National Laboratory Program
Frequently Asked Questions
1. What changes regarding laboratory services are UnitedHealthcare and its affiliates,
including Oxford, announcing?
Effective January 1, 2007, LabCorp is UnitedHealthcare’s sole national laboratory
services provider.
Effective January 1, 2007, Quest Diagnostics is no longer a contracted laboratory
services provider for Oxford or UnitedHealthcare except in limited markets (the state
of Washington terminated January 31, 2007).
UnitedHealthcare has contracted with Laboratory Corporation of America (LabCorp)
for reference laboratory services. LabCorp will participate with other regional and
local laboratory providers in the comprehensive and expanding UnitedHealthcare
laboratory network across the United States. LabCorp will also assume responsibility
for managing the Oxford laboratory network in the greater New York metropolitan
region, effective January 1, 2007.
2. Why was this change in lab networks made? Why did Quest become a non
participating provider?
In 2006, UnitedHealthcare engaged in lengthy discussions with various parties and
came to the conclusion that building our network around one leading national
provider in combination with hundreds of regional and local providers would help us
deliver the best combination of affordability, quality, usability and access to all of our
customers.
When this process began, Quest was a participating provider in UnitedHealthcare’s
network and they were active participants in the RFP process. As that process
evolved, Quest was simply unwilling to make the same level of commitment to our
customers on clinical support and affordability that LabCorp agreed to offer.
Consequently, in the fourth quarter of 2006, it was announced that Quest Diagnostics
would not renew its participation agreement with UnitedHealthcare, and that it would
no longer participate in our network as a national vendor effective January 1, 2007.
The remainder of the laboratory network remained participating while additional local
and regional laboratories have been contracted.
3. Who is LabCorp?
LabCorp offers laboratory services that are as complete and comprehensive as any
other national laboratory company. LabCorp offers more than 4,400 types of
laboratory tests from routine blood assays to HIV and genomic testing. LabCorp
processes more than 360,000 specimens daily for 220,000 physicians and other
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clients. LabCorp is well-regarded for its complex testing capabilities related to
oncology, infectious disease, and genomic, esoteric, or anatomic pathology.
In addition, LabCorp operates several affiliated Centers of Excellence including the
Center of Esoteric Testing in Burlington, NC; the Center for Molecular Biology and
Pathology in Research Triangle Park, NC; the Center for Occupational Testing in
Research Triangle Park, NC; National Genetics Institute in Los Angeles, CA; and
ViroMed in Minneapolis, MN.
LabCorp has an excellent reputation for providing outstanding customer service. An
explicit goal of this new relationship between UnitedHealthcare and LabCorp,
however, is to improve the diagnostic and administrative support provided to
UnitedHealthcare participating physicians. As such, LabCorp is accountable to
ensure that UnitedHealthcare and Oxford network physicians receive a level of
service commensurate with that offered by any other laboratory. UnitedHealthcare
will monitor that performance based upon our own review and input from
participating physicians.
Given the importance of simplifying the administrative burden of ordering and
receiving diagnostic tests and results, LabCorp provides a variety of electronic
interfaces that may be of interest to you. Their systems are compatible with the
electronic connectivity software used by most medical practices today, and we
encourage physicians to evaluate the applicability for their practice.
If physicians desire the comprehensive services and special capabilities of LabCorp,
effective January 1, 2007, and are not currently a customer, they may simply contact
LabCorp.
4. With LabCorp becoming UnitedHealthcare’s and its affiliates national laboratory
services provider, will Quest Diagnostics still be a participating provider?
As of January 1, 2007, (January 31, 2007, for the state of Washington) Quest
Diagnostics will no longer be a contracted laboratory and will be considered a nonparticipating provider except in limited markets. There are no ongoing or planned
contract negotiations with Quest Diagnostics at this time.
5. Why is Quest, or any non-par provider an issue?
When our Members use non-par providers like Quest, the cost of each lab service is
dramatically more than when they use a participating provider. (These concerns were
well-founded. Our claims data indicate that Quest is now billing our customers more
than 6-7 times what they pay participating laboratories for the same services on an innetwork basis.)
