Labs to gov’t: Order insurers to pay for COVID-19 tests
By John McPhaul
jpmcphaul@gmail.com
Laura Trujillo, president of the Clinical Laboratories Association of Puerto Rico (ALCPR by its Spanish initials), demanded on Monday that the island government order insurance companies to pay for the COVID-19 tests carried out under executive and administrative orders and orders of the Office of the Insurance Commissioner (OCS).
“Clinical laboratories have carried out their functions and have complied with social obligations following the official mandates of the different government structures,” Trujillo said in a written statement. “Now, insurers want to impose payment policies retroactively in order to recover the money paid.”
She noted that “despite the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) and the rates set by the Centers for Medicare and Medicaid Services (CMS), both the Puerto Rico Health Insurance Administration and all insurers established and imposed their own rates, some of them equal to or less than their reference cost.”
“If the government decides to change its current public policy according to its respective orders, we recommend that specific criteria be established for insurers to pay for the tests,” Trujillo said. “This public policy must be applicable prospectively.”
“We understand that some people have not used their health plan properly for a variety of reasons,” she continued. “Clinical laboratories have to accept any medical order that is duly completed and that meets the criteria for its acceptability; our responsibility is to carry out the ordered tests. Given this situation, it is not reasonable for us to be forced to participate in abusive audits where copies of medical orders and the results of all the COVID-19 tests carried out are required. These audits require a lot of staff time and significantly increase the cost of operation of clinical laboratories. Governor, the clinical laboratories have followed the orders of you and your government; we ask you to force the insurers to respect your orders, stop the abusive audits and recoveries, and likewise, make the corresponding payments.”