New integrated benefits coming soon to fully insured 51+ clients
Beginning July 1 in select states, fully insured 51+ clients to have Designated Diagnostic Provider lab benefits embedded to help members choose cost-effective, high-value care. Applicable markets: AL, AR, CO, CT, FL, ID, IL, IN, LA, MI, MO, MS, NE, NV, OH, OK, OR, SC, TN, UT, WI, WV and WY.
- Select states
- Employee experience
In an effort to reduce member cost and improve transparency, we are integrating Designated Diagnostic Provider (DDP) benefit designs* into all new fully insured commercial plans with group sizes 51+, effective July 1, 2021, or upon renewal for existing business. All of our Preferred Lab providers representing 81% of the national network meet DDP quality and efficiency requirements and will be designated as DDP.1 A preliminary list of the labs included within DDP are as follows:
- AmeriPath Inc.
- BioReference Laboratories, Inc.
- Invitae Corporation
- LabCorp & Subsidiaries
- Mayo Clinic Laboratories (Laboratory services billed by Mayo Clinic and Mayo Health System are not included under the Mayo Clinic Laboratories agreement)
- Millennium Health, LLC
- Quest Diagnostics
Note: This list is not complete as contracting is still underway and more lab providers are being added.
Subject to state regulatory approval, outpatient diagnostic lab services will be covered at the highest benefit level if delivered by DDPs. Services may not be covered or covered at a lower level; and members could be responsible for payment if performed by providers who are not designated.2, 3
DDPs are designed to support our members in choosing cost-effective and high-value care providers. Network freestanding and hospital lab providers who meet certain quality and efficiency requirements, as well as all Preferred Lab Network (PLN) providers will become DDPs.
We are continuing our work toward the Triple Aim of better care, better health and lower costs for UnitedHealthcare members. Many outpatient hospital labs charge significantly more when compared to a freestanding setting, with some lab services performed in an outpatient hospital setting costing as much as 1000% more on average compared to freestanding labs.
DDP benefit designs are intended to maximize member benefits for lab services and ensure laboratory services are performed by providers that meet both quality and efficiency requirements. By helping members choose health care services that are quality with less cost, they may be more likely to get needed care and be more engaged in improving, maintaining and managing their health. Together, we can make the health system work better for everyone by consistently promoting cost-effective lab locations that deliver safe, quality services.
Non-DDPs will remain in network in all benefit plans, but outpatient diagnostic lab services will be covered at a lower benefit level and possibly deny as non-covered for members with DDP benefit designs. As a result, members may be liable for charges. The DDP benefit designs will not apply to lab services rendered as part of inpatient admissions, emergency room visits, outpatient surgery pre-operation testing that is billed as part of a global surgical package, services that are part of chemotherapy/cancer treatment (applicable only for markets that have approved covered/non-covered DDP lab benefits) or buy-ups such as Infertility Services.
UnitedHealthcare will build out access as necessary to help ensure all members and physicians have access to DDPs.
A new DDP indicator and additional member messaging will be included in the Provider Search on myuhc.com®. A static, Searchable Directory, Provider Search displays, Frequently Asked Questions and other resources are available through your UnitedHealthcare sales team.
For in-force business, refer to Uniform Modification and renewal materials for more information. For complete details of the coverage, contact your UnitedHealthcare sales representative.
- UnitedHealthcare network reporting, as of January 2021.
- Subject to state approval, UnitedHealthcare plans (51+) effective July 1, 2021, and beyond will cover outpatient diagnostic lab services when delivered by DDPs at the highest level. Services may not be covered or covered at a lower level and plan members could be responsible for payment if performed by providers who are not designated. Exclusions to this benefit include lab services rendered as part of inpatient admissions, emergency room visits, outpatient surgery pre-operation testing that is billed as part of a global surgical package, services that are part of chemotherapy/cancer treatment, or buy-ups such as Infertility Services.
- Subject to regulatory requirements, certain markets will cover outpatient lab services performed at non-designated providers at a lower benefit level.
*Filings for all markets implementing DDP on July 1, 2021, are completed. The following states will implement DDP at a later date: AR, LA, MS, TN and WV.
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