allow out-of-network labs to name astronomically high prices for tests, while labs say that insurers could negotiate to drive payments below what tests cost.
Congress’ second COVID-19 relief package forced private health plans, Medicare, Medicaid, Medicare Advantage and other public payers to provide beneficiaries coronavirus testing with no cost-sharing. It also set aside $1 billion to reimburse providers for testing uninsured people.
Lawmakers waded into the issue of testing reimbursement in a massive economic stimulus package that President Donald Trump signed Friday. Early drafts of the bill would have required insurers to pay out-of-network labs the cash price labs posted on their websites. The final bill was tweaked to allow insurers either to pay the posted cash price or negotiate a lower price with out-of-network labs.
Payers and labs disagree about what would happen if an insurer tried to negotiate a lower price, but the two sides were unable to agree.
Pacific Business Group on Health health policy director Shawn Gremminger said it appears that a lab could refuse to negotiate a price, and insurers would then be legally obligated to pay a “cash price” that could have little relationship to the actual cost of a test or to Medicare rates. Medicare has announced it will reimburse around $51 for non-CDC test kits.