COVID-19 testing company Diagnostic Affiliates of Northeast Hou LLC filed a complaint on Monday against health plan companies Entrust LLC, operating under the name 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 diagnostic testing without cost-sharing requirements such as deductibles, prior authorization or other medical management requirements. Health insurance issuers are also required to reimburse providers for testing related costs, either at the cash price listed on the provider’s website or at a negotiated rate. However, 90 Degree Benefits, which administers TSHBP’s health plans, rebuffed attempts by the plaintiff to negotiate reimbursement rates, instead denying the majority of its submitted claims, according to the complaint.
“The manner in which 90 Degree Benefits adjudicated TSHBP’s members’ Covid Testing claims is in complete conflict with Congress and the Departments’ intentions that no covered individual is to ever be left financially responsible for Covid Testing services as it pertains to their cost-sharing and balance-billing obligations,” the complaint states.
Diagnostic Affiliates is also currently in the midst of similar litigation with nearly 70 other insurance providers, including United Health Group Inc.
The plaintiff is claiming violations of Section 60001 of the FFCRA and Section 3202(a) of the CARES Act, and is seeking injunctive and declaratory relief. It is represented by The Law Office of Ebad Khan PLLC.
