UnitedHealthcare Updates Laboratory and Pathology Protocol Effective Sept. 1, 2016

As of Sept. 1, 2016, UnitedHealthcare network physicians and other health care professionals in several states—including Pennsylvania, Delaware, and New York—are required to obtain consent from UnitedHealthcare members before referring them to non-network laboratories and pathologists.

This requirement will include:

  • Specimens collected in your office and sent to a non-network laboratory or pathologist for processing.
  • Providing a patient with UnitedHealthcare coverage a prescription, requisition, or other form to obtain laboratory or pathology services outside your office.

Please note that emergency situations are exempt from this process.

The process for documenting a patient's decision to use non-network benefits or be responsible for billed charges will be as follows:

  1. Discuss network and non-network care provider options with the patient and provide them with a copy of UnitedHealthcare's Laboratory and Pathology Services Consent Form. Access the Consent Form.
  2. The patient/UnitedHealthcare member must complete the consent form indicating whether they wish to use a network or non-network laboratory or pathologist. If the patient indicates they wish to choose a non-network laboratory or pathologist, then:
    1. If the member has non-network benefits, the non-network laboratory/pathology claim will be paid according to their non-network benefits and any non-network cost shares will apply.
    2. If the member does not have non-network benefits, they will be responsible for the full cost of the non-network laboratory/pathology services.
  3. Keep a standard or electronic copy of the consent form in the patient's medical record. UnitedHealthcare may request a copy of the completed form.

The Laboratory and Pathology Services Consent Form includes an "Ongoing Monitoring" box. Keep in mind that a separate consent form will be required for each episode of laboratory care and is valid for 15 days from the date of signature unless the "Ongoing Monitoring" box is selected. If the "Ongoing Monitoring" box is checked, the form is valid for one year from the date of signature.

UnitedHealthcare says that there will be no additional requirements for physicians and other health care professionals who collect specimens in their office and use a network laboratory or pathologist for processing.

To find in-network laboratories, access the Physician Directory at www.UnitedHealthCareOnline.com, select the "General Physician" directory link, choose a plan, select "Laboratory Facility or Laboratory – National," and then enter your patient's location.

The "Participating Provider Laboratory & Pathology Protocol, " which includes the steps required in the event that UnitedHealthcare requests a copy of the form, is available on UnitedHealthcare's website. Physicians and practices with questions can contact UnitedHealthcare at 877-842-3210.

Pennsylvania Medical Society (PAMED) members can also call our Knowledge Center at 855-PAMED4U (855-726-3348).

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