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Laboratory benefit management program
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.
Florida Pathology Group Lost Volume After BeaconLBS Started
CEO SUMMARY: A 22-physician pathology group in Tampa has complied with rules for lab test ordering that UnitedHealthcare and BeaconLBS established, yet has experienced a steep decline in the volume of specimens it receives. Physicians told the pathologists that other labs were not using t…
Florida bill to restrict BeaconLBS advances in state Senate
THE DARK REPORT is first to report on the latest development as part of its ongoing coverage of how Florida physicians are reacting to the implementation of the UnitedHealthCare laboratory be…
Lab Benefit Management Bill Advances in FL Senate
CEO SUMMARY: To date, a bill to restrict how health insurers use lab benefit management systems such as UnitedHealthcare’s BeaconLBS, has been favorably received in the Florida Senate. But the bill may face opposition when presented to the Senate’s Appropriations Committee. In a repor…
Doctors’ resistance to BeaconLBS comes to Florida legislature
CEO SUMMARY: THE DARK REPORT IS THE ONLY LAB INDUSTRY NEWS SOURCE to report on this important development. A hearing took place recently on a healthcare bill in the Florida senate. Physicians in Florida are working to get language inserted into a state law that would restrict the …
Florida Legislators to Hold Hearing on Bill About Payer Use of Decision Support for Lab Orders
CEO SUMMARY: Physicians in Florida and their state medical associations continue to battle UnitedHealth over its laboratory benefit management program that uses the lab test ordering system by BeaconLBS, a business unit of LabCorp. The latest round in this fight is language in a Florida S…
2015’s Top 10 Lab Stories Show Significant Changes
CEO SUMMARY: During 2015, two stories captured the full attention of most pathologists and clinical lab managers. One was how CMS intends to gather lab price market data as mandated by PAMA. The other was the continued efforts by the FDA to move ahead on proposed guidance for regulation o…
Letter to Florida Doctor Offers to Waive Lab Test Fees
CEO SUMMARY: Florida’s highly-competitive market for lab testing services is again seeing some lab companies use “Waiver of Charges to Managed Care Patients” agreements with physicians in situations where the lab is an out-of-network provider. This means the lab will do free testing…
UnitedHealth Not Paying Lab Claims of Some Docs
CEO SUMMARY: It continues to be tough going in Florida for UnitedHealthcare and its contractor, BeaconLBS. Efforts to implement the UHC laboratory benefit management program face stiff resistance from some physicians and a number of state medical associations. One primary care gr…
LabCorp’s Plans for Docs, Pathologists and Labs
WHAT’S IN THE FUTURE FOR PHYSICIANS, PATHOLOGISTS, AND CLINICAL LABORATORIES if Laboratory Corporation of America’s strategy for managing lab test utilization is deployed across the country per the company’s plan? For the nation’s physicians, LabCorp’s BeaconLBS system will be required when …
Some Florida Docs Are Not Using BeaconLBS System
CEO SUMMARY: Some physicians in Florida are not complying with UnitedHealthcare’s laboratory benefit management program since the claims impact took effect on April 15. Although officials from UnitedHealthcare and BeaconLBS, a business division of LabCorp, state publicly that the…
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