United Healthcare Changes Coverage
June 25th, 2021
Pana Community Hospital has been made aware of changes in United Healthcare’s insurance coverage for outpatient lab services that the hospital feels it is important to share. For individuals with United Healthcare insurance, it is important to monitor your coverage for potential changes which could limit your ability to obtain in-network outpatient lab services at Pana Community Hospital. United Healthcare is implementing plan changes for fully insured commercial insurance plans. These changes require outpatient laboratory services be performed at Designated Diagnostic Providers for you to receive in-network outpatient laboratory benefits. We do not know which plans this will impact and United Healthcare is not allowing Hospitals to negotiate terms of participation as a Designated Diagnostic Provider.
With the new United Healthcare plan changes, Pana Community Hospital and your providers at the Community Medical Clinics of Pana, Assumption and Nokomis and Pana, Ramsey and Nokomis Medical Groups may be listed as “in-network”; however, you may not be able to receive outpatient laboratory services as “in-network”. You will need to look at your insurance card to see if it includes a Designated Diagnostic Provider logo as indicated below. This benefit change by United Healthcare is for outpatient labs only and will not impact lab services received in emergency and inpatient care settings provided at Pana Community Hospital.
Outpatient labs performed at a non-Designated Diagnostic Provider lab may be denied as non-covered or processed for payment at a much lower out-of-network coverage rate. What that means to you is that you will be responsible for paying higher out of pocket costs for lab services not received through a Designated Diagnostic Provider.
Pana Community Hospital is not a United Healthcare Designated Diagnostic Provider. However, please know that our Lab does meet all the same high-quality standards that United Healthcare has used to select laboratories for Designated Diagnostic Provider status. Pana Community Hospital’s lab is accredited by the College of American Pathologists. United Healthcare made this change to fully insured commercial insurance plans. The contracts United Healthcare provided to hospitals to join the Designated Diagnostic Provider program for outpatient lab services did not allow hospitals to negotiate terms of participation. When rural community hospitals evaluate new contracts with health insurance companies, we must make the decision that best protects our ability to maintain vital services to our community like inpatient and emergency care and a wide range of ancillary services. If United Healthcare provides Pana Community Hospital the ability to negotiate participation terms, we are willing to consider joining this new program that United Healthcare has created that may limit service options for patients.
In the best interest of our patients, we are providing this information to you so you better understand your health insurance plan coverage and changes that United Healthcare is making that could limit your access to care at your normal healthcare facilities. Again, United Healthcare may still list Pana Community Hospital laboratory as “in-network”; however, if your fully insured commercial insurance plan has the Designated Diagnostic Provider designation, you may have higher out of pocket costs for outpatient lab services performed at our facility due to the new United Healthcare Designated Diagnostic Provider program.
If you have concerns about these changes made by United Healthcare and your ability to obtain lab services locally, you may call the Illinois Department of Insurance office toll-free at 877-527-9431 or visit their website at http://insurance.illinois.gov.