GS Labs, LLC V. Medica Insurance Company

Why this Matters
The plaintiff, a clinical lab, argues that a health insurance company’s refusal to properly reimburse for COVID-19 testing services violates the Coronavirus Aid, Relief, and Economic Security (CARES) Act. The CARES Act specifies that health insurers must provide coverage for COVID-19 testing without requiring any cost sharing on the part of patients. It also requires insurers to reimburse testing providers (both in- and out-of-network) for conducting such testing. But the law’s requirement that health insurers pay an out-of-network provider of COVID-19 testing a “cash price” listed on their public website— rather than a market-determined price or amount keyed to Medicare payment rates — has the potential to inflate costs for out-of-network COVID-19 testing.

Potential Impact
The lack of guardrails related to capping payment rates for out-of-network COVID-19 testing services can drive up the costs of such testing.