Ever been shocked with an "out-of-network" additional bill after you've done your homework and selected an in-network provider?

Source: www.fiercehealthcare.com

Doctors angered by proposed UnitedHealth fines

With a new policy poised to take effect which would impose fines for out-of-network lab referrals, UnitedHealth Group has gone too far, doctors say. Late last year, UnitedHealth struck a 10-year deal with LabCorp making its locations the preferred in-network testing facilities for the health plan's 28.5 million members. While that didn't raise eyebrows, UnitedHealth's next step did. UHG has now warned doctors that if they referred to other labs frequently, it could potentially fine them $50, slice their fees or even kick them out of the network entirely. This isn't sitting well with the plans' 520,000 contracted physicians, to say the least. UHG is defending the policy as a necessary cost-cutting measure, given that other labs are charging many times what LabCorp does. It also wants LabCorp data to be complete so it can do clinical analysis of patient disease patterns. But the AMA and state medical societies have angrily demanded that UHG change its plans. Meanwhile, UHG promised to suspend its proposed fines in New Jersey after regulators questioned the legality of its actions.

To learn more about the dispute:
- read this piece from The Wall Street Journal (sub. req.)