UHC’s new Clinical Laboratory Benefit Management Program Triggers Objections from Physicians and Excludes Most Medical Laboratories

On January 1, 2015 UHC will require all physicians serving UHC patients in commercial HMOs in Florida to use the BeaconLBS service when ordering any of 82 tests. UHC lists some 80 laboratory tests that require advance notification and two (BRCA1 and BRCA2) that require prior authorization. If referring physicians do not use the BeaconLBS system when ordering any of the tests, UHC may not pay the physicians or the labs that run these tests. Pathologists are particularly concerned that BeaconLBS requires them to get a second review when ordering certain tests and to ensure that subspecialist pathologists who review tests have specific certifications. Board-certified anatomic pathologists will no longer be permitted to sign out any malignant cytology or derm cases, or any lymphoma specimens (both nodal and extra nodal), without a second read by a pathologist who is board-certified or board-eligible in that sub-specialty. This requirement would be a significant hardship on many small hospital and independent pathology groups that employ or contract AP and/or AP/CP-certified pathologists without subspecialty certification, and will prevent perfectly capable and competent pathologists from being able to sign out certain specimens at all.