Designated Diagnostic Providers
Using your benefits for outpatient lab services
Maybe you've heard about Designated Diagnostic Provider benefits or maybe it's a new benefit to you. If you get your health insurance through your employer, it's important to know the details because it may affect your coverage for outpatient lab services. Let's go over what it is and how it works.
What is a Designated Diagnostic Provider?
Designated Diagnostic Providers are laboratory providers that meet certain quality and efficiency requirements. If you have a Designated Diagnostic Provider benefit, you’ll have the highest level of coverage — and likely save money — when you use Designated Diagnostic Providers for your outpatient lab services.
How do I know if I have Designated Diagnostic Provider benefits?
You can sign in to myuhc.com, call the number on your member ID card or look for the Designated Diagnostic Provider icon on your card to learn if these benefits apply to you. If you have Designated Diagnostic Provider benefits and you don’t use a Designated Diagnostic Provider, you may have a higher cost-share and end up paying more out-of-pocket for your outpatient lab services.
How do I find a Designated Diagnostic Provider?
To find a Designated Diagnostic Provider near you, sign in to myuhc.com and select Find Care and Costs or use the UnitedHealthcare app. Look for the green check that indicates a provider is a Designated Diagnostic Provider. Here's an example:
When do I need to use a Designated Diagnostic Provider for lab tests or services?
Using a Designated Diagnostic Provider may help you save money on many common lab services. If you need lab work, be sure to tell your doctor which Designated Diagnostic Provider to use. Designated Diagnostic Provider benefits apply to most outpatient services, including:
Blood glucose tests
Rapid strep tests
Comprehensive metabolic panel
General health panel
Obstetric panel (including HIV testing)
Renal function panel
Acute hepatitis panel
Hepatic function panel
Insulin tolerance panel
Frequently asked questions (FAQs) about Designated Diagnostic Providers
Designated Diagnostic Provider benefits help protect members from higher, unjustified costs for outpatient lab services while maintaining access to quality, safe, efficient providers. These benefits are part of a strategy to lower overall healthcare costs.
Member benefits for outpatient diagnostic lab services will be maximized when using Designated Diagnostic Providers that meet quality and efficiency requirements. If outpatient lab services are performed by a non-Designated Diagnostic Provider, you may have a higher cost-share and end up paying more out-of-pocket for those services. Designated Diagnostic Provider benefits do not apply to lab services performed as part of an inpatient admission or emergency room visit.
We created Designated Diagnostic Provider benefits to focus on outpatient lab service providers that drive the best quality and efficiencies to deliver a better experience, better health outcomes, and lower costs.
Designated Diagnostic Provider benefits are effective for members with fully insured commercial plans in select states. If these benefits apply to your plan, you will receive a new member ID card with a Designated Diagnostic Provider indicator.
For members that travel to states and receive lab services in states where Designated Diagnostic Provider benefits do not apply, services from in-network providers will be covered at the Designated Diagnostic Provider benefit level.
Designated Diagnostic Provider benefits apply to most common outpatient lab services such as blood and pathology tests. Examples include:
- Blood draws and blood glucose tests
- Metabolic tests or panels
- Rapid strep tests
The following are services that do not apply for Designated Diagnostic Provider benefits:
- Outpatient surgery pre-operation testing that is billed as part of a global surgical package
- Lab procedures billed as a component of a bundled charge
- Lab procedures billed as part of an ER service, with same date of service
- Lab procedures billed as part of an outpatient surgery event, with same date of service
- Lab procedures billed as part of pre-admission testing, with same date of service
- Lab procedures billed as part of an inpatient event, with same date of service
- Lab procedures billed as part of an observation event, with same date of service
- Lab procedures billed as part of an Infertility treatment
Designated Diagnostic Provider benefits apply to any outpatient lab service performed in a free-standing or outpatient hospital lab setting, regardless of where the specimen was collected.
Designated Diagnostic Provider benefits only apply to outpatient diagnostic lab work. Other provider types (e.g., emergency, inpatient, outpatient surgical, chemotherapy) are covered as in-network per your plan benefits. Pre-op labs done on the same date of service or bundled will not be subject to Designated Diagnostic Provider benefits.
For members who may face access gaps because of their geographical location, UnitedHealthcare will assess each situation and work with the nearest hospitals, labs, or clinics to ensure they meet quality and efficiency requirements to serve as a Designated Diagnostic Provider. If you can’t find a Designated Diagnostic Provider, contact us by calling the number on your ID card.
UnitedHealthcare has invited all in-network free-standing and outpatient hospital labs to meet the quality and efficiency criteria to become a Designated Diagnostic Provider. Labs must demonstrate accreditation from more than one independent, industry-recognized organization that conducts quality reviews, such as the American Association for Laboratory Accreditation, College of American Pathologists, or Joint Commission. Labs must also meet efficiency standards and return test results to members within a specified amount of time.
Designated Diagnostic Providers are always in-network. A non-Designated Diagnostic Provider may still be an in-network provider where you can receive full benefits for services which may not apply for Designated Diagnostic Provider benefits (e.g., ER Labs, inpatient hospital labs, etc.). Since Designated Diagnostic Provider benefits are nationwide, the provider directory does not exclude in-network non-Designated Diagnostic Providers. Look for the indicator next to Designated Diagnostic Providers to identify a location with the best coverage and lowest price for you.
It is your responsibility to communicate the need to use a Designated Diagnostic Provider to your doctor. We are educating all doctors to ensure referrals are made to Designated Diagnostic Providers, but you can help by making sure your doctor understands that your lab work should be done at or sent to a Designated Diagnostic Provider. If your doctor sends your labs out for processing, ask that they are sent to a Designated Diagnostic Provider. Your online search tool and the one used by your doctor both clearly indicate labs that are designated.
It is easy to make sure your lab work is done at a Designated Diagnostic Provider location, as the largest and most accessible labs in the country are included. In most cases, Designated Diagnostic Providers will be labs that you and your doctor are familiar with and are already using.
As your doctor requests any lab tests during your next appointments leading up to 1/1/2022 and after, ask them if your place of care is considered a Designated Diagnostic Provider and if the tests requested receive the best coverage under your new benefits. Your doctor will know where to direct your tests from there to ensure you have the best coverage and lowest price under your UnitedHealthcare plan.
If your doctor’s office is a Designated Diagnostic Provider, there will be no change to your lab care routine. If they are not a Designated Diagnostic Provider, you should speak to your doctor about switching or sending your lab work to a Designated Diagnostic Provider.
If the specialty facility is a non-Designated Diagnostic Provider, your doctor can call the UnitedHealthcare provider services call center.
If you visit or your lab is sent to a facility which is not designated, you may have a higher cost-share and end up paying more out-of-pocket for those outpatient lab services.
You can contact us with questions by calling the member phone number on your health plan ID card.
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