Texas COVID-19 testing provider sues insurance companies over denial of reimbursement

COVID-19 diagnostic testing company Affiliates of Northeast Hou LLC has filed a complaint Monday against health plan companies Entrust LLC, doing business as 90 Degree Benefits, and Texas School Health Benefits Program for allegedly violating federal requirements to cover COVID-19 testing services.

Under the Families First Coronavirus Response Act and the Coronavirus Aid, Relief and Economic Security Act, passed by Congress in March 2020 in response to the pandemic, health insurance issuers are required to provide services related to COVID-19 diagnosis without cost-sharing requirements. such as deductibles, prior authorization or other medical management requirements. The health insurance issuers are also required to reimburse providers for the costs of testing, either at spot price indicated on the provider’s website or at negotiated rates. However, 90 Degree Benefits, which administers TSHBP health plans, rejected attempts by the complainant to negotiate reimbursement rates, refusing to place the majority of the claims submitted, according to the complaint.

“The manner in which 90 Degree Benefits adjudicated on Covid testing requests from TSHBP members is in complete conflict with Congressional and departmental intentions that no covered person should ever be financially liable for Covid testing services with respect to relates to their cost sharing and balance billing obligations,” the complaint states.

Diagnostic Affiliates is also currently in the midst of similar disputes with nearly 70 other insurers, including United Health Group Inc.

Plaintiff alleges violations of FFCRA Section 60001 and CARES Act Section 3202(a), and seeks injunctive and declaratory relief. He is represented by The Law Firm of Ebad Khan PLLC.

Kristan F. Talley