At a time when patients and providers alike are being severely impacted by the COVID-19 Public Health Emergency, UnitedHealthcare (UHC) has taken the opportunity to push some aggressive policy changes to limit care — all while reaping record profits. As of July 1, most UnitedHealthcare commercial members no longer have benefits for out-of-network (OON) Laboratory, Dialysis and Durable Medical Equipment services. Physicians are now required to obtain a patient’s consent when involving a OON provider for non-emergent services. Failure to do so will could put you in violation of your contract and could result in a host of penalties, including a lowered fee schedule or termination of your contract. MORE: View the full bulletin from UHC. MORE: Download the member consent form required for OON referrals (PDF). When considering this change alongside UHC’s introduction of its new Lab Test Registry that will roll out on Jan. 1, 2021, it’s hard not to feel like providers are being made to jump through hoops during a vulnerable time, says Mick Raich, CEO of Vachette Pathology. “The new rules basically say if a referring physician sends work to an out-of-network laboratory, then the patient must sign a form allowing this to take place — basically this is an ABN for out-of-network work,” Raich says in regard to the new OON policy. “UHC has leveled several consequences for those who don’t play nice, including the option to terminate the referring physician’s contract or making the patients pay out-of-pocket costs. This will tighten up the network referral patterns even more and make it harder for out of network laboratories to see these patients.” Vachette also reached out to Matthew Zaborski, Assistant Vice President of Sales and Marketing at APS Medical Billing, to discuss how their clients have been impacted by these recent changes and to get his thoughts on what’s spurring them.
- What was your initial reaction to the out-of-network policy change? How have clients responded?
- Are you surprised UHC would make a change like this in the middle of a public health emergency, especially when many patients could be utilizing OON lab services for covid testing?
- Along with the lab test registry that will go into effect next year, UHC seems to be aggressively instituting new policies that are narrowing its network and restricting services. Why do you think they’ve become so emboldened as of late and do you anticipate other commercial payers will follow suit with similar policies?