CEO SUMMARY: Physicians in Florida continue to express significant concerns about UnitedHealthcare’s pilot program requiring pre-notification for 80 clinical laboratory tests, including many routine tests, and pre-authorization for two genetic tests. The program is so onerous that some physicians have said they want to get out of their United contracts. Moreover, during a recent webinar to show Florida physicians how the BeaconLBS system works, officials from BeaconLBS could not get the system to function!
BATTLE LINES ARE HARDENING in Florida over UnitedHealthcare’s laboratory benefit management program. On one side are a growing number of physicians with legitimate concerns about the effect of the program on patient
care and daily operations.
On the other side are executives of UnitedHealthcare (UHC) and BeaconLBS. The BeaconLBS lab benefit management program requires Florida physicians to obtain pre-notification or pre-authorization via the BeaconLBS website for a list of
82 medical laboratory tests. At some unspecifed date in the future, failure to comply means that UHC may not pay medical laboratories that perform these tests and, innetwork labs would be unable to bill patients for the cost of those tests. BeaconLBS is a wholly-owned business division of Laboratory Corporation of America.
In the closing weeks of December, THE DARK REPORT learned that the concerns about UnitedHealthcare’s new test-ordering pilot program is now at the point at which some physicians are declaring their intent to get out of their UHC contracts, according to Jeff Scott, General Counsel for the Florida Medical Association. Physicians say the UHC program is onerous, time-consuming, and not worth the hassle, he said.
UHC’s laboratory benefit management program has been criticized since its inception. If enough physicians declare their intention to drop out of their UHC contracts, then patients may need to seek new physicians, which could lead to enough complaints to force UHC to postpone, revise, or scrap the program.
Program Deployed as a Pilot
Currently, the program is being introduced only for those patients in UHC’s commercial HMO network, which contracts with employers and individuals. If employers hear enough complaints from their employees in commercial HMOs, the employers could demand that UHC make changes in the program to address physicians’ complaints.
When UHC contracted with BeaconLBS to install the system, it planned to have the program begin on September 1. Then UHC required physicians to use the program starting October 1 but said their use of the program would have no effect on claims payment. The effect on claims payment was scheduled to begin January 1, 2015, but in late December, UHC postponed using the program to make claims payment determinations. No new date was set. (See story about UnitedHealthcare on page 12.)
Members of the Florida Medical Association have significant concerns. “Physicians repeatedly tell UHC that the BeaconLBS system is difficult to use and it requires them to spend more time ordering tests, time for which they will not be paid,” stated Scott. “Our members are not at all pleased with the pilot project. And that’s putting it mildly.
‘Very Much Against It’
“The physicians we’ve talked to are very much against it,” emphasized Scott. “For some, this system is a reason to get out of the contractual relationships they have with UnitedHealthcare.
“The level of frustration is significant and that’s why they are looking for any reason they can find not to participate in this program,” added Scott. “These physicians also don’t like the fact that they are limited to one lab or the cumbersome nature of the BeaconLBS system.”
In response to complaints from physicians, recently UHC held a webinar to demonstrate how the system would work. During the webinar, however, even officials from BeaconLBS couldn’t get it to work, noted Michael A. Wasylik, M.D., an orthopedic surgeon in Tampa and chairman of the FMA’s Medical Services Committee.
“We’ve been getting inundated with complaints about this from physicians,” said Wasylik. “Doctors are very concerned about this because we already have to spend an extra hour a day just on electronic medical record systems. Now this makes our job that much more difficult. We are not against electronic transmission. But this is something that was set up poorly. It’s just too cumbersome.
“When we complained to UHC, they said, ‘It’s not as bad as you think it is,’” he noted. “Then, they offered to set up a webinar but during the webinar, they couldn’t get it to work. You could hear the UHC people in the background, saying ‘Oh my word.’”
Scott said the failure to connect during the webinar was significant. “When the demonstration of the BeaconLBS system failed, it cemented the opinions for a lot of physicians,” he stated. “It persuaded them this is not something they want to participate in.
“We have used every avenue and any contact we have with UnitedHealthcare to tell them how much we don’t like this program,” said Scott. “Officials from UHC and BeaconLBS have said they would pass along the physicians’ concerns.”
When asked about physicians’ complaints, UnitedHealthcare referred questions to BeaconLBS. As of press time, BeaconLBS had not responded to requests for comment from THE DARK REPORT.
Physicians Are Concerned
The Florida Medical Association is not alone in its public statements about its members’ concerns over UHC’s lab test pilot program. Physicians representing family physicians and obstetricians and gynecologists also have sent letters criticizing the BeaconLBS system. In December, the Florida Society of Pathologists sent a letter asking UHC to suspend implementation of the pilot program. (See pages 8-11 in this issue.)
In its letter to the UHC, the American Congress of Obstetricians and Gynecologists (ACOG) District XII (Florida) asked UHC to discontinue the program immediately and indefinitely. (See TDR, November 3, 2014.)
Contact Jeff Scott at JScott@FLmedical.org or 850-224-6496; Michael L. Wayslik, M.D., at 813-877-9413.