Clinical labs warn insurer cuts could force closures
The Association of Clinical Laboratories of Puerto Rico has warned that further rate cuts by health insurers threaten the survival of independent laboratories and patient access to diagnostic services.
The alert follows notice from Triple-S Advantage of a reimbursement reduction of up to 25% that took effect in August.
“As dozens of hospitals are expected to close, and a significant loss of physicians and a shortage of nurses persists, the common denominator of the crisis facing our health system is the practices of insurance companies,” said Felipe Cintrón, president of the laboratory association.
“Insurance companies are benefiting from record increases in premiums while continuing to exert economic pressure on independent laboratories that provide critical diagnostic information to physicians and patients,” he said.
According to correspondence reviewed by the association, Triple-S informed laboratories that reimbursements would be cut to 85% of current Medicare rates, representing an effective reduction of 25% to 27%.
Triple-S announced the change in June in accordance with new rates set by the Centers for Medicare and Medicaid Services for 2025. The company said the update followed contractual parameters.
“We’re surprised that, despite having been notified two months in advance, it is only now — at the end of September — that a reaction from the Laboratory Association has been made public,” said Edward Zayas, chief communications officer at Triple-S.
“We reiterate that the relationship with our health care providers — including laboratories — has always been open, transparent and professional, and this occasion was no exception,” he said. “We maintain constant dialogue with our network and deeply value the collaboration with all who are part of it. Our priority remains to guarantee access to quality health care services for our members, within the applicable regulatory and contractual framework.”
The trade group said small laboratories in rural towns face particular risks.
“We have absorbed significant increases in raw materials, profits and workers’ compensation costs, without any rate adjustments,” said Alba Rivera-Torres, administrator of Plaza Oasis Clinical Laboratory in Santa Isabel. “This latest reduction pushes us below economic sustainability.”
An economic analysis for the association showed that while Medicare Advantage rates fell nearly 30% between 2012 and 2022, insurance premiums rose more than 40% from 2010 to 2023.
The association said it will urge ASES, Puerto Rico’s health insurance administration, and the Legislature to intervene, supporting measures such as Bill 2 of 2025, which would set minimum reimbursement rates, and Rule 91, which mandates collective bargaining between insurers and providers.
“The current situation regarding rates and payment timing is financially unsustainable,” Cintrón said.
