Clinical Labs Battle Complex Claims Denials

By Stephen Beale | From the Volume XXXII, No. 11 – August 4, 2025 Issue

CEO SUMMARY: While the number of denials is not going up, the reasons that private payers deny claims are becoming more complex and time-consuming to appeal. After reviewing noteworthy trends among payers, learn a three-level approach to appeals that may lead to greater su…

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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…

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Role of Price Transparency During Path Contract Talks

By Robert Michel | From the Volume XXXII, No. 5 – March 31, 2025 Issue

CEO SUMMARY: Pathology groups have a much better opportunity to turn the tables on payers and other third parties during contract negotiations if they come armed with the data and other information recommended by two well-respected pathology experts…

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Some Health Plans Drop Deductibles as Response to New Consumerism

By Robert Michel | From the Volume XXXII, No. 4 – March 10, 2025 Issue

It may surprise many pathologists and clinical laboratory administrators to learn that one major health insurer’s best-selling plan has only copays and no deductible, no coinsurance, and no cost-shifting! That plan is Surest, a group plan offered by UnitedHealthcare in recent ye…

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Grim Realities Drive Payer Behavior with Lab Test Claims

By Robert Michel | From the Volume XXXII, No. 3 – February 17, 2025 Issue

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Review of Genetic Testing Companies During 2024

By Robert Michel | From the Volume XXXII, No. 1 – January 6, 2025 Issue

CEO SUMMARY: Investors in genetic testing companies are taking it on the chin these days. During 2024, a number of the nation’s largest firms providing genetic test services reported significant losses. Other genetic testing companies are dealing with class action lawsuits claiming that…

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Gold Cards Offer Labs Limited Relief for Prior Auth Woes

By Virchow | From the Volume XXXI, No. 17 – December 16, 2024 Issue

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Hurdles Continue When Labs Request Genetic Test Coverage

By Virchow | From the Volume XXXI, No. 13 – September 23, 2024 Issue

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Behind-the-Scenes Audits Often Hide Cause of Test Claim Denials

By Virchow | From the Volume XXXI, No. 9 – July 1, 2024 Issue

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How Private Health Insurers May Respond to FDA LDT Regulation

By Virchow | From the Volume XXXI, No. 8 – June 10, 2024 Issue

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