One other Blue Cross and Blue Protect insurer sued GS Labs over its COVID-19 assessments on Thursday, alleging the nationwide testing facility compelled commercially insured clients to take pointless, costly assessments to fleece Premera Blue Cross out of $26 million.
The go well with, filed within the U.S. District Courtroom for the Western District of Washington at Seattle, represents the second criticism towards Omaha, Nebraska-based testing firm. In July, BCBS Kansas City accused GS Labs of trying to revenue from the general public well being disaster by upcharging the not-for-profit insurer $9.2 million for COVID-19 assessments. GS Labs responded by counter-suing BCBS Kansas Metropolis, accusing the insurer of “authorized bullying” by submitting a shock lawsuit supposed to stiff the corporate out of paying for some 34,600 member claims. The case is pending.
On the time, the AHIP insurance coverage lobbying group mentioned BCBS Kansas Metropolis’s go well with represented the primary insurer criticism within the nation. The advocacy group mentioned it was not conscious of another lawsuits towards testing suppliers apart from GS Labs, which additionally faces questions from state regulators. GS Labs mentioned its costs replicate the greater than $100 million its homeowners have invested to construct its testing services, a spokesperson wrote in an electronic mail. The corporate is part-owned by Gabriel Sullivan, who faces an ongoing go well with from a earlier healthcare employer that accuses him of inappropriately billing insurers. GS Labs mentioned it conducts “one out of each 4 or 5” COVID assessments in Washington day by day, the spokesperson wrote.
“Premera is making report margins and accumulating report reserves within the billions of {dollars} and now desires to close down one of many largest suppliers of COVID testing within the state,” the spokesperson wrote. “Whereas Large Insurance coverage feels compelled to place communities in danger with a harmful lawsuit like this, we is not going to be deterred.”
Like BCBS Kansas Metropolis, Premera Blue Cross seeks a declaratory judgment that forestalls the insurer from having to pay 80,000 claims associated to coronavirus testing accomplished by GS Labs, which operates 27 places throughout 13 states. The Coronavirus Help, Aid, and Financial Safety Act requires insurers to cowl testing with out cost-sharing through the public well being emergency, and instruct insurers to pay out-of-network suppliers their listed money worth. The regulation is silent on how a lot a well being plan should pay if it can’t agree on a negotiated charge with a supplier, nonetheless.
GS Labs prices about 10 occasions what Medicare reimburses clinicians for administering a COVID-19 antigen take a look at, and twice as a lot for administering extra superior PCR assessments, the criticism says. Fifteen p.c of hospitals within the U.S. cost related charges, an April evaluation from the Kaiser Family Foundation discovered. In June, the insurance coverage lobbying group AHIP reported that insurers throughout the nation are being “price gouged” by out-of-network COVID-19 testing facilities, that are performing extra diagnostic, antibody and antigen assessments than ever. In the meantime, GS Labs accepted money funds from shoppers for as much as 70% of what it charged insurers.
Along with the “terribly excessive charge it calls for” from insurers, GS Labs additionally carried out a number of, pointless assessments on a single particular person, as a method to submit as many claims as potential to insurers, the criticism mentioned. For commercially-insured people to ebook a web-based appointment, they have to consent to obtain a fast antibody, antigen and PCR take a look at, the lawsuit mentioned. In the meantime, money pay sufferers should choose a particular take a look at to ebook an appointment.
“As a result of GS Labs buries this info in a “clickwrap” settlement, sufferers usually usually are not conscious that they’ve agreed to this uncommon time period,” the lawsuit says.
The insurer additionally contends that GS Labs’ delay in processing testing has exacerbated the general public well being disaster. In a single occasion, the corporate didn’t inform shoppers their outcomes for 2 weeks, resulting in a person who examined optimistic to “stroll round with COVID for per week,” doubtlessly spreading the virus, in response to a report in KCTV.
Premera is just not the one group questioning the costs of GS Labs, which is owned by Omaha, Nebraska-based Metropolis Ventures developer.
In December, the Kansas Insurance coverage Division started investigating a GS Labs facility that was charging $1,000 for assessments, which the state’s common counsel mentioned was higher-than-average.
