Labs Demand Insurers Pay for COVID-19 Tests
Association Claims Lack of Compliance With Federal Law
SAN JUAN — The Association of Clinical Laboratories of Puerto Rico (ACL) denounced that local insurance companies are not complying with the federal guidelines for the coverage of detection tests for the coronavirus SARS-CoV-2 (Covid-19), and that they have established their own billing and payment policies, including the use of codes and rates not accepted by the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS).
“The local insurance companies, both those contracted by ASES [Spanish acronym of the Health Insurance Administration] for the Government Health Plan, as well as Medicare Advantage plans and private plans, are not following the guidelines established by the federal government for the fulfillment of the payment corresponding to the laboratories. Some medical plans are even generating retroactive collections against clinical laboratories claiming that sampling is part of the test; this, in violation of federal guidelines and the Health Insurance Code,” ACL Chairwoman Laura Trujillo said a press release.
“Clinical laboratories have paid substantial amounts of funds to offer COVID-19 diagnostic tests to the public. The lack of payments and the aforementioned collections by the insurers make the economic situation of the clinical laboratories in Puerto Rico precarious, and in turn, the adequate provision of health services to the people,” Trujillo stressed.
“None of the dependencies of the executive branch related to this situation, such as ASES, the Office of the Commissioner of Insurance and the Department of Health, has managed to implement the CMS guidelines to oblige insurers operating in Puerto Rico to cover the tests and the taking of samples, as required by the federal and state governments,” she added.
The association sent letters to the presidents of both legislative branches, and to the insurance commissioner, demanding an investigation of the insurance companies in order to monitor compliance with Regulatory Letter CN-2020-289-D, of December 11, 2020 and CN-2021-292-D, of January 28, 2021, which require insurers in Puerto Rico to compensate providers in certain cases.
In accordance with the provisions of the Coronavirus Aid Relief and Economic Security Act (Cares Act), the legal mechanism by which federal funds were allocated to pay for pandemic-related services, “Puerto Rico receives a substantial amount for the payment of the tests for the detection of COVID-19 and remit the corresponding payment to the clinical laboratories,” the release reads.
“We believe that this highly worrisome situation puts the public health of our country at risk and threatens the existence of more than 800 community clinical laboratories around the island,” Trujillo said.