6. How will this change affect physicians?
Physicians who currently refer UnitedHealthcare or Oxford patients or their lab
specimens to Quest Diagnostics for laboratory services, as of January 1, 2007, must
use LabCorp or another participating laboratory. For physicians who are already
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using LabCorp or another participating laboratory, this development will have no
significant effect on their practice.
We strongly urge physicians and their practice staff to make any necessary
arrangements with LabCorp or another participating laboratory. Physicians who rely
on patient service centers to secure lab specimens should ensure those centers are in
the UnitedHealthcare and/or the Oxford network.
7. How will this change affect Oxford members?
As long as physicians use one of the many Oxford participating laboratories, there
will be no effect on the patient who is an Oxford member. However, after January 1,
2007, if patients or their specimens are referred to non-participating laboratories
(including Quest Diagnostics), then Oxford members who are your patients may be
subject to higher health care costs due to the nature of the various health care benefit
plans offered and selected by purchasers and consumers. This would be an
unfortunate result of inattentiveness to this issue and we desire to do all we can to
prevent such consequences.
Patients are generally unaware of which laboratory service their physicians use. In
80% of cases, specimens are collected in a physician’s office and picked up by a
courier. Test results are then delivered electronically. In other cases, a physician
may refer a patient to a patient service center to have a specimen taken. An important
way a physician’s office can help patients control the cost of care is to ensure that lab
specimens remain in network with LabCorp or another participating lab provider. We
encourage our members to take an active role in their health care and learn which
laboratories participate in our network so that together we can minimize any
applicable expenses associated with the use of out-of–network providers.
8. What is UnitedHealthcare doing to help physicians use participating laboratories?
UnitedHealthcare and Oxford made tens of thousands of phone calls, sent millions of
pieces of mail and provided countless electronic notices to members, employers and
physicians of this change. As a result, almost all of our participating physicians are
only using participating laboratories. We continue to make phone calls and send
letters to physicians and members as we identify data suggesting that a non-par lab is
being used. We offer assistance to the office to establish an account with a
participating laboratory.
9. What is UnitedHealthcare doing to help members and employers get affordable
access to laboratory services?
UnitedHealthcare has responded to this challenge by working with LabCorp and the
1,500 other reference laboratories in our network to assure adequate access for our
customers. As a result of those efforts, LabCorp alone has added more than 400 new
patient service centers, and our national laboratory network now features more than
5,600 service centers across the country.
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10. Will LabCorp be UnitedHealthcare’s and Oxford’s only contracted laboratory
provider?
In the overwhelming majority of the country, UnitedHealthcare’s laboratory network
will continue to include a combination of other regional and local laboratory service
providers. In addition, in many areas we will be contracting with new providers and
adding to the breadth of our network.
LabCorp will be the sole national capitated laboratory services provider for the HMO
benefit plans in the markets covered by PacifiCare of Colorado, Neighborhood Health
Partnership in Florida, and Mid-Atlantic Medical Services (MAMSI) in Maryland and
Virginia. LabCorp is already the exclusive provider for HMO benefit plans for
PacifiCare of Arizona. If you have any questions about the 2007 participating labs in
your area, you can access a list of them at www.UnitedHealthcareOnline.com at
any time.
11. How can physicians obtain a list of 2007 participating laboratories?
A current list of 2007 participating laboratories is available online using the
2007 Lab Locator tool at www.oxfordhealth.com.
12. What if there are no conveniently located participating labs?
Physicians, customers and members can conveniently find the identity and location of
participating laboratories on our Web site. We wish to emphasize, as the protocol
itself does, that physicians should call us if they believe there is no participating
laboratory that will meet their needs. We will work with them to make sure they have
access to the services they need.
13. Will Oxford and UnitedHealthcare have the same laboratory network?
Not necessarily. Some labs may be participating for lab services with
UnitedHealthcare, but not with the Oxford Laboratory Program. A complete list of
2007 participating laboratories may be accessed as noted above.
14. Are all UnitedHealthcare products included in this arrangement?
Yes. The arrangement applies to all UnitedHealthcare commercial plans, as well as
acquired plans including PacifiCare, Oxford, MAMSI, Neighborhood Health
Partnership, and UnitedHealthcare of the River Valley (formerly known as John
Deere Health).
15. Are AmeriChoice and Ovations also included?
Yes, AmeriChoice and Ovations, including Secure Horizons products, are included.
