Blue Cross and Blue Shield of Kansas City and GS Labs accuse each other of impropriety as they dispute the cost of Covid testing in federal court. Blue KC initiated the lawsuit, and GS Labs has filed a countersuit.

Jabs fly in Blue Cross and Blue Shield of KC court battle with Covid test supplier

Nick Moran -
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GS Labs is responding to a July 2021 lawsuit from Blue Cross and Blue Shield of Kansas City with a counterclaim that alleges the payer violated federal antitrust laws and conspired with other affiliated companies to withhold payments. The payer initially sued GS Labs alleging it charged 10 times more for COVID-19 tests than competitors, resulting in $9.2 million in "inflated and otherwise improper claims." Now, the counterclaim alleges that Blue Cross and Blue Shield of Kansas City aimed to prevent GS Labs' expansion into Missouri, conspired with other Blue Cross Blue Shield affiliates to deny payments, defamed the lab and interfered with its business relationships, according to a news release shared with Becker's. Specifically, the counterclaim alleges that various Blue Cross Blue Shield affiliates shared "competitively sensitive information" among themselves to align negotiations and deny payments. It also alleges that Blue Cross and Blue Shield of Kansas City investigators provided false information to state and federal regulators. "The conduct of Blue KC in trying to destroy a business that provides critical COVID-19 testing is disturbing, especially at a time when the Omicron variant has made testing more difficult to find and more important than ever," said Kirk Thompson, a partner with GS Labs. "Given Blue KC's refusal to negotiate in good faith, we forge ahead with the counterclaims to protect patients and our business." Blue Cross and Blue Shield of Kansas City did not respond to Becker's request for comment. GS Labs has been surrounded in lawsuits since the second quarter of 2021. Two Blue Cross Blue Shield affiliates sued the lab over alleged COVID-19 test price inflation, and GS Labs sued Minnesota-based Medica alleging it withheld $10 million in test payments.

GS Labs hits BCBS of Kansas City with counterclaims, alleges antitrust, defamation violations

By MARGARET STAFFORD - Associated Press
Dec 9, 2021
Blue Cross and Blue Shield of Kansas has changed a policy that denied sex reassignment surgery to people who did not legally change their names, the company confirmed Thursday. The change came after the American Civil Liberties Union of Kansas and the Transgender Legal Defense and Education Fund raised the issue on behalf of Charley Osman, a transgender man, who was rejected after he sought pre-authorization in June for two surgeries. “I’m pretty sure I’m not the first person to go through this, but I want to be sure I’m the last,” Osman said in a news release issued by ACLU Kansas. “This is an incredibly expensive surgery, and for a long time I was afraid I wouldn’t be able to have it. I’m very glad Blue Cross Blue Shield changed their policies so that no one else has to go through what I did.”
Several medical providers agreed Osman’s surgery was medically necessary, ACLU of Kansas said. The organizations sent a letter to Blue Cross Blue Shield on Osman’s behalf in August saying the name change requirement was outdated, inconsistent with medical standards, discriminatory and illegal. With the policy change, Osman will undergo the surgeries by the end of the year, according to the statement. Blue Cross and Blue Shield of Kansas said it makes decisions based on feedback and insights from its members. “Policies are important to ensure we keep costs down and insurance affordable," the company said in a statement. "However, we are constantly reviewing and updating these policies to meet the evolving needs of our members, and this is a good example of that process working.”
Ezra Cukor, senior staff attorney with the Transgender Legal Defense and Education Fund, said many transgender people may not want to change their names. Legal name changes can also be expensive and time consuming and have no relation to medical necessity, she said. “We’re glad that BCBS of Kansas stepped up to change this antiquated policy requirement," said Sharon Brett, legal director for the ACLU of Kansas. "This is an important first step toward ensuring that Blue Cross/Blue Shield of Kansas provides care that is inclusive, non-discriminatory, and rooted in clinical standards.”
Thomas Witt, executive director for Equality Kansas, the state's leading LGBTQ advocacy group, praised the change. “Transgender Kansans have struggled for years overcoming disparities in access to health care and insurance,” Witt said in a statement. "Today’s news signals another step forward for LGBTQ Kansans on our long road to full equality.”
The insurance company's new policy lists 18 procedures often associated with gender reassignment that it said are considered cosmetic and will not be covered. Those include such things as breast or calf implants, hair removal, voice modification or chin reshaping. Brett said the two advocacy groups will continue to work with Blue Cross and Blue Shield Kansas for policy changes to ensure other subscribers are not denied "medically necessary care.”
Copyright 2021 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed without permission.

