United announces Pre-Authorization for Genetics Testing

United announced that starting 10/1/2017 all genetic (BRACA, PGX, Cancer etc..) testing will require pre-authorization before the sample is collected or payment will not be made. It is the labs responsibility to make sure the ordering physician gets the authorization. This is the new world the labs live in. It follows the Maryland Medicaid decision to require pre-authorization for the top 2 tier (G0482 & G0483) confirmatory drug testing codes. Most insurances will follow suit in 2018. I am accused of being a troll for my other posts on this website. I am not a troll, just in tune to what is going on. Sales Reps need to educate themselves and not rely on the labs. Wake up because the s**t will hit the fan in 2018 especially with PAMA starting at a 10% cut to Medicare Rates. Remember almost all insurances set their rates to a % of Medicare CLFS. And most insurers will require out of network labs to submit claims through a clearinghouse like BeaconLBS in 2018, so most OON claims will get rejected . Time to find in network labs that are full service and dump the toxicology and PGX specialty labs. CMS and the insurers are conspiring to put the specialty tox and PGX labs out of business.

 

Imagine the last scene of Saw... the door is being shut... Game Over!

 

The sky is falling, the sky is falling. So what if they are requiring pre authorizing. It just amkes the labs that much more profitable as they will only ruin tests where they get paid. No big deal. Go home your panties are showing. Leave this for the real lab reps.

 

I already deal with this in Florida. The amount of denials for preauthorization in Florida is astronomical. They reject about 66% of all requests for BRACA and 99% for PGX. My numbers have plummeted. If you do not think this will affect the amount of preauth denials you are delusional. The sky is falling you moron!

 

Dropping loads

 

The Dark Report published an update from Aetna that said they are doing the same thing starting now. They have 20 million covered lives in the USA. Goodbye 1099, HOPD scum

 

My business is basically down to 0. Not only are they pre authing Pgx, Cgx, and blood wellness panels, BUT my docs are pised because they are getting threatening letters from the insurance companies saying that they will be kicked out of network if they keep ordering these "overpriced" tests. This will be a horrible year for me.

 

Lol. You must be new to this game.

This has been a long time coming. You put "overpriced" in quotes like you think your lab isn't raping the system. If your docs are getting letters, then your lab is filing too much. It's that cut and dry.

Insurers are not going to spend extra money for things like pgx, brca, and tox when in-network providers can provide comparable testing at a fraction of the cost. It's bad business and a reason why premiums are so high.

We've seen this movie with BV/Yeast testing, toxicology, cardiovascular risk, NIPT, etc. Specialty labs employ one type of testing, bill at outrageous amounts, then get shut down once the mayor's figure it out. The lab world was never meant to function like this.

Go get a job with a legit lab. Glad the insurers are putting a stop to this nonsense.

 

Anthem requires all doctors to get pre-authorization for genetic testing July 1 , 2017. This will reduce genetic testing substantially! Ambry Genetics just sold to a Japanese company because their revenue fell by 25% because of pre-authorization. The game is over for all the genetics companies. Especially PGX. Good riddance to all the criminals!

 

I work for an in network lab. And we had less than 5 percent of requested tests get preauthourized. None of the docs want to fill out the extra paper work or complete the "peer to peer" call. I am basically screwed, thinking of leaving the field. This is the worst I have ever seen medical sales. It is as if we don't matter anymore.

 

United Healthcare does not pay for shit anyways!

UnitedHealth Group CEO Stephen Hemsley made $17.8 million in total compensation in 2016 for running the nation's largest health insurance company. Hemsley's compensation grew by 22.4% over 2015, according to a document filed with the U.S. Securities and Exchange Commission on Friday.

 

United Healthcare does not pay any labs! RICO is what they do as they put them out of business!

https://www.nytimes.com/2017/05/19/business/dealbook/unitedhealth-sued-medicare-overbilling.html

https://www.justice.gov/opa/pr/unit...uit-alleging-unitedhealth-group-Incorporation (business)

http://www.npr.org/sections/health-...ent-joins-second-lawsuit-against-unitedhealth

http://www.reuters.com/article/unitedhealth-lawsuit or suit in law-idUSL1N1I41QP

http://www.modernhealthcare.com/article/20170530/NEWS/170539989

 

You are way off trying to say that United Healtcare does not pay any labs. They are typically one of the best payers.