Labs Sue National Insurers for Not Reimbursing COVID-19 Testing Claims

Medical testing lab Genesis Laboratory Management is suing UnitedHealth Group for not paying claims for COVID-19 tests. The lawsuit, filed on June 2 in the U.S District Court for the district of New Jersey, claims that United Health and its Oxford Health Plans unit didn’t reimburse 51,000 claims for COVID-19 tests, in violation of both state and federal laws. New Jersey-based Genesis also claims that UnitedHealth issued burdensome requests for medical reports. “Genesis has been, and continues to be, harmed by United’s failure to pay valid claims that Genesis submitted to United for reimbursement for services to United’s members and beneficiaries,” the complaint states.

Meanwhile, it’s been reported that UnitedHealthcare recently sent out a letter reassuring its providers saying that it will reimburse pediatric and family medicine clinicians for COVID-19 tests administered in 2021.

The Genesis Lawsuit

The federal Families First Coronavirus Response Act (FFCRA) and Coronavirus Aid, Relief and Economic Security (CARES) Act require group health plans and health insurance issuers to cover COVID-19 testing services free of deductibles, copayments or any other charges to patients.

In Genesis’ complaint, the molecular diagnostic and anatomic pathology lab that provides coronavirus testing services is an out-of-network provider, “notwithstanding multiple attempts to become in-network with United.” UnitedHealth paid the majority of the lab’s claims for March, April and May 2020, but it began “systematically denying” payment for claims starting in June, even though the lab didn’t change its testing, billing or documentation practices.

Genesis contends that it has never refused to treat United members despite the insurer’s failure to pay and despite its demands that the lab “produce voluminous patient treatment and other records with tight response time demand.”

In addition to FFCRA and CARES, Genesis claims that UnitedHealthCare violated a pair of New Jersey state laws, including the:

• Healthcare Information Networks and Technologies Act; and
• Health Claims Authorization, Processing and Payment Act.

The complaint also accuses UnitedHealthCare with breach of implied contract, breach of the covenant of good faith and fair dealing, unjust enrichment, quantum meruit and promissory estoppel.

Takeaway

UnitedHealthCare, which has yet to answer the complaint, isn’t the only national insurer being sued for not paying COVID-19 test claims. Cigna, is facing similar claims from a radiology lab in New Jersey. The lawsuit accuses Cigna of wrongfully denying payment for nearly $400,000 in services provided to COVID-19 patients.