FRANK PALLONE, JR., NEW JERSEY

GREG WALDEN, OREGON

CHAIRMAN

RANKING MEMBER

ONE HUNDRED SIXTEENTH CONGRESS

Congress of the United States
House of Representatives

COMMITTEE ON ENERGY AND COMMERCE
2125 RAYBURN HOUSE OFFICE BUILDING
WASHINGTON, DC 20515-6115
Majority (202) 225-2927
Minority (202) 225-3641

July 1, 2020

Dr. R. William “Bill” Worden
Medical Director
Oklahoma ER & Hospital
15103 N. Pennsylvania Avenue
Edmond, OK 73013
Dear Dr. Worden:
I am writing to request information about Oklahoma ER & Hospital’s practices and
prices for diagnostic and serological tests for coronavirus disease of 2019 (COVID-19).
Pursuant to Rules X and XI of the U.S. House of the Representatives, the Committee on Energy
and Commerce is conducting oversight of the Families First Coronavirus Response Act (the
Families First Act), and the Coronavirus Aid, Relief, and Economic Security Act (the CARES
Act). The Committee’s initial examination has yielded disturbing information about the price of
COVID-19 tests, and providers’ compliance with both the Families First Act and the CARES
Act. I am concerned that some providers, including your company, may not be in compliance
with these two laws that are critical to our efforts to combat this pandemic. Additionally, I am
deeply concerned about reports that some patients are receiving surprise bills for hundreds or
even thousands of dollars for out-of-network laboratory charges for COVID-19 testing. 1 As a
result, I am seeking further information about the price that your company is billing issuers and
consumers, both uninsured and out-of-network, for COVID-19 diagnostic and serological tests
and related items and services.
The Families First Act requires individual and group market health plans to provide
benefits for certain items and services related to diagnostic testing for the detection of COVID19 without imposing any cost-sharing requirements, including deductibles, copayments, and
coinsurance. The Families First Act also prohibits prior authorization or other medical
management requirements for COVID-19 diagnostic testing. Additionally, the Families First
Act requires individual and group market health plans to provide coverage for health provider
office visits, including urgent care visits and emergency room visits, that result in an order of or
administration of an in vitro diagnostic test at zero cost-sharing.

1

Two Friends in Texas Were Tested for Coronavirus. One Bill Was $199. The Other?
$6,408, The New York Times (June 29, 2020).

 Dr. R. William “Bill” Worden
July 1, 2020
Page 2
The CARES Act requires individual and group market health plans to cover a broad
range of diagnostic items and services in order to detect COVID-19 without any cost-sharing,
including serological tests used to detect antibodies against COVID-19. Additionally, the
CARES Act requires issuers to reimburse providers of COVID-19 diagnostic testing at an
amount that equals the negotiated rate in effect prior to the public health emergency or, if the
issuer does not have a negotiated rate with the provider, the cash price for such service that is
listed by the provider on a public website. The issuer may also negotiate a rate less than the
listed cash price. The CARES Act requires providers of COVID-19 tests to list the cash price for
the service on a public website. Providers who do not comply with this requirement may face a
civil monetary penalty of up to $300 per day.
On April 18, 2020, the Trump Administration issued guidance implementing both the
Families First Act and the CARES Act. 2 The guidance required that individual and group
market health plans provide coverage for items and services related to diagnostic tests for the
detection of COVID-19, and for serological tests used to detect antibodies against COVID-19
without any cost-sharing.
The Committee has been informed of troubling instances in which providers are charging
up to $6,000 for one COVID-19 test. In a number of instances identified to the Committee,
providers are charging prices for diagnostic tests to detect COVID-19 that range from $300 to
$6,000. As of May 29, the Medicare payment rate for a COVID-19 diagnostic test is generally
under $100 per test. 3 Additionally, some providers’ public websites do not list the cash price for
the COVID-19 test as required by the CARES Act.
The Committee is also concerned by reports that consumers are receiving large balance
bills for COVID-19 testing and related services. In one instance, two acquaintances went to the
same emergency clinic to receive COVID-19 testing together. One paid the cash price of $199;
the other, who used his insurance, was charged $6,408. 4 Unfortunately, these do not appear to
be isolated incidents. 5
These examples we have received if accurate are unconscionable and clearly excessive.

2

Centers for Medicare and Medicaid Services, FAQs About Families First Coronavirus
Response Act and Coronavirus Aid, Relief, and Economic Security Act Implementation Part 42
(Apr. 11, 2020) (www.cms.gov/files/document/FFCRA-Part-42-FAQs.pdf).
3

Centers for Medicare and Medicaid Services, Medicare Administrative Contractor
(MAC) COVID-19 Test Pricing (May 19, 2020) (www.cms.gov/files/document/mac-covid-19test-pricing.pdf).
4

Two Friends in Texas Were Tested for Coronavirus. One Bill Was $199. The Other?
$6,408, The New York Times (June 29, 2020).
5

Most Coronavirus Tests Cost About $100. Why Did One Cost $2315?, The New York
Times (June 16, 2020).

 Dr. R. William “Bill” Worden
July 1, 2020
Page 3
In light of these concerns, I request documents and responses to the following questions
by July 10, 2020:
1. Please provide the Committee with all documents that describe Oklahoma ER &
Hospital’s policies regarding billing of issuers for all items and services related to
diagnostic testing for the detection of COVID-19, and for items and services related to
serological testing used to detect antibodies against COVID-19.
2. Please provide the Committee with all documents that describe Oklahoma ER &
Hospital’s policies regarding billing of individuals, including uninsured individuals and
individuals receiving out-of-network care, for all items and services related to diagnostic
testing for the detection of COVID-19, and for items and services related to serological
testing used to detect antibodies against COVID-19.
3. Please provide all available information on how much Oklahoma ER & Hospital’s
charges for a diagnostic test for the detection of COVID-19, and for serological testing
used to detect antibodies against COVID-19.
a. In responding to this request, please provide a list of all diagnostic tests your
company performs for the detection of COVID-19 and serological tests for the
detection of antibodies against COVID-19, as well as the average negotiated rate
for each test. Please provide information on the amount charged and ultimately
reimbursed in cases where there is no negotiated rate.
b. Please also provide, if applicable, information on in-network and out-of-network
rates for health provider office visits, including urgent care visits and emergency
room visits that result in an order of or administration of a diagnostic test or
serological test for COVID-19.
4. Please provide a link to the public website that lists the cash price for a COVID-19
diagnostic test and the date that the information became publicly available online.
5. Have you received complaints from consumers billed for diagnostic tests or serological
tests for COVID-19 and related items and services? If so, please provide copies and
records of all such consumer complaints, and any documentation of action you took in
response.

 Dr. R. William “Bill” Worden
July 1, 2020
Page 4
We appreciate your prompt attention to this matter. If you have any questions, please
contact Saha Khaterzai with the Committee staff at (202) 225-2927.
Sincerely,

Frank Pallone, Jr.
Chairman