Mar 2, 2015 | Compliance, Legal, and Malpractice, Laboratory Instruments & Laboratory Equipment, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Management & Operations
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…)
Jan 5, 2015 | Coding, Billing, and Collections, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology
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…)
Jan 27, 2012 | Compliance, Legal, and Malpractice, Laboratory News, Laboratory Pathology
Experts predict employers will use this data to create “report cards” on individual physicians
In a big step forward for public access to data about provider outcomes, the Department of Health and Human Services (HHS) will make its enormous Medicare claims database more broadly available to the public. Both the press and the public will be able to search for information about individual physicians. It is likely that information about pathologists will be searchable in this manner.
Specifically, Medicare will relax its restrictions on the release of information about individual doctors who participate in Medicare. This development was reported recently by The Wall Street Journal, which played a role in getting HHS to make physician data available to the public.
“This is a giant step forward in making our health care system more transparent,” stated Marilyn Tavenner, Medicare’s Acting Administrator. (more…)
Apr 11, 2010 | Compliance, Legal, and Malpractice, Managed Care Contracts & Payer Reimbursement
Apparently physicians in several states besides New Jersey are catching the attention of their insurance regulators over UnitedHealthcare’s effort to fine doctors who continue to use out-of-network laboratories. Now, state authorities in Texas, Connecticut, Iowa, Florida, and California have joined New Jersey state regulators by announcing plans to review the legality of the $50 fine announced by United Healthcare for doctor’s who refer their patients to out-of-network laboratories.
In March, the California Medical Association said that this new policy illegally interferes with PPO patients’ right to access out-of-network benefits and improperly obstructs the physician-patient relationship. “Patients have the right to decide where to receive health care services, without having to worry that their physicians are being fined or otherwise penalized for their choices. This right is particularly acute for patients who pay premiums for nonexclusive PPO benefits,” wrote CMA chief legal counsel Catherine Hanson. “And physicians have the right to speak freely with their patients about their health care choices, without having to worry that they will be fined or otherwise penalized should their patients choose an out-of-network option.”
The Florida Medical Association initially asked United Healthcare to take the policy out of its protocols with physicians, but now simply says “We’re confident United is going to be working with physicians not to charge that $50,” said Lisette Gonzales-Mariner, FMA spokeswoman.
United Healthcare spokesman Roger Rollman said that the policy was for “worst-case scenarios” and that fines would not be imposed the first couple of times a doctor didn’t abide by the policy.
American Medical Association spokesman Robert Mills said, “I think, while others [insurers] may have protocols that talk of out-of-network labs, I don’t believe any other insurers are using the stick approach versus the carrot.”
It is not difficult to see that United Healthcare is receiving significant bad press from the medical community on the $50 fine for doctors with patients that use out-of-network labs. This decision has triggered growing concern among doctors, who are worried that they can be made responsible for the actions of their patients. The American Association of Family Physicians has clarified United Healthcare’s new lab protocol and outlined how and when fines can be dispensed, trying to put physicians at ease.
However, it is important to remember that, as part of the 10-year exclusive national lab services contract between UnitedHealth and Laboratory Corporation of America, UnitedHealth has a commitment to take active steps to enforce compliance by its physicians with the laboratory services network. It is believed that the financial benefits to UnitedHealth from this exclusive national lab services contract are significant enough to motivate it to continue its tough stance. What remains to be seen is whether the bad press and negative impact on relationships built with state medical associations will do lasting harm to the long term relationship between UnitedHealth and its physician panel.
Related Articles:
CMA Calls United Healthcare’s New Lab Policy Illegal and Ill-Advised
Doctors upset over insurer’s new policy
AAFP Clarifies UnitedHealthcare’s New Lab Protocol
