CEO SUMMARY: One common complaint about the efforts of UnitedHealthcare to introduce its unpopular laboratory benefit management program in Florida is that the insurer-and its agent, BeaconLBS, a division of Laboratory Corporation of America-don’t respond to physicians when they request guidance. One family practice physician in Jacksonville said that UHC has not even acknowledged several letters he sent via certified mail, return receipt requested.
PHYSICIANS IN FLORIDA have a common complaint about the laboratory benefit management program UnitedHealthcare introduced last year. They say UHC and BeaconLBS are not providing adequate answers to questions the physicians have about what they describe as a poorly-designed system for ordering laboratory tests.
In fact, many physicians and their medical societies report that officials from UnitedHealthcare and BeaconLBS (a division of Laboratory Corporation of America) simply ignore requests for information about different aspects of the laboratory benefit management program. THE DARK REPORT made requests to UnitedHealthcare and BeaconLBS to comment on this situation. As of press time, no comment had been received from either company.
Physicians consider the answers to those questions to be critically important because, during February, UHC notified Florida physicians that the “claims impact” portion of the laboratory benefit management program would begin on April 15. (See TDR, March 9, 2015.)
After that date, UHC will refuse to pay labs that perform tests Florida physicians order if the physicians do not obtain prenotification or pre-authorization through the BeaconLBS system. UHC also may penalize physicians who do not use the program and exclude them as providers to UHC’s insured members, UHC said.
Given UHC’s firm position that it is prepared to enforce the punitive aspects of this lab test ordering program, and given the well-documented disruptions to the existing clinical and operational workflow in the offices of physicians serving UHC patients, it is easy to understand the discontent among these physicians.
No response From Insurer
In Jacksonville, one physician said that no official from either UHC or BeaconLBS has answered any of the requests for information that he and his staff sent to the two companies.
Family physician Terry Hashey, D.O., said he and his staff have called UHC’s offices and sent letters to UHC by certified mail. All have gone unanswered.
Equally troubling to him, he said, is that the UHC and BeaconLBS notices sent to his offices do not include a phone number or return email address in case physicians have questions. All this frustration has caused Hashey to refuse to participate in the program, which began October 1.
Charge: Unfair Practices
“UnitedHealthcare is not using fair business practices,” Hashey said in an interview with THE DARK REPORT. “It sends us letters and email with no phone numbers or return email and so we can’t even ask for clarification.
“We sent two notices [to cure] by certified mail saying the BeaconLBS program is not part of our contract and that it’s not a reasonable expectation under our contract,” he continued. “In our letters we said, ‘You have five days to respond or we’re going to ignore you. They ignored both of our letters. Since we got the receipts back, we know someone at UHC signed for those letters. But no one responded to us. So now, we have no recourse but to say no to using the BeaconLBS program.
“This insurer ignores us and so we’re ignoring it,” added Hashey, a former flight surgeon who served in Afghanistan. “I’m not participating. We put them on notice and they should feel free to reach out to me. But so far, I’ve gotten no response.”
The problem for BeaconLBS and UHC is that other physicians in Florida hold the same opinion as Hashey, telling THE DARK REPORT that they are unwilling to use the lab-test decision support system. How many physicians currently refuse to use the system is unknown. Neither UHC nor BeaconLBS responded to requests for comment on this aspect of the laboratory benefit management program.
The letters from Hashey’s office were sent to UHC over the last several months. “In addition to the two letters sent by certified mail, we sent four or five emails and we’ve called the BeaconLBS tech support line,” stated Hashey. “But the Beacon tech support people say they can’t help us because our problems are beyond what tech support can do. They say we have to call our representative. We’ve called the main number and left messages, but they never call us back. I have no idea if we even have a representative.”
Hashey’s comments are similar to those from other Florida physicians who have complained that the BeaconLBS system is onerous, time-consuming, unnecessary, and an intrusion into their practice of medicine. (See sidebar at right.)
In a recent communication, UHC advised physicians of the April 15 “claims impact” date and wrote that “If you have questions, please contact your UnitedHealthcare network manager or Provider Advocate.” There is no phone number or email provided in that notice. Hashey’s practice did not get the announcement from UHC. “We got the notice from the Florida Association of Family Physicians (FAFP),” he said.
“My understanding is that we are supposed to have an assigned representative from UHC and BeaconLBS,” added Hashey. “But I don’t know if we have a name or a phone number. It seems as if both companies don’t want any interaction or don’t want to answer questions from physicians about their own lab test ordering program.
Help with Ordering System
“As of today, my office staff doesn’t understand how to use the BeaconLBS system,” he noted. “I have no idea how to do it, and no one from UHC and BeaconLBS seems willing to tell me.” In his practice, First Coast Family Medicine, he has a physician assistant and six nonclinical support staff.
But what makes Hashey most unhappy is the intrusion into the practice of medicine that is imposed by UHC’s laboratory benefit management program. “The lab tests UHC has listed are nonsensical!” declared Hashey. “These are routine lab tests that are ordered appropriately all the time. It’s not like these are specific lab tests that are done only in certain circumstances.
“Previously when insurers introduced similar programs, they aimed at testing or treatments that are experimental, overused, or ordered inappropriately,” he observed. “But UnitedHealthcare lists clinical lab tests which are routine, such as Pap smears and thyroid studies. The clinical significance of having to use a decision support system to order routine tests is missing and has not been provided by UHC.”
