Blue KC is Committed to Protecting Members from Abusive Billing Practices
Blue Cross and Blue Shield of Kansas City (Blue KC) has reached a settlement in its lawsuit against GS Labs, LLC. The lawsuit sought a judgment holding that neither Blue KC nor its members would be required to pay GS Labs’ excessive reimbursement demands.
After receiving GS Labs’ initial claims, Blue KC attempted to negotiate reasonable payment rates for all substantiated diagnostic testing claims. But GS Labs continued to insist on inflated reimbursement rates many times higher than other providers in the Kansas City metropolitan area. ($380 per rapid antigen test – tests which can be purchased over the counter for $10 each.)
When ongoing due diligence uncovered not only unusually high reimbursement demands but duplicative testing and critical record discrepancies, Blue KC filed the lawsuit asking the Court to prevent GS Labs from billing Blue KC members for testing Blue KC refused to cover.
“Throughout the pandemic, Blue KC worked diligently to provide support for our members – including access to COVID-19 testing,” said Dr. Greg Sweat, Blue KC Senior Vice President and Chief Health Officer. “We worked with approximately 1,300 providers who accepted reasonable reimbursement rates for testing services, so it was important that we take this step to hold GS Labs, LLC accountable.”
As part of the settlement, Blue KC will reconsider paying certain nonduplicative GS Labs claims that have been substantiated by records, at considerably reduced rates. Blue KC received more than $25,200,000 in claims from GS Labs but, as a result of the settlement, it anticipates paying GS Labs less than $500,000 for verified, nonduplicative testing.
GS Labs also agreed it would not attempt to bill or take other collection actions against Blue KC members. In addition, GS Labs agreed to refund any Blue KC member that paid GS Labs an out-of-pocket fee. If you paid an out-of-pocket fee directly to GS Labs and it has not been refunded, you may contact GS Labs at email@example.com to request a refund.
Not only will the settlement require GS Labs to refund Blue KC members that paid GS Labs out of pocket, Blue KC was also able to secure claims adjustments for certain group health plans.
Additional terms of the settlement were not disclosed.