UnitedHealthcare Pushes Back Start Date for Making Claims-Payment Decisions Based on its Florida Pilot Management Program for Medical Laboratory Tests
Health plan sets no new date for BeaconLBS claims-payment decisions but promises 30-days’ notice before making decisions on claims payment
Physicians, pathologists, and clinical laboratories in Florida got a late Christmas present last week. UnitedHealthcare (UHC) (NYSE:UNH) postponed the date when its medical laboratory benefit-management pilot program in Florida, administered by BeaconLBS, would affect claims payments.
This was welcome news, because, beginning January 1, if physicians serving UHC patients had failed to use the BeaconLBS system to obtain pre-notification or pre-authorization for 82 medical laboratory tests, the physicians or labs performing the tests would not be paid by UHC—nor could clinical labs and pathology groups in the UHC provider network bill patients for these tests.
BeaconLBS Program Is Unpopular with Florida Physicians
It was the third time UHC has changed an implementation date for the program, which has been unpopular with physicians and pathologists since it went into effect on October 1, according to physicians and pathologists interviewed by our sister publication, The Dark Report. Rather than use the program, some Florida physicians are seeking to get out of their UHC contracts, sources told The Dark Report. The physicians say BeaconLBS is onerous, time-consuming, and could have an adverse effect on patient care.
UHC did not set a new date for making claims payments decisions under the BeaconLBS system. Instead, the health insurer said it would give providers 30 days notice before it uses the system to make claims payment decisions. In May, UHC said the program would go into effect on September 1. Then it moved that date to October 1 when it required physicians to use the system, but said it would not use the system to make decisions on claims payments. That date was set for January 1, but has now been moved indefinitely.
Doctors Must Obtain Pre-Notification when Ordering Certain Lab Tests
A subsidiary of Laboratory Corporation of America (NYSE: LH), BeaconLBS is under contract with UHC to implement the decision-support program for physicians serving members of UHC’s commercial HMO in Florida. Physicians serving these patients must use the BeaconLBS program to obtain pre-notification from UHC whenever they order from a list of 80 clinical laboratory tests, some of which are routine and recommended tests with well-established medical protocols. Florida physicians also must use the program to get UHC to preauthorize orders for two genetic tests for breast cancer (BRCA1 and BRCA2).
Once UHC starts using BeaconLBS to make claims payment decisions, clinical laboratories may not get paid if physicians do not use the program when ordering these tests. Clinical labs would have 10 days from the initial test order date to have physicians file pre-notification or preauthorization requests in the BeaconLBS system.
UnitedHealthcare Won’t Pay Labs If Doctors Don’t Get Pre-Notification
If the physicians still do not file pre-notification or preauthorization requests, clinical labs would not be paid. Also, clinical labs in the UHC network that are not paid for these tests would be unable to bill patients, said UHC’s Elizabeth Calzadilla-Fiallo, UHC Director of Public Relations for Florida and the Gulf States Region. Out of network labs could bill patients if their physicians fail to use the BeaconLBS system when ordering any of the 82 tests, she added.
In an interview with The Dark Report, Calzadilla-Fiallo explained that postponing the implementation date should not be interpreted as resulting of negative feedback from physicians or pathologists. Instead, she said, “We have lifted the January 1 claims impact deadline in order to give providers additional time to become further familiar with all aspects of the pilot program and allow for the continued exchange of constructive feedback.”
The January 5 issue of The Dark Report has the full interview with Calzadilla-Fiallo, along with detailed stories about the criticisms Florida physicians have with the UHC program and BeaconLBS system.
Physicians Say Use of BeaconLBS System Could Delay Patient Care
Physicians and pathologists in Florida have told The Dark Report that they find the program is so onerous and time consuming that it will have a negative effect on patient care by delaying some diagnoses. It also interferes with the physician workflow and is not linked to many of the most common electronic health record systems, they said.
In interviews conducted and published by The Dark Report since August, members of the Florida Medical Association (FMA), the Florida Society of Pathologists, the College of American Pathologists, the American Congress of Obstetricians and Gynecologists, and the Florida Association of Family Physicians all have expressed deep reservations about the program.
“Physicians repeatedly tell UHC that the BeaconLBS system is difficult to use, and it requires them to spend more time ordering tests, time for which they will not be paid,” said Attorney Jeff Scott, the FMA’s General Counsel. “Our members are not at all pleased with the pilot project. And that’s putting it mildly. The physicians we’ve talked to are very much against it. For some, this system is a reason to get out of the contractual relationships they have with UnitedHealthcare.
Docs Say BeaconLBS System Didn’t Work for Its Managers during Webinar
The system is so difficult to use that when BeaconLBS held a webinar for FMA members last month, the BeaconLBS representatives could not get it to work, said Michael A. Wasylik, M.D., an orthopedic surgeon in Tampa and chairman of the FMA’s Medical Services Committee.
In August, Dennis Saver, M.D., a family physician and geriatrician in Vero Beach, Florida, said BeaconLBS would interrupt office workflow substantially. “There are few better examples of an unfunded mandate than this Beacon system,” he added. Saver is an adjunct clinical associate professor at the University of Florida School of Medicine and a clinical associate professor at the Florida State University College of Medicine.
In October, Robert W. Yelverton, M.D., Chair of the American Congress of Obstetricians and Gynecologists’ District XII (Florida), said, “For physicians, the BeaconLBS service is much more than a headache. It’s a migraine.” In a letter to UHC, Yelverton asked UHC to “suspend this test program as a requirement for Florida providers immediately and indefinitely.”
Requirements Seem to Ignore Existing Evidence-based Care Protocols
To date, news outlets in Florida have not picked up on the growing dissatisfaction of physicians to UHC’s pilot program. Further, many physicians said the BeaconLBS system requires doctors to obtain pre-notification for a significant number of high-volume lab tests that are ordered routinely in accordance with long-established care protocols issued by the federa Centers for Disease Control and Prevention and many national medical specialist associations.
To this point, physicians, including the Florida Society of Pathologists, have asked UHC and BeaconLBS to provide documentation and clinical data to support their assertions that the requirements of this lab test management program are needed to improve how physicians use lab tests and control unnecessary costs. To date, these physicians say that they have not received this information from either UHC or BeaconLBS.
Another significant aspect to this story is that physicians outside of Florida should be concerned as well as those in the Sunshine State. Physicians and pathologists in other states may be required to comply with this UHC laboratory benefit-management program at some date in the future.