Notices of Improper Orders
What compounds this unsatisfactory situation is that, according to Hashey, the few communications he has received from BeaconLBS have been notifications when his practice did not use the prenotification system when ordering specific lab tests. In February, he said he received an email from Matt Parise, Director of Operations for BeaconLBS. The letter is not addressed to Hashey but begins, “Dear Provider, The UnitedHealthcare Laboratory Benefit Management program requires that you provide advanced notification for these Decision Support Tests for your Florida commercial fully insured patients.
“The report below identifies the test(s) that you did not provide advanced notification,” continued this BeaconLBS email. “In the future, when ordering these test(s) please provide advanced notification via the PDS portal at www.BeaconLBS.com, through one of our integrated laboratory ordering systems or EMR partners.”
The letter includes the date (December 12) when Hashey ordered a Thyroxine (T4) test, the procedure code (84439) and the lab in question, LabCorp. The letter closes with a phone number for Hashey to call if he needs more information “on how to provide advanced notification for these test(s).”
When Hashey called the BeaconLBS office at the number provided on the email notice, however, he was told staff at BeaconLBS could not address his problem of how to use the BeaconLBS program. Instead, he was told to call UHC, he said.
Physicians’ Questions Go Unanswered by UHC
QUESTIONS PHYSICIANS HAVE about the laboratory benefit management program
of UnitedHealthcare fall into three broad categories. First, why is UnitedHealthcare requiring pre-notification for about 80 common recommended clinical laboratory tests and thus infringing on the physicians’ professional practice of medicine?
Physicians and their medical associations have written to UHC stating that many of the tests on the BeaconLBS prenotification list are supported by guidelines issued by the CDC and national medical organizations.
Second, many physicians are asking why the BeaconLBS system is not integrated with more of the most common electronic health record systems? They point out that the lack of such electronic interfaces means that they and their staffs must enter the same patient data twice- and this is for lab tests that are essential to patient care and supported by widelyused care guidelines.
The third area of questions to UHC centers upon: a) the difficulties in using the complex and unwieldy BeaconLBS system; and, b) the fact that the extra time required to enter lab tests into the BeaconLBS system can add up to several hours of physician and staff time each day-for no additional compensation.
On April 15, when UHC begins making decisions about whether to pay claims or not for physicians who do not use the BeaconLBS system, Hashey believes patients will suffer.
“My understanding is that UHC will punish the patient and treat the tests that don’t go through the BeaconLBS system as being non-prior approved, out of network, or something like that,” Hashey explained. “A few years ago, UnitedHealthcare sent bills to doctors when patients went to the
‘wrong’ lab companies.
“After there was a big uproar about that, UHC rescinded that decision because we physicians have no control over where a patient takes a lab test requisition,” he stated. “We can print LabCorp on the requisition, but if a patient takes it to Quest Diagnostics, that’s their business.”
Another aggravation for Hashey is that UHC set the start date for making claims payment decisions after open enrollment ended for Medicare and other health plans. “That means everyone is locked into place with their health insurer and their insurer’s network. So physicians like me must deal with this for the next nine to
12 months before we can do anything, such as walk away from our United contract,” Hashey said.
“I’m reluctant to take that step because that would be abandoning my patients. Yet here we have a situation where an insurance plan [UnitedHealthcare] that doesn’t pay a lot of money to reimburse providers-yet it now requires even more work from physicians and staff without additional compensation. If our practice was to get rid of our lower-paying insurance plans, what does that do to our patients? Nothing good. So, right now, I’m unsure about what I’ll do.
“I run a small practice. I’m one doc and my office has one PA. We do the best we can to deliver quality care,” emphasized Hashey. “Yet, for years UHC tells me they can’t adjust what they pay me because the market is tight. So I don’t get any increase in revenue but now UHC wants me to do even more work by using the BeaconLBS system to order routine lab tests.
“When we spend more time with patients, we are more thorough and produce better patient outcomes. That’s good medicine. But all we see from UnitedHealthcare are hostile actions. The insurer has not reached out for improved quality, or error prevention, or more wellness. It’s just using bully tactics,” noted Hashey.
Physicians Take Steps to Avoid Using BeaconLBS
WHEN PHYSICIANS IN FLORIDA find the BeaconLBS system to be difficult or time-consuming to use, they are adopting one of several strategies to avoid using the decision-support program when ordering lab tests.
One strategy some specialty physicians use is to send patients back to their primary care providers with test requisitions. The specialty physicians tell their patients to ask their PCPs to order the tests, physicians have told THE DARK REPORT.
This allows specialists to avoid the prenotification or preauthorization requirements for about 80 common recommended clinical laboratory tests. But, of course, they have to hope the PCPs order the tests and send the results to them for the patient’s next visit.
A second strategy some physicians use is to stop sending their tests though the BeaconLBS system. Instead, they send their test requisitions to out-of-network labs that have offered to run the tests for them. Then the out-of-network labs submit claims to UHC and hope for payment.
A third strategy may prove the most problematic for UnitedHealthcare. Some physicians have reviewed their agreements with the insurer. They are sending letters to UHC notifying the insurer that they need more information and request an answer within five days, as is common in commercial contract law [notice to cure]. If no answer is received, after five days, the physicians ignore UHC’s request to participate in the BeaconLBS program.
Each strategy imposes a cost on the physician and his or her patients, without producing much benefit for UnitedHealthcare. The disruption to normal clinical workflow and clinical services provided to patients is another way that UnitedHealthcare may actually experience greater overall health costs.
Contact Terry Hashey, D.O., at 904-538-0950 or firstname.lastname@example.org.