As Medical Laboratory Test Utilization Grows, Health Insurers Develop Programs to Manage Rising Costs

After seeing a rise in the volume of clinical lab tests physicians order, managed care plans are develop a variety of strategies to manage utilization and costs

Health insurers are taking more aggressive actions to control the cost of clinical laboratory testing. For many years, clinical laboratories and pathology groups have been concerned about the strategies used by Medicare to control the utilization and costs of medical laboratory tests. Private health insurers usually follow the actions of Medicare, the nation’s largest health insurer. But today, managed care plans are developing their own lab-test-utilization strategies in addition to following those of Medicare.

Recently, Managed Care magazine explained many of the steps health insurers take to keep the costs of clinical laboratory tests under control. The cover story in the October issue of the magazine, “Health Plans Deploy New Systems To Control Use of Lab Tests,” outlined how health insurers Cigna, Group Health Cooperative, Priority Health, and UnitedHealthcare (UHC) are managing lab test utilization. (more…)

Florida Rheumatologist Says UnitedHealthcare’s Management Program for Clinical Laboratory Tests Could Jeopardize Patient Care

Miami physician asks why UnitedHealthcare requires use of the BeaconLBS system for authorization for recommended medical laboratory tests that may help identify lymphoma early

In Florida, the confrontation between one of the nation’s largest health insurance corporations and physicians, clinical laboratory managers, and pathologists continues. The source of this confrontation are the restrictive and burdensome requirements for medical laboratory test ordering imposed last fall by UnitedHealthcare (NYSE:UNH) and administered by BeaconLBS, a business division of Laboratory Corporation of America (NYSE:LH).

For Florida rheumatologist Olga Kromo, M.D., UnitedHealthcare’s new decision-support system that physicians are required to use when ordering clinical laboratory tests is highly flawed. (more…)

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. (more…)

In Florida, UnitedHealthcare’s New Clinical Laboratory Benefit Management Program Triggers Objections from Physicians and Excludes Most Medical Laboratories

College of American Pathologists and associations for family physicians and ob-gyns in Florida have asked UnitedHealthcare to discontinue implementation of BeaconLBS system

Medical laboratory testing is at the center of a contest of wills in Florida. On one side is a health insurer that wants to require physicians to obtain pre-notification or preauthorization for a list of clinical laboratory tests. On the other side are the physicians who question the clinical basis for these requirements and the time and resources required to comply with the health insurer’s program.

This rancorous dispute is in reaction to the laboratory benefit management program created by UnitedHealthcare (NYSE: UNH) (UHC) administered by BeaconLBS, a business division of Laboratory Corporation of America (NYSE: LH) (LapCorp). (more…)

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