Health Insurers Balk at Paying for Multigene Panels While Clinical Pathology Laboratories and Physicians Pursue Evidence of Clinical Utility

News reports state that Anthem and Cigna have denied payment for some multigene panel tests, saying that the tests are unproven. Other insurers, such as UnitedHealthcare and Priority Health, pay for such tests but only for certain patients A conflict is building between patients and health insurers over the reluctance among health plans to pay for new, expensive molecular diagnostic assays and genetic tests that clinical laboratory companies offer. This conflict has caught the attention of the...

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...

Aetna CEO Warns of Approaching Health Insurance ‘Premium Rate Shock’ in 2014 for Consumers and Others Under Affordable Care Act

Steep increases in insurance costs may leave patients with less money to cover deductibles and copayments for clinical laboratory tests Next year, consumers and small businesses can expect what one health insurance CEO says will be, “Premium rate shock for 2014.” As this happens, clinical laboratories and pathology groups are likely to find it even more difficult to collect co-pays, deductibles, and out-of-pocket fees from patients who had medical laboratory tests performed. The premium rate...

New Managed Care Contract Opportunity for Clinical Labs and Pathology Groups

As health insurers build patient-friendly web sites, they now want all the lab test data For laboratories wanting to contract with managed care plans, it will soon be “all about the data.” In upcoming contract renewal talks, expect health insurers to have a keen interest in working specifically with those clinical laboratories and pathology groups which can interface and electronically provide lab test data. Dark Daily is first to identify this important development. It creates an opportunity...

Employers and Health Insurers Jump on Wellness Bandwagon

Employers increasingly see wellness programs as effective ways to reduce the money they spend on health benefits. Health insurers are responding to these employer needs by launching wellness programs aimed at better prevention and disease management. Such wellness programs often have two dimensions. First, most wellness programs encourage beneficiaries to utilize healthcare in a proactive mode. Beneficiaries are encouraged to receive regular medical check ups, along with preventive tests or...