CEO SUMMARY: Once Anthem and UnitedHealthcare establish their respective genetic test prior-authorization programs, a new era for genetic testing will commence. The 80 million beneficiaries served by these two payers make up half of the individuals who have private health insurance. It is reasonable to expect that other health insurers will follow the lead of
Tag: Laboratory benefit management programSkip to articles
The laboratory benefit management program is a controversial program created by UnitedHealthcare in 2014, which “is designed to help improve quality of care and manage appropriate utilization for outpatient laboratory services,” according to UHC.
The pilot launch was for laboratory services ordered by Florida network providers for fully insured UnitedHealthcare Commercial members in Florida, excluding Neighborhood Health Partnership.
All outpatient laboratory services for members who are part of the Laboratory Benefit Management Program are subject to new requirements including advance notification and new medical policies.
Beacon Laboratory Benefit Solutions, Inc. (BeaconLBS®), which specializes in laboratory services management, administers the Laboratory Benefit Management Program for UHC.
Under the program, physicians serving UHC’s commercial patients in Florida must notify UHC when ordering any of 80 clinical laboratory tests. Pre-authorization is also required for certain tests.
The program has generated widespread resistance from Florida physicians, who protest that it will cause unnecessary delays for patient treatment, and undue burdens for doctors ordering tests. In addition to problems with lab test pre-notification algorithms within the BeaconLBS system, other problems cited by physicians include the exclusion of all but 13 Florida labs from the BeaconLBS “laboratory of choice network.”
Physicians claimed that this disrupts longstanding clinical relationships between physicians and their preferred labs. It also means that patients who have been served for years by their physicians’ preferred labs must now visit one of the 13 labs in the BeaconLBS network.
Pathologists are particularly concerned that BeaconLBS requires them to get a second review when ordering certain tests and to ensure that subspecialist pathologists who review tests have specific certifications, according to the College of American Pathologists. After CAP asked UHC to reconsider these two requirements, UHC left these requirements in place.
UHC is Florida’s second largest health insurer with approximately a 14% share of the market.
CEO SUMMARY: Since Anthem and AIM Specialty Health began a prior-authorization program for genetic testing July 1, a Northeast lab has not had any genetic tests approved through the new system. Physicians told the lab that the steps required for prior authorization were disruptive. Those doctors who regularly order genetic tests had not been trained
CEO SUMMARY: In a letter to the Texas Legislature, 20 Texas medical societies say UnitedHealthcare’s BeaconLBS program would be detrimental to patient care. The Texas Medical Association and the Texas Society of Pathologists said they were concerned that the program increases the administrative burden on referring physicians, takes away a physicians’ right to choose a
CEO SUMMARY: UnitedHealthcare will not implement the claims impact part of its laboratory benefit management program in Texas on March 1, 2017, as it had previously announced. Opposition to the program and the requirement that physicians use the BeaconLBS system when ordering about 79 lab tests is building among physicians in Texas. Officials from the
CEO SUMMARY: As of January 1, 2017, clinical laboratories and pathology groups in Texas will find it more difficult to serve the 500,000 patients enrolled in UnitedHealthcare’s fully-insured commercial plans in the Lone Star State. That’s because—just as it did in Florida—UnitedHealthcare, with its partners BeaconLBS and Laboratory Corporation of America, is implementing its laboratory
CEO SUMMARY: In launching BeaconLBS in Texas, UnitedHealthcare included a new, more onerous twist than it used for BeaconLBS in Florida. To be a BeaconLBS in-network ‘lab of choice,’ a lab must be in the lowest quartile for lab test prices. Any lab above the 25th percentile would have to renegotiate its contract with UHC
CEO SUMMARY: Within THE DARK REPORT’S list of the Top 10 Lab Industry Stories for 2016 is one story of disruption that might have been one story of disruption about to happen. The disintegration of Theranos during 2016 is the big story about a self-proclaimed disruptor of the lab industry that finds itself struggling just
This is an excerpt from a 1,200-word article in the October 17 issue of THE DARK REPORT. The complete article is available for a limited time to all readers, and available at all times to paid members of the Dark Intelligence Group.
CEO SUMMARY: In this breaking story, THE DARK REPORT analyzes the news that UnitedHealthCare will bring
CEO SUMMARY: With a quiet announcement this month that it was bringing its laboratory benefit management program to Texas on March 1, 2017, UnitedHealthcare is taking on a big challenge. Enrollment in UHC’s commercial plans in Texas is 4.3 million. That is twice the two million commercial plan members UHC has in Florida, where it
IT WON’T BE WELCOME NEWS TO CLINICAL LABS AND PATHOLOGY GROUPS IN TEXAS that UnitedHealthcare will introduce its laboratory benefit management program in the Lone Star State. It will change the access many labs have to UHC patients and probably reduce the money these labs are paid if and when they do perform testing for