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Reimbursement of Non-Network Laboratory Claims

Jun 12, 2014

Currently, outpatient laboratory claims for members who use non-network laboratories are typically reimbursed based on the network status of their referring health care physicians. 

Starting August 1, 2014, outpatient laboratory claims submitted by out-of-network laboratories will be paid at the out-of-network benefit level, in accordance with member benefit plans. This applies to fully insured members whose employer groups are situated in Alabama, Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan, Mississippi, Missouri, Montana, Nebraska, Nevada, New Mexico, North Dakota, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virgin Islands, Washington, Wisconsin, and Wyoming.  

UnitedHealthcare believes that aligning the reimbursement of outpatient laboratory claims, from non-network laboratories, with the member's non-network benefits as provided in the applicable Certificate of Coverage, will result in: 

Notification
Letters regarding this policy will be sent to affected subscribers and UnitedHealthcare network providers at least 30 days prior to August 1, 2014.

For questions regarding the reimbursement, please contact a member of your b&p Sales Team - 888.722.3373.

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