As you probably know, the ACR is one of several organizations that has been advocating against the UnitedHealthcare (UHC) Laboratory Benefit Management Program, which was launched in Florida in 2014 and was due to expand to Texas on March 1. The program requires use of certain laboratories and online physician decision support for certain tests, including some tests frequently ordered by rheumatologists.
The good news: We heard from UHC in late January that it will not expand the program to Texas as scheduled. At this time, the company’s representatives will say only that implementation has been delayed “until further notice.” Once a new effective date has been set, providers will be given 90 days’ advance notice.
UHC provided the following information regarding the delay:
- Although the claims impact will be delayed, network physicians continue to have access to the physician decision support tool and are encouraged to use it when ordering decision support tests.
- UHC previously communicated that claims impact related to the pilot expansion in Texas would go into effect on March 1, 2017. A new effective date has not been established.
- The program applies to fully insured UHC Commercial members and was piloted in Florida beginning Oct. 1, 2014. It’s designed to help improve quality of care and support appropriate use of outpatient laboratory services.
- UHC has been closely monitoring progress of the Florida pilot and is evaluating additional refinements based on data, experience and feedback from care providers, including concerns associated with the advanced notification process.
- During the delay, UHC will continue to engage in discussions with professional societies that have concerns about the program. In the meantime, BeaconLBS, with whom UHC collaborates to administer the program, will end any outreach to network care providers about the pilot expansion.
- Care providers will be notified of the new effective date 90 days before the claims impact associated with the lab benefit management program goes into effect.
The ACR/ARHP will continue to monitor for updates, as well as request clarification on the status of the ongoing program in Florida. Many ACR/ARHP volunteers and staff have devoted considerable time and energy to this issue, and it seems our hard work is paying off.
Contact Meredith Strozier with any insurance advocacy questions.
Sean Fahey, MD, of Mooresville, N.C., is chair of the ACR’s Insurance Subcommittee.