Where someone goes for laboratory services can make a dramatic difference in cost. On average, some lab services can cost an average of five times more1 when performed at an outpatient hospital, instead of a free-standing clinic — meaning higher out-of-pocket costs for the members we serve.
In addition, price increases at hospitals are significantly outpacing annual inflation rates and are unsustainable for both employers and consumers.
To help promote cost-effective care, UnitedHealthcare is launching a new benefit design on July 1 for outpatient laboratory services, called Designated Diagnostic Provider*. These benefit plans are designed to maximize member benefits for lab services, while maintaining access to the broad network of providers at UnitedHealthcare.
For example, if a patient needs a blood glucose test, they may pay about $801 at an outpatient facility versus $5 at a free-standing clinic. For those who require quarterly testing, that may be the difference between $320 compared to $20. The plan is designed to help ensure these lab services go to a Designated Diagnostic Provider, with rates consistent to free-standing facilities, who meets broadly recognized efficiency and quality standards to help lower members’ out-of-pocket costs.
Designated Diagnostic Providers will be accessible to members and health care professionals, regardless of location, and easily identified by an icon to make clear they are part of that network.
UnitedHealthcare has invited all in-network free-standing and outpatient hospital laboratories to become a Designated Diagnostic Provider, as long as criteria for quality and efficiency are met.
To meet necessary criteria, Designated Diagnostic Provider labs need accreditation from the Centers for Medicare and Medicaid Services (CMS) and Clinical Laboratory Improvement Amendments. In addition, labs must complete a survey to demonstrate accreditation from more than one independent, industry-recognized organization that conducts quality reviews of labs. This includes the American Association for Laboratory Accreditation, College of American Pathologists or the Joint Commission.
The inclusion of Designated Diagnostic Providers does not redefine what it means to be an in-network provider, and as such, services covered remain dependent on a member’s benefit plan. The Designated Diagnostic Provider network does not apply to labs provided in conjunction with emergency care, and providers who may not be a Designated Diagnostic Provider are still in network with UnitedHealthcare.
Physicians will be provided with information and tools on the new plan design, as well as resources to help them identify and access Designated Diagnostic Providers. Those interested in applying to the program can fill out the questionnaire or contact their network representative.
For more information about the Designated Diagnostic Providers, click here.
*applies to commercial members only in all states where we have regulatory approval and does not include Hawaii and the U.S. Virgin Islands.
1UnitedHealthcare claim data for outpatient lab services from 2019