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- CAP to Meet with UnitedHealthcare Regarding Designated Diagnostic Provider Program
UnitedHealthcare recently announced a new program impacting outpatient laboratory services for fully insured commercial members. Effective July 1, 2021, the insurer will only cover outpatient laboratory services for members when delivered by a “Designated Diagnostic Provider” laboratory. Concerns regarding the new program resulted in the CAP securing a meeting with UHC on February 19 to request more information and advocate for pathologists and laboratories across all settings. The CAP engages with private payers to protect access to pathology services for patients, and ensure pathologists can practice without excessive burdens or interference with the practice of medicine.
Starting July 1, laboratories that are not a “Designated Diagnostic Provider” will remain in-network, but outpatient diagnostic laboratory services will be denied as non-covered. UnitedHealthcare sent communications to all diagnostic providers to encourage them to become a Designated Diagnostic Provider by completing a quality questionnaire by February 28.
UnitedHealthcare did notify the CAP of the upcoming reimbursement policy change in a January 4 letter. The CAP will share additional information as it is available. Visit the CAP’s private sector advocacy webpage for more information.