Last year United Health Care, UHC, the nation’s largest health insurer, reported $257.1 Billion in revenue and $22.4 Billion in profit. It is very easy for someone to view those numbers as outrageous and ridiculous. Unfair might even enter one’s mind. I am not one of those people.
The Right to Profit
We live in the greatest country in the world, and I believe in our capitalist society. If you have a product people want and they are willing to pay, you have a right to make as much money as you are legally allowed. However, (you didn’t think I was going to sing the praises of UHC, did you?) when I read about a laboratory who UHC owes $20,419,169, it galls me to read about their revenues. What is worse, UHC owes this lab over 20 million dollars for COVID tests.
Illegal Reviews
One of the tactics UHC has employed, which we also see in our lab, is the disingenuous and illegal claim that it must review detailed clinical records to determine a patient’s symptoms to determine if the COVID test they received was medically necessary. The CARES act, along with the Families First Coronavirus Act (FFCRA) both state that insurers cannot use medical screening criteria to deny claims for COVID-19 testing. Even to those with the worst vision, it is obvious to see the delay tactic involved with this. The irony is even though this lab has not been paid the money UHC owes them, they have never refused to perform a COVID test, all at a cost to them.
Frivolous Record Requests
An additional tactic, one we also see from UHC and other insurers, is the request for information from the lab that only the requesting physician would have. The lab is tasked with requesting all documentation from the providers ordering the testing, which puts a ridiculous burden on providers who were inundated with sick and frightened patients needing COVID tests during the height of the pandemic. This unreasonable, and in many ways morally reprehensible, request of medical records from providers for COVID tests is just one of the reasons for the lawsuit.
Accountability From UHC
There were very few, if any exceptions, to the obligations of payers to cover COVID-19 tests. Our country was in the middle of a pandemic, and there were a lot of terrified people wondering if they had COVID or not. Labs throughout the country stepped up, many working 24/7 to provide the testing required to give those afraid citizens the answers they needed. Our lab was one of many who experienced the shortage of materials and the added expense of materials necessary to perform the number of COVID tests requested. To be denied or experience delays in payment for conducting such tests is, in a word, criminal. It would be nice to see UHC held accountable and have to pay, what amounts to a drop in a bucket to them, what they owe this lab.
As I always do, I would like to thank all of you for trusting us with your business.
President/CEO Industry Lab Diagnostic Partners