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Out-of-network lab? Pay $50

United Healthcare plans to make doctors pay a fee if they refer patients elsewhere.

By KRIS HUNDLEY
Published February 9, 2007

Doctors who deal with United Healthcare soon may be taking a financial hit if they send patients to an out-of-network lab.

In January, United, which has 2.1-million members in Florida and about 800,000 in the Tampa Bay area, ended its contract with Quest Diagnostics Inc., the giant Lyndhurst, N.J., lab company, and signed an exclusive national agreement with Laboratory Corp. of America Holdings of Burlington, N.C.

To enforce the change, the insurer has taken the unusual step of threatening doctors with a $50 fine if they refer United’s members to Quest. The penalty takes effect March 1.

“I’m just flabbergasted,’’ said Dr. Michael Wasylik, a Tampa orthopedic surgeon who heads the managed care committee for the Florida Medical Association. “I can’t recollect hearing of anything like this in 10 years of handling managed care issues across the state. It’s outrageous.’’

A United spokesman said doctors have had 90 days since the end of the Quest contract to get used to the change. It’s about ensuring affordable health care, said Roger Rollman, a spokesman for the Minneapolis-based insurer.

“In those instances where people go out of network, the costs tend to be higher.’’

Rollman said that most doctors have no problem referring within the network and that the fine is expected to be applied “only in rare circumstances.”

The Connecticut State Medical Society has written to the state attorney general about United’s exclusive contract with LabCorp, saying the company has a limited number of facilities in its area.

In Florida doctors say that is less of an issue since both companies have widespread presence. LabCorp has 34 locations in the Tampa Bay area and 146 in Florida. Quest has about 40 in the Tampa Bay area and 164 statewide.Wasylik said doctors generally don’t have a preference about which lab their patients’ use for tests.

“We just want the results to be fast and accurate.’’

But convenience is definitely an issue for patients, said Wasylik, who shares an office building with a Quest lab.

“If I give a patient a script for LabCorp, but they go to the Quest Lab in my building because it’s convenient, do I get fined?’’ Wasylik asked.

“The insurer allows a patient to have out-of-network benefits. But if they use them, they punish the docs. That doesn’t make sense.’’

Kris Hundley can be reached at hundley@sptimes.com or (727) 892-2996.

[Last modified February 9, 2007, 21:52:16]