LAST WEEK, ONE PART OF THE Beacon Laboratory Benefit Solutions pilot program in Florida was postponed. A UnitedHealthcare spokesperson provided additional information about this decision.
“We have lifted the January 1 claims impact deadline in order to give providers additional time to become further familiar with all aspects of the pilot program and allow for the continued exchange of constructive feedback,” stated UHC’s Elizabeth Calzadilla-Fiallo, Director, Public Relations for Florida and the Gulf States Region.
“Constructive provider feedback has been instrumental in our refinement of this important program that seeks to improve upon our overall delivery of healthcare to our members,” she added. “We’ve been having conversations with a variety of specialty groups, including the College of American Pathologists, the American Academy of Dermatology Association, and the American Congress of Obstetricians and Gynecologists.”
“The pilot program was implemented officially on October 1, and a great majority of those physicians and pathologists in the UHC network who were required to participate have started using this new process,” Calzadilla-Fiallo explained.
“Now only the claims impact date has been changed,” she emphasized. “Please note that the claims impact date should not be confused with the pilot program implementation date. The claims impact date has now been pushed back for a second time with no definitive deadline being set. However, we will give all appropriate parties a 30-day notice before initiating the claims impact portion of the program,” she said.
“We have removed the January 1 deadline in response to some of the feedback we received from physicians and pathologists,” she added.
In response to questions from THE DARK REPORT about what steps clinical labs could take to get paid if physicians ordering lab tests fail to use the BeaconLBS system, she said: “If an in-network lab completes a test for a UnitedHealthcare member that is among the 80 tests requiring advance notification–but notification was not filed–the lab has an opportunity within 10 days after the date of service to request that the physician secure notification prior to submitting the claim.”
Out-of-Network Labs
If the ordering physician does not notify UHC about the lab test, in-network labs would not be allowed to bill UHC patients. But out-of-network labs could bill the patient, she said. “Contracted, in-network labs cannot balance bill UnitedHealthcare members. In general, as part of participating in an insurer’s network, physicians, hospitals, labs, ancillary providers, etc. cannot balance bill patients because they’ve agreed in advance to specific reimbursement rates and administrative guidelines,” she explained.
“However, if the care provider does not have a contract with the insurer, the insurer cannot prevent them from balance billing the patient,” said Calzadilla-Fiallo. “That’s why a key goal of the lab management program is to encourage greater use of in-network labs, so our members can maximize their in-network benefits coverage.”
Contact Elizabeth Calzadilla-Fiallo at Elizabeth.Calzadilla-Fiallo@uhc.com.
