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Puerto Rico lab association: Gov’t plan, Medicare Advantage cuts affecting patient health

By on June 13, 2018

SAN JUAN – The decreased rates insurers pay providers of the Puerto Rico government’s Mi Salud health plan and Medicare Advantage plans are affecting patients because they limit needed tests, the island’s Clinical Laboratories Association (ALC by its Spanish initials) said in a statement.

“They are depriving our patients of benefits and services. Equally, strangulating the clinical laboratories,” warned Alba Rivera, president of the ALC. “With control of the market insurers have, they have imposed absurd reductions to the rates they pay to laboratories, affecting the health of patients by making it impossible for them to take necessary tests that cost much more than what medical plans pay for.”

Rivera, who is also a hospital and health services administrator, explained that, “generally, these tests are sent to reference laboratories because of their high cost for community laboratories.” She added that “reference laboratories refuse to accept the samples, perform testing and bill these plans because the rates they pay do not cover costs and insurers refuse to cover the costs of the tests even if they are included in the coverage.”

Rivera mentioned “the example of an associate laboratory that received a patient from Mi Salud for a test that the most inexpensive reference laboratory charges $120, while others charge up to $285, and the insurer only pays $12.20. The patient, a baby, was left without having the test done because the plan refused to pay the cost.”

She also wrote about another case, a Medicare Advantage patient who needed 15 specialized tests, “for a reference cost of $702.50 while the plan pays $321.35 and, again, the reference laboratories refused to do the tests because the plan refused to pay the costs. The patient also was left without the tests he needed.”

“Again, we call on the Health Insurance Administration of Puerto Rico [ASES by its Spanish acronym] and its Board of Directors so that in order to protect and guarantee services to our patients, they reconsider the establishment of payment for services that are 30% below Medicare rates, when laboratories, including reference ones, cannot do the tests for even 100% of the Medicare rates established for Puerto Rico,” said Rivera, who predicts the closure of more than 50 clinical labs if this does not occur, “affecting public health” and the island’s economic development.

.”We reiterate our request for ASES to evaluate our proposals to control expenses and discard the actuarial study based on reductions of 20% and 30% to Medicare rates for laboratories, radiological centers and different types of medical specialists,” Rivera emphasized.

“We are concerned that ASES, however, included a striking increase in insurer premiums of 6.3,” the association president added. “It is imperative and necessary that both La Fortaleza [the governor’s office] and the Legislature take action in this matter to end this unfortunate situation once and for all, which affects both patients and providers, by taking measures to prevent the collapse of the health system and health of our people.”

She further said that “Our health system is in a serious situation due to financial and infrastructure limitations, factors that, according to the Commonwealth Fund, contributed to hundreds or thousands of deaths as a result of Hurricane Maria; therefore, the government should seek more good use of the funds destined for healthcare.”

Rivera also recalled that she wrote to Senate Health Committee Chairman Ángel “Chayanne” Martínez, to address the ALC’s complaints and learn about the status of public hearings held in April but that “coincidentally have not been rescheduled.”

The Puerto Rican Association of Private Clinical Laboratory Owners Inc. was founded in 1969, and includes more than 500 laboratories, according to the group.

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