Blue Cross of Kansas changes policy on transgender surgery

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AUSTIN, Texas, Dec. 6, 2021 /PRNewswire/ -- Iris Healthcare , the leading provider of Advance Care Planning (ACP) solutions for health plans and provider groups, and  Blue Cross and Blue Shield of Kansas City (Blue KC), the largest not-for-profit health insurer in Missouri and the only not-for-profit commercial health insurer in Kansas City, are announcing a new partnership to offer advance care planning to Blue KC's Medicare Advantage and commercial members. Iris will provide ACP services through the Premier program, an innovative, comprehensive ACP intervention designed to engage seriously ill members to better align their goals of care. Iris specializes in creating high-quality advance care plans by providing individuals with a tailored, person-centered experience. Their expert healthcare facilitators provide supportive guidance for individuals and their loved ones through the full lifecycle of ACP including discussion, documentation, and distribution. Their high-touch approach helps individuals make educated, scenario-based decisions about their future care goals, to advocate for their future care and to feel empowered in their care decisions. "The Iris Premier program will help our members and provider partners navigate serious illnesses.'' said Dr. Tracy Miles, Medical Director of Oncology at Blue KC. "Having Iris's experts provide dedicated one-on-one time to walk through the different treatment options and paperwork will relieve the burden for providers and improve care for our members in line with their individual goals." The Iris suite of digital ACP solutions provides the framework to support Blue KC's provider partners and their staff by easing the burden of time intensive and sensitive conversations, allowing clinical teams to focus on providing excellent care. "Our new partnership will empower their most vulnerable members to receive the care they want, and avoid care they don't want." said Steve Wardle, CEO of Iris. "We are honored to be working with Blue KC and serving their members with this beneficial service." About Iris
Iris partners with at-risk healthcare organizations to scale the delivery of Advance Care Planning to their member populations by leveraging a telehealth model and risk-stratification to match our ACP solutions to a population's risk level. Our ACP solutions allow you to provide a meaningful and beneficial program to your patients while taking the burden off internal resources, driving appropriate care utilization, recognizing cost savings, and delivering quality care. About Blue Cross and Blue Shield of Kansas City
Blue Cross and Blue Shield of Kansas City, the largest not-for-profit health insurer in Missouri and the only not-for-profit commercial health insurer in Kansas City, has been part of the Kansas City community since 1938. Blue Cross and Blue Shield of Kansas City provides health coverage services to more than one million residents in the greater Kansas City area, including Johnson and Wyandotte counties in Kansas and 30 counties in Northwest Missouri. Our mission: to provide affordable access to healthcare and to improve the health of our members. Blue Cross and Blue Shield of Kansas City is an independent licensee of the Blue Cross and Blue Shield Association. For more information on the company, visit its website at BlueKC.com. Media Contact:

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Iris Healthcare and Blue KC Partner to Offer Advance Care Planning to Medicare and Commercial Members

