Charges of COVID-19 Diagnostic Testing and Antibody Testing Across Facility Types and States

Excerpt

The high charges for COVID-19 testing by some healthcare providers have received broad media and public attention.¹ Individual providers determine their own charge, which does not vary with insurance type.^{2, 3} The charges for COVID-19 testing have important implications for out-of-network plans, uninsured patients, and other payers with little negotiating power. The CARES Act requires that private plans that do not have a negotiated rate with the provider pay the price publicly listed by the provider for COVID-19 testing, which is usually the same as or a percentage of the charge.^{4, 5} Providers that have tested uninsured patients can choose to either seek reimbursement from the Department of Health and Human Services or bill uninsured patients at a self-determined price, which equals the charge unless the provider offers a discount. Therefore, the higher the charge for COVID-19 testing, the higher the potential cost exposure of plans without negotiating power and of uninsured patients. Nationwide COVID-19 testing charges across facility types remain unexplored. In this study, we aim to examine the charges for the most commonly performed COVID-19 diagnostic test (CPT code: 87635) and antibody test (CPT code: 86769) across facility types and states. …