When Lisa Robertson sought coronavirus testing for her college athlete daughter, a pediatrician recommended a small, independent pharmacy in Arlington, Virginia.
Preston’s Pharmacy charged $35 to take a nasal swab specimen and sent it off to a lab, Principle Diagnostics, for quick results. The lab billed her insurance company $864 – more than eight times what the federal Centers for Medicare and Medicaid Services reimburses for COVID-19 tests.
“I was floored,” Robertson said.
Her daughter learned days later she did not have the coronavirus that causes COVID-19 and returned to her studies and college soccer team at Rice University. Robertson was surprised her insurer, a Blue Cross and Blue Shield plan with robust benefits for federal employees and retirees, paid the full amount, via a check that she forwarded to the Bethlehem, Pennsylvania-based lab.
The lab did not respond to questions from USA TODAY about the charges.
“Why would it cost the lab $864, and then our insurance paid” the full amount, Robertson asked. “Is the lab taking advantage of a situation and not being regulated?”
It’s a question more are raising. There have been 85 million tests administered, and congressional mandates require insurers to pay the full cost of testing, no matter how much hospitals or labs bill. As routine testing expands to workplaces, universities and professional sports leagues, labs may have found a lucrative niche amid the pandemic.
Erin Fuse-Brown, a Georgia State University College of Law associate professor who has researched medical billing, said federal legislation does not limit the amount labs and hospitals can charge for COVID-19 testing.
“It is not surprising that the price of tests are all over the map,” Fuse-Brown said. “This requirement can create incentives for labs who are out-of-network to stay out-of-network and to charge higher prices for COVID tests because insurers are required to pay for them.”
In July, the House Energy and Commerce Committee sent inquiries to 10 laboratories and hospitals about COVID-19 test prices that ranged from $300 to $6,000. The committee’s letters described the charges as “unconscionable and clearly excessive” and questioned whether the labs complied with the Families First and Coronavirus Aid, Relief and Economic Security Acts, both intended to ensure widespread testing at little to no cost for patients.
A doctor who worked for a chain of free-standing emergency rooms in Texas went to an Austin location to get a COVID-19 antibody test. His insurance plan was billed $10,984 for the test and paid the entire amount, prompting the doctor to quit the chain, ProPublica reported.
Under the federal legislation, insurance companies must cover COVID-19 testing at no cost to the patient. The legislation requires providers to post on a website the prices for testing, but the Energy and Commerce Committee noted some labs failed to meet this requirement.