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UnitedHealth's lab rules upset doctors

February 15, 2007|From the Associated Press

Doctors say UnitedHealth Group Inc. is threatening to fine them over something they can't control: patients' behavior.

UnitedHealth said that beginning March 1 it could fine a doctor $50 if a patient has tests done in facilities besides Laboratory Corp. of America or other labs that the company has selected. Doctors with patients who go out of network could also be subject to lower reimbursement and to exclusion from United's network.

The American Medical Assn. said this was the first time a doctor could be financially punished for a patient's behavior. Trustee Dr. James Rohack said doctors could refer patients to in-network labs but patients might choose to go elsewhere because of convenience or preference.

UnitedHealth spokesman Tyler Mason said the policy was not intended to punish doctors for patients' choices but to remind doctors to refer patients to labs in the network. He said the insurer wouldn't fine a doctor if a patient defied a referral and selected a non-network lab.

"The fine scenario is highly unlikely," Mason said.

Mason said he understood how doctors could be upset by the notion of fines but added that all contracts subject physicians to smaller reimbursements and possible expulsion for failing to abide by the terms. He said patients' expenses for going out of network would depend on their individual policies.

In October, Minnetonka, Minn.-based UnitedHealth announced that effective Jan. 1, its major national carrier would be Laboratory instead of Quest Diagnostics Inc. and began communicating with physicians about the switch. The fines don't go into effect until next month to give doctors and patients time to adjust to the change.

Rohack remains skeptical about UnitedHealth's pledge to work with doctors to avoid fines. He said the current policy was more about saving UnitedHealth money than providing the best coverage for patients.

"They [United] always say they are going to play nice in the sandbox," Rohack said. "But if the stock price starts to get shaky, they don't [play] nice anymore."

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