16. Is UnitedHealthcare still negotiating with Quest Diagnostics?
No, there are no ongoing or planned contract negotiations with Quest Diagnostics at
this time.
17. How has UnitedHealthcare and Oxford communicated this change in lab
network?
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We have been engaged for months in active outreach to the physician community on
this issue. We have contacted more than 65,000 physicians who had been significant
users of Quest to make sure they were aware of the change in our lab network and to
assure that a participating laboratory was available to meet their needs. (Physicians
can find participating labs in their area on unitedhealthcareonline.com). LabCorp and
our other in-network laboratory service providers have been active participants in
understanding and responding to the needs of our participating physicians.
18. Why is this protocol necessary?
The purpose of the lab referral protocol is not to sanction physicians. Our simple goal
is to have physicians refer patient specimens to participating laboratories. As a result
of the millions of communications regarding this issue, almost all physicians are
doing so at this time. While most physician offices have adjusted to the change, some
physicians may choose to continue to use a non-participating lab without a good
clinical reason, and without a patient freely choosing to use an out-of-network
laboratory. Such a physician office is not working in the spirit of their
UnitedHealthcare (or affiliate) participation agreement. The purpose of this protocol
is to further emphasize that an office’s elective use of non-par laboratory providers is
not consistent with a collaborative relationship. The protocol offers a range of
options, short of termination that could be applied in the event that physician declined
to work with us in using participating laboratory providers. Our focus remains on
outreach, not sanctions as evidenced by the fact that no sanction has yet been applied
to any physician.
This protocol will have no applicability to the many thousands of physicians who
have actively worked with us to find a participating laboratory solution to meet their
patients’ needs. We will take action with respect to laboratory referrals only when
physicians make continued, material use of non-participating laboratories, and then
only after an opportunity to dialogue with those physicians and understand the
reasons why non-par laboratories are being used.
19. How was the protocol communicated to physicians?
Every participating physician was sent notice of the protocol by postcard. The
Protocol on the Use of Non-Participating Laboratory Services has been available
since November on www.oxfordhealth.com under Messages on the log in page.
20. Where can I get a copy of this protocol?
The Protocol on the Use of Non-Participating Laboratory Services can be viewed in
full on www.oxfordhealth.com under Messages on the log in page.
21. How and when will the new protocol be applied?
Each situation will be considered on its unique merits and will depend to a great
degree on the outcome of our dialogue with the physician. Until such dialogue occurs
we cannot say how it will proceed or conclude. The protocol will not be applied to
any physician until we have attempted such dialogue. Our goal is to work with
physicians to provide cost-effective access to quality clinical services. All of the
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appeal and dispute resolution rights contained in our participation agreements will be
available to any physician to whom the protocol is applied.
22. Will UnitedHealthcare hold physicians responsible if their patients choose an outof-network lab?
It is our policy that physicians should not, and will not, be held accountable for these
patient-initiated actions. Although physicians make more than 80% of the decisions
concerning where their patients go for lab services, occasionally patients will make
the choice to use an out-of network lab. Patients who are Oxford members with outof-network benefits can request to use an out-of-network lab provider, although it
may significantly increase their costs. We also have done outreach to our highest
utilizing members regarding this change in our network of labs and a complete listing
of labs is available on our site,www.oxfordhealth.com.
Summary
After reviewing all the comprehensive services and special capabilities LabCorp has
to offer, and given the increasingly broad array of choice among laboratories
participating in the UnitedHealthcare and Oxford networks, we are comfortable there
will be no compromise of the ability of physicians to order the diagnostic tests
necessary to meet the clinical management needs of their patients. If any such issue
arises, LabCorp and UnitedHealthcare are prepared to work with physicians and their
practice staff to resolve the issue so that the patient covered by UnitedHealthcare and
Oxford can be assured access to high quality, affordable health care and a simplified
experience. For further information, contact the UnitedHealthcare Customer Service
Center at 1-877-842-3210 or Oxford Provider Services at 1-800-666-1353..
Resources
 www.UnitedHealthcareOnline.com > Policies & Protocols > 2007 Laboratory
Network
 American Academy of Physicians article
(http://www.aafp.org/online/en/home/publications/news/newsnow/practice-management/20070307uhclabprotocol.html
May 2007
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