Clinical Laboratories, Pathology Groups Being Squeezed by ‘Balanced Billing’ Dispute That Puts Providers, Hospitals, and Insurers at Odds

Health plans increasingly refuse to pay out-of-network providers who they claim often inflate their charges, leaving patients with unexpected medical bills  As health insurers narrow their provider networks in an effort to lower costs and hold down premiums, clinical laboratories and anatomic pathology groups may increasingly be designated as out-of-network providers and find themselves struggling to get paid. This is particularly true in cases where a hospital is in-network and its...

California Regulators Find Many Problems with the Provider Directories That Health Insurers Make Available to Consumers

In California, a survey found significant inaccuracies in provider directories posted online—may trigger action by regulators to have insurers address this problem Transparency in healthcare is an important trend. In recent years, much attention has been given to increasing the transparency of the prices charged to patients by hospitals, physicians, and medical laboratories. But now the transparency trend is about to drive change in the provider directories that health insurance plans make...

Growing Wave of Hospital and Health System Mega-Mergers Means Changing Dynamics for Pathology and Clinical Laboratory Medicine

Accelerating pace of hospital consolidation brings new pressure to pathologists and clinical laboratory directors to maximize the value of pathology services Large and financially-stable multi-hospital health systems are racing to form regional mega-systems. It’s a strategy to get ahead of the Affordable Care Act’s (ACA) mandate to improve quality and increase efficiency through coordinated care across the entire care continuum. This growing national trend means further consolidation of...

More Media Reports of Health Insurers’ Reluctance to Reimburse for Genetic Tests, Thus Angering Many Patients and Causing Medical Laboratories to Go Unpaid

Pathologists should take note that an increasing number of patients who want genetic tests are complaining when they learn their insurance plan will not pay for such tests Concerned about the increased cost of genetic tests, health insurers are becoming reluctant to pay for many types of molecular diagnostics and gene tests. When refusing to pay for these tests, however, they face a buzz saw of angry patients—many of whom see a genetic test as their last resort for a diagnosis and selection of...

Higher Enrollment in Medicare Advantage Plans Means that More Local Clinical Laboratories and Pathology Groups Lose Access to these Patients

Health insurers offering Medicare Advantage plans are narrowing their networks and favoring the national clinical lab companies over local medical labs and pathology groups Enrollment in Medicare Advantage health plans is booming. This development is not auspicious for local medical laboratories, hospital lab outreach programs, and anatomic pathology groups because the private health insurers operating these plans typically prefer to contract with national lab companies while narrowing their...
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