Stimulus package sets up clash over payment for COVID-19 tests

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.


Josh Sandberg

Josh Sandberg is the President and CEO of Ortho Spine Partners and sits on several company and industry related Boards. He also is the Creator and Editor of OrthoSpineNews.

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