Ordering lab tests, which are not medically necessary or investigational

Effective January 20, 2012, coding updates in the claims system for some Genetic/Laboratory Testing policies may result in investigational/not medically necessary determinations resulting in expanded out-of-pocket costs to your patients. If you order a non-covered laboratory test, discuss the coverage issue with your patient so they are aware, before the test is performed, that you are ordering a laboratory test that will not be covered; why you are recommending it; and that they could be responsible for the full cost of the test if the test does not meet the clinical criteria in Empire’s medical policies or clinical UM guidelines. To ensure the member understands this financial liability, have the member sign the Empire Non-Covered Services Waiver.