How is your lab getting around this ????? Pathline is not credentialed with anyone and fraudulently uses their hospital contracts which are held under a different corporation -Orange Pathology
The only way to "get around" it is to convince each Blues plan that your services are medically necessary AND unavailable from any of their currently contracted labs. You don't do that, you aren't going to be in-network. Speaking as the eprsonat one of those Blues plans that's hearing from dozens of you labs, I can say that I'm turning away all of you, as I have yet to see any lab offering necessary testing that can't be offered by LabCorp, Quest, Myriad, and Genomic Health combined. Why do you think we started enforcing that BlueCard rule in the first place? We were sick of labs doing unnecessary, expensive testing and never having to justify their behavior to us as the Plan (and members) that ultimately had to pay your bills. It's a brave new world - best to go find employment with a lab that knows how to justify its value to the payers...
Interesting ti see a blues person here, so what are you doing about all the pathology Pathline is buying from urology in house labs who don't get paid by you and then reporting it under Orange and billing it there fraudulently, as the blues contract for the hospital is for hospital patients and you a re paying a much higher hospital rate for that work?
yes. it is true. or thye bill under "Histopathology Services" Can belies the OIG hasnt come knocking yet
