Effective November 8, 2019, UnitedHealthcare will begin a new process for the use of out-of-network laboratories

UnitedHealthcare will require providers to document members’ written consent and obtain UnitedHealthcare approval prior to referring members to an out-of-network laboratory.

What this means to you:

Use Preferred Lab Network (PLN) or participating in-network lab providers:

Required provider actions for out-of-network laboratory referrals:

According to the UnitedHealthcare bulletin1, ”out-of-network laboratory referrals can create excess costs in the health care system and may pose a potential quality risk to your patients”.

To avoid these, UnitedHealthcare will implement the following required process, effective November 8, 2019, if you refer to an out-of-network laboratory:

  • Obtain and upload the member’s written consent to use an out-of-network laboratory
  • Receive UnitedHealthcare approval to refer that member to an out-of-network laboratory

Penalties for non-compliance:

Per the UnitedHealthcare bulletin1, “Care providers who refer a laboratory service to an out-of-network care provider and haven’t completed the referral request process and documented the member’s written consent are out of compliance with their Participation Agreement and may be subject to administrative actions, which include:

  • Loss of eligibility for the Practice Rewards programs
  • A decreased fee schedule
  • Financial responsibility for any costs or expenses collected from a member by a non-participating laboratory, including non-covered services and balance bills, if there is no written member consent authorizing the referral to the non-participating laboratory
  • Ending network participation, as outlined in the Participation Agreement.”

To learn more, visit the UnitedHealthcare Requirements for Out-of-Network Laboratory Referral Requests bulletin.