COVID-19 Pandemic Spotlights Need for Better Access to Behavioral Health Care
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SAN FRANCISCO, Oct. 19, 2021 /PRNewswire/ -- Blue Cross and Blue Shield of Kansas (BCBSKS) and MiResource announced they have launched a free resource, MiResource  to help guide Kansans through the process of searching for and connecting with the right mental health care. "With demand for mental health services skyrocketing during the pandemic, many Kansans are seeking mental health care for the first time. Deciding that you're ready to find help is a big first step, but this process can be time consuming and difficult," said Matt All, BCBSKS President/CEO. "MiResource helps solve that problem for all Kansans to find the care they need quickly and with less confusion." This BCBSKS initiative will address mental health conditions, such as depression, anxiety, and substance use disorder, by providing the MiResource solution  to any person in the State of Kansas regardless of BCBSKS membership. MiResource allows users to anonymously filter through providers by specific patient needs such as conditions treated, location, language, availability, preferred payment method and much more. This solution connects Kansans with in-person and virtual mental health providers that best fit their needs. MiResource also enables mental health professionals serving Kansans to quickly and easily post their specialties and availability online. This unique platform allows patients to get to know these professionals' qualifications and personal dispositions to better match patient preferences for treatment. "MiResource is excited to transform the way Kansans access mental health care" said Mackenzie Drazan, CEO of MiResource. "We created MiResource because I watched my sister struggle and fail to find the right care in her darkest moments. We are thrilled to partner with BCBSKS so that no Kansan must struggle the way my sister did. I applaud BCBSKS's commitment to making mental health care a priority for all Kansans to quickly and easily get the most appropriate mental health care for their unique needs." Since the COVID-19 pandemic, Americans are reporting significant and sustained increases in symptoms of depression and anxiety. According to a Kaiser Family Foundation poll, more than half of American adults believe the COVID-19 pandemic is taking a toll on their mental health. In October 2021, BCBSKS launched the New State of Mind Campaign to encourage Kansans to open the conversation around mental health. Thousands of people accessed the site and utilized its resource guides, assessment quizzes, toolkits and wellness media library to help themselves or loved ones find a starting point for seeking the help they need. MiResource enables this campaign as an easy and free way for Kansans to evaluate their need for care and identify a provider that fits their needs. About MiResource
MiResource makes it easy for people to connect with the right mental health care for their needs. We leverage advanced technologies to enable the entire spectrum of care options, professionals, and programs, to share their availability, specialty, identity and more, providing our users with the information and support they need to find the right match. Backed by venture funding from top investors including Draper Associates, The One Mind Institute, What if Ventures, and Royal Street Ventures and more. MiResource partners with health insurance plans, and health systems across the country to help people get the care they need. Our current network of more than 5,000 health care providers helps people get the personalized support and resources they need to manage their mental health. About Blue Cross and Blue Shield of Kansas
For more than 75 years, Blue Cross and Blue Shield of Kansas has built a reputation of trust with its members and contracting providers by providing outstanding customer service while quickly and accurately processing claims; fairly administering benefit plans and contracts; offering programs, services and tools to help members improve or maintain their health; and operating under the highest ethical standards while being good stewards of premium dollars. Blue Cross and Blue Shield of Kansas is an independent  licensee of the Blue Cross Blue Shield Association and is the state's largest insurer, serving all Kansas counties except Johnson and Wyandotte. For more information, visit bcbsks.com . Blue Cross and Blue Shield of Kansas is an independent licensee of the Blue Cross Blue Shield Association. BLUE CROSS®, BLUE SHIELD® and the Cross and Shield Symbols are registered service marks of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Blue Cross and Blue Shield of Kansas serves all Kansas counties except Johnson and Wyandotte. Blue Cross and Blue Shield of Kansas contracts with MiResource to provide mental health resources to members. MiResource is not affiliated with Blue Cross and Blue Shield of Kansas. SOURCE MiResource

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Blue Cross and Blue Shield of Kansas and MiResource Partner to Connect Kansans To The Right Mental Health Care

Nymbl Science provides training that helps maintain and improve balance for a better quality of life at every age. Nymbl combines medical science and mobile wearable technology to improve balance and prevent falls. Nymbl movement sensors, worn on ankle bands, together with a smartphone app measure, track and train the balance of users in just a few minutes a day.

Nymbl Science

Nymbl Science has partnered with Blue Cross and Blue Shield of Kansas City to help improve the lives of Blue KC 's older adult population with Nymbl Science 's evidence-based and scientifically proven fall prevention program .

Nymbl Advances Efforts to Prevent 1 Million Falls Among Older Adults by Partnering with Blue Cross and Blue Shield of Kansas City.

Buck provides integrated HR and benefits consulting, administration and technology services. It is based in New York.

Buck

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Zero provides a way for self-funded employers to lower plan costs while improving employee benefits. The company works with employers and providers to build an entirely new ecosystem of healthcare delivery and everybody wins.

ZERO Health

Wellframe is a digital health company providing care transformation services, a patented engagement platform, clinical programs that support the clinical and social determinants of health, and rigorous measurement.On October 19th, 2021, Wellframe was acquired by HealthEdge. The terms of the transaction were not disclosed.

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Blue Cross and Blue Shield of Kansas City (Blue KC) is a health insurance solution company. The company offers health insurance plans for groups, employers, individuals, and families. It is based in Kansas City, Missouri.

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