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A state court jury in West Palm Beach, Florida, awarded a verdict to a toxicology lab earlier this month in connection with a $3.1 million insurance billing dispute.
The lab, American Clinical Solutions, sued Triple-S Salud in 2016 over allegations that Triple-S Salud had ignored 25,648 claims for drug tests and had not given it clear answers about whether claims would be paid.
ACS is a big drug testing services provider based in Sun City Center, Florida.
Triple-S is the Blue Cross Blue Shield health insurer in Puerto Rico. GuideWell, the company that owns Blue Cross and Blue Shield of Florida, which is also known as Florida Blue, acquired TripleS in 2022.
Representatives for ACS and Triple-S could not immediately be reached for comment.
Lawyers at White & Case, the firm that represented ACS, estimated in an announcement of the verdict that the total size of the judgment will be $6 million.
What it means: Many health care providers, health insurers and health plan administrators end up settling out of court, and the amounts are not always announced.
In this case, a jury awarded providers an average of about $240 per disputed drug test claim. The amount could help employers, benefits administrators and plan administrators estimate how much Florida juries might award in other billing disputes.
The case: Most of the patients involved in the ACS case sought care in Puerto Rico.
Providers sent samples to ACS, which was not in the Triple-S network, because comparable services were not readily available in Puerto Rico, according to court filings.
Over the years, one dispute was over whether a Florida court should have jurisdiction over the case. A state appeals court panel ruled 2-1 in 2022 that a Florida court could hear the case, in part because the plaintiff is based in Florida and Triple-S had 8,757 insureds with home addresses in Florida. One judge on the appeals court ruled against letting a Florida court handle the case, noting that, as of 2015, Triple-S had made no effort to create contacts in Florida.
A recent dispute related to the language ACS could use when talking to the jury about why doctors in Puerto Rico had ordered the drug test. Triple-S received a court ruling stating that ACS witnesses could not mention the "term 'Zombie Island' or similar inflammatory descriptive words for the drug use in Puerto Rico at the relevant times," according to an order issued by Circuit Judge Gregory Keyser Nov. 2.
Keyser also discouraged ACS from referring to an ACS study indicating that many patients in Puerto Rico lie about whether they had been using illegal drugs.
"Excessive focus on the drug use in Puerto Rico, especially with inflammatory language like 'Zombie Island,' could be prejudicial to the defense," Keyser said in the ruling.
The backdrop: Providers have filed many suits against insurers, health plans and plan administrators over payment of out-of-network claims in recent years, with many providers accusing payers of using systematic strategies to reduce or ignore payment obligations.
The insurers and plan administrators have filed many suits of their own against the providers, accusing the providers and their billing representatives of using aggressive strategies to puff up the size of claims and to seek payments for care that was not provided.
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