Managed Care Update

UnitedHealth Rumored to Be Excluding Labs from Its Network

Early information indicates the health insurer is terminating contracts of regional, indy labs

IN RECENT DAYS, RUMORS HAVE SURFACED that UnitedHealthcare has begun to terminate the contracts it holds with a number of regional and non-national clinical laboratories.

This news surfaced just as The Dark Report went to press. Given its importance to the clinical laboratory industry, we wanted to alert lab executives and pathologists to this development as soon as possible. It may be the earliest sign that major health insurers are in the first stages of changing their long-standing managed care contracting strategies with clinical laboratories and anatomic pathology groups in ways that will deny many local labs and independent lab companies access to the beneficiaries of UnitedHealthcare and other major health insurers.

The next issue of The Dark Report will have a more complete presentation of the known facts and an analysis of why one of the nation’s biggest health insurers is taking this step—and why now—before the start of the new year.

Labs In-Network for Decades

Information from late last week included statements that many of these labs have been in-network lab providers for UnitedHealth (UHC) for a decade or longer. One source said that he was told by an executive of an independent clinical laboratory company that UHC had said the reason it was terminating its contract with that lab company was because it needed “to adapt to the ever-changing healthcare environment.”

Two reasons may be behind this development. First, UnitedHealth, Aetna, and Horizon Blue Cross Blue Shield of New Jersey all added both national lab companies to their networks during 2018. This may mean that, by including both national lab companies in their respective networks, those two labs together eliminate the coverage gaps that were formerly filled by regional labs. These regional labs can now be excluded from provider networks.

Second, the ongoing shift away from fee-for-service reimbursement and toward value-based payment arrangements may be a factor. This would be particularly true if health insurers were recognizing that the national labs do a more complete job of reporting utilization data and lab test results on the insurer’s beneficiaries. Both are necessary for health insurers in their population health management initiatives.

Any administrator, executive, or pathologist working at a lab that UnitedHealthcare is terminating as an in-network provider—or with knowledge of other labs that are being similarly terminated—are invited to contact our Editor in confidence with this information. Such information will help The Dark Report develop a more detailed and accurate analysis of this developing situation, along with remedies that may be available to labs that have recently received a notice terminating them as a provider for UHC or another health insurer.

Contact Editor-in-Chief Robert Michel at labletter@aol.com or 512-264-7103.

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