In March, CMA asked state insurance regulators to investigate United Healthcare’s new laboratory policy, which imposes financial penalties on contracted physicians who refer patients to out-of-network laboratories.  CMA called the policy illegal and ill-advised, as it interferes with PPO patients’ right to access out-of-network benefits and improperly obstructs the physician-patient relationship.

The policy, which became effective March 1, authorizes the insurer to fine physicians $50, decrease contracted payment rates, and even terminate the contracts of physicians whose patients choose to go to out-of-network labs.

In response to CMA’s objections, the insurer has insisted that the new policy will not influence physicians’ professional medical judgment or prevent patients from choosing an out-of-network lab.  United Healthcare has failed to provide any details on how the policy will be enforced and what the process is for appeals.

CMA continues to have serious concerns with the new policy and the chilling effect it is bound to have on patient-physician communications.

Despite United Healthcare’s assertions to the contrary, this ambiguous and onerous policy will create a profound chilling effect on a physician’s willingness to refer to out-of-network labs when medically appropriate, or even to talk openly with patients about their choices,” wrote Jodi Black, associate director of economic services for CMA, in a follow-up letter to United Healthcare.  “By not providing any clarity on how the policy will be administered or how penalties will be assessed, United Healthcare gives itself unlimited discretion as to when, how, or against whom it will direct its enforcement efforts.”

CMA also has serious concerns about the adequacy of United Healthcare’s participating laboratory network. CMA has received complaints from physicians, who to comply with the policy, would have to refer their patients to labs more than 50 miles away.

CMA has again urged United Healthcare to rescind this onerous policy and will continue to work with state insurance regulators to resolve the issue.

Click here to read CMA's letter to United Healthcare on this issue.

Contact: CMA’s Reimbursement Help Line, 888/401-5911 or jblack@cmanet.org.