Labs call on Health Insurance Administration to address multiple claims

Association of Clinical Laboratories has ‘filed complaints to investigate the discriminatory and abusive actions’ of insurers

SAN JUAN — The Association of Clinical Laboratories (ACL), which represents about 200 facilities in Puerto Rico, is urging the Health Insurance Administration’s (ASES by its Spanish Acronym) board to investigate the government agency’s claims process to determine why multiple complaints filed by the labs have yet to be addressed, ACL President Juan Rexach said.

“Since April we have filed complaints with ASES to investigate the discriminatory and abusive actions of the country’s insurers, and this agency has turned a blind eye. For this reason, we present this request for an investigation to the Board of Directors, headed by the Health secretary, Lorenzo González, from whom we await his intervention to enforce the essential functions of this agency,” said Rexach, who was accompanied by the association’s legal adviser, Luis E. Romero.

According to ACL’s petition, among the issues ASES has yet to resolve is the decision of insurers to reduce the fees paid to laboratories by up to 70%. ASES was also requested to adopt the guidelines issued by the Centers for Medicare and Medicaid Services (CMS) in a normative letter that incorporates a new, increased fee for clinical laboratories for certain Covid-19 tests.

“We are concerned that this situation occurs in an agency that has had serious allegations of corruption in the past, precisely because of actions where insurers have been favored, to the detriment of Providers,” Romero stated.

Among the reasons that motivated the fee review are the costs involved in administering the tests, the sophistication that the processing of samples requires from labs, and other operational factors. However, in Puerto Rico, most insurers chose to impose the codes used by ASES in the Government Health Plan (PSG by its Spanish initials) for Medicare and Medicaid patients, which prevents them from covering the costs of administering coronavirus tests or those associated with providing the service.

“We hope that the ASES Board of Directors will establish the rigorous guidelines necessary for this agency to fulfill its obligations. We are seeking payment for medical-hospital services to be guaranteed for the beneficiaries of the PSG, as well as a fair payment for the services offered by clinical laboratories, and [for ASES] to order the reimbursement to the community laboratories for the money that has been illegally withheld by the insurers as a result of the illegal reduction of rates that have been observed since 2017,” Romero stressed.

“Undoubtedly, the delay in investigating and resolving all these issues is to the detriment of patients since in the end they are the ones who suffer the consequences of seeing the services they receive from the laboratories limited,” the attorney added.

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