managed care Archives

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managed care

Don’t Let the Payers Enjoy All the Benefits of Data

By R. Lewis Dark | From the Volume XXXII, No. 11 – August 4, 2025 Issue

PROBABLY SINCE THE ADVENT OF M…

UnitedHealth Group Heads into Difficult Waters Mid-Year

By Scott Wallask | From the Volume XXXII, No. 8 – June 2, 2025 Issue

WITH THE NEWS THAT THE FORMER HEAD OF UNITEDHEALTH GROUP (UHG) has returned after the sudden resignation of the company’s CEO, it is apparent that pressure on the healthcare company continues to mount. This latest twist comes on top of a bad…

Payers Are Right to Be Wary of Claims for Some LDTs’ Value

By Virchow | From the Volume XXX, Number 17 – December 4, 2023 Issue

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How Private Payers Audit Labs for Possible Claims Fraud

By Virchow | From the Volume XXX, No. 14 – October 2, 2023 Issue

EDITOR’S NOT…

‘Virchow’ Is Your New Source of Managed Care Insights

By R. Lewis Dark | From the Volume XXX, No. 11 – July 31, 2023 Issue

WE ARE UNVEILING A VALUABLE INTELLIGENCE RESOURCE FOR YOU. It is a new commentary focused exclusively on managed care contracting for diagnostic services provided by clinical laboratories and anatomic pathology gr…

With Z-codes, Will Other Payers Follow UnitedHealthcare’s Lead?

By Virchow | From the Volume XXX, No. 11 – July 31, 2023 Issue

EDITOR’S NOT…

Payers Continue to Increase Coverage of Liquid Biopsies

By Robert Michel | From the Volume XXVIII, No. 17 – December 20, 2021 Issue

SINCE THE FIRST BLOOD-BASED, circulating-tumor DNA (ctDNA) sequencing test for cancer became available in 2014, federal and private payer coverage of these so-called “liquid biopsy” tests has increased substantially. Now, clinical laboratory and pathology directors can expect additional coverage …

COVID-19 Lab Test Prices Give Some Health Plans ‘Indigestion’

By Robert Michel | From the Volume XXVIII, No. 11 – August 16, 2021 Issue

HEALTH INSURANCE PLANS CONTINUE TO BE UNHAPPY with the higher prices they are charged for COVID-19 tests by out-of-network clinical laboratories. That is one theme in a report on COVID-19 test prices published by a health insurance trade group. In its…

Benefits Investigation Is Growing Issue for Genetic Testing Labs

By Robert Michel | From the Volume XXVIII, No. 9 – July 6, 2021 Issue

QUIETLY AND WITH LITTLE NEWS COVERAGE, a new complication is challenging clinical laboratories that offer genetic testing. It involves a steady growth in the number of patients who do a “benefits investigation” before allowing their physician to order a genetic test….

Getting Payer Coverage for New Tests Continues to Be Difficult

By Robert Michel | From the Volume XXVIII, No. 8 – June 14, 2021 Issue

EVERY YEAR, IT BECOMES TOUGHER FOR CLINICAL LABORATORIES WITH NEW GENETIC AND OTHER TESTS to obtain favorable coverage decisions by government and private payers. Not only does it take longer to get a decision from a payer, but payers today want to see …

Volume XXXII, No. 13 – September 15, 2025

The Dark Report examines a new bill that would reform PAMA and avoid reimbursement rate cuts scheduled for January 2026. Clinical laboratory leaders are urged to make their voices heard in Congress. Also, an expert describes how labs can fix pre-analytical errors and avoid disaster.

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