UHC is one of the biggest health insurances in the US. Quest Diagnostics on January 01, 2019 took over to become the preferred in-network provider for around 49M UHC enrollees.
Aetna too, underwent a similar culling of in-network labs a few years back when a contract with LabCorp was signed.
Since the inception of these events, smaller and regional labs along with some hospital lab outreach programs have been filling the gap In UHC’s network. This only takes place where LabCorp and Quest are not present.
Following the lead, Horizon BCBS NJ also went on to include LabCorp and Quest into its network thereby, closing panels for new labs across all the major states.
“There are indeed a series of procedure that a lab can follow when declared out-of-network by a health plan. But it’s best to be prepared than to suffer the repercussions”, says Steve Stonecypher, who works at a lab consulting firm “Shipwright Health Group”. According to Steve, it is a smart strategy to identify the advantages that your lab may bring for the health plan. “Labs would require a significant factor in their favor, possibly something apart from geography.”, he adds.
According to experts, if there’s something that your lab does which would contribute to delivering better results, it must be highlighted. For example, if your lab has a large specialty group or health system in contract, it is wise to put it up front for the payers to notice.
If you have clinical opinion leaders in your team, include them in the discussion that you make with the insurance. They may also help you devise a strategic plan by analyzing the strengths and weaknesses of your lab system. Working on the cost factor is equally important as insurances like UHC are always on a lookout to eliminate high-cost labs, even if they are performing at their best.