UnitedHealth comes under fire for new diagnostic test policy
The American Hospital Association sent a letter to the Federal Trade Commission last week asking it to investigate the policy’s coverage.
The American Hospital Association (AHA) is challenging the provisions of a new UnitedHealtchcare policy.
The association sent a letter to the Federal Trade Commission last week asking it to investigate the policy’s coverage for diagnostic tests and to explore rate hikes for temporary nurses. The letter was sent nearly a month after the agency announced that is studying the impact of physician group and health-care facility consolidation and is seeking data from six major insurers, including UnitedHealthcare.
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The AHA questioned UnitedHealthcare’s plan to implement a new Designated Diagnostic Provider (DDP) program on July 1. The insurer will eliminate all coverage for diagnostic tests at freestanding or hospital labs, including those in the health plan’s network, unless the facilities are a DDP.
“In order to become a DDP, freestanding and network labs must complete a programmatic registration process and meet certain thresholds for quality and efficiency that are not publicly available for review,” the letter said.
A patient could receive care at a non-DDP lab even if it is in their network and have their coverage denied. The program could become a new avenue for surprise bills, because the lab services still may be listed as in-network for the consumer, the AHA said.
UnitedHealthcare countered that the policy is meant to address wide discrepancies in price between freestanding and outpatient labs.
“UnitedHealthcare members may pay as much as 500 percent more on average for lab services, depending on where they are performed,” it said. “Designated Diagnostic Provider benefit designs will cover outpatient lab services provided by qualified freestanding and outpatient hospital laboratories who meet quality and efficiency criteria. The new benefit designs provide our members with access to quality, efficient care while helping to protect them from higher lab costs.”
The AHA also is concerned about multiple reports of “outrageous” rate hikes from nurse staffing agencies that “appear to be naked attempts to exploit the pandemic by charging supercompetitive prices to desperate hospitals.”
Hospitals across the country are reporting higher labor costs and have turned to nurse staffing agencies to shore up staff as they fight COVID-19. The AHA said it has received reports from hospitals that nursing agencies are engaged in anticompetitive pricing.
“While the nurse staffing agency industry too often blames hospitals for driving up the rates,” the association wrote to the FTC, “the fact is that hospitals are in dire need of nursing staff to care for their patients and have little choice but to pay the rates demanded and refrain from complaining publicly for fear of being cut off from the supply of travel nurses.”
It called for the FTC to use its authority to investigate the price hikes. The AHA also called the FTC’s study into the impact of physician group and health-care facility consolidation flawed. “The insurers from which the FTC seeks data have substantial market power, a fact that the FTC does not appear to plan to investigate,” it said.
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