United to fine physicians if patients go to "wrong" lab

Health plan executives say the policy is a reminder to help patients stay in-network. Doctors fear it sets a disturbing precedent.

By Bob Cook, AMNews staff. March 5, 2007.

If UnitedHealth Group members get blood drawn at an out-of-network lab, then United says it could draw some blood from physicians.

The nation's second-largest private-pay health plan said that, beginning March 1, it would institute a policy that will minimally fine a physician $50 if a patient goes outside United's network for lab services. The sum represents the cost difference to United between nonparticipating and participating laboratories, according to a letter to physicians dated November 2006.

If patients continued to use out-of-network labs, the letter said, doctors could face further sanctions. Those include a "change of eligibility" in United's pay-for-performance and quality-rating programs, a "decreased fee schedule," or termination from the plan's network.

In a January meeting with the Iowa Medical Society, United representatives said the health plan did not intend to fine physicians every time a patient went to an out-of-network lab, unless there was evidence a doctor sent the patient there, said Jeanine Freeman, IMS senior vice president of legal affairs.

The objective, United told the medical society, was to remind doctors to refer patients to in-network labs. United spokespeople could not be reached for comment at press time.

But what is upsetting physicians and organized medicine is "the precedent that this sets," Freeman said.

The AMA and state medical societies sent letters to United protesting the intent to fine doctors. While plans have used various means to fight paying out-of-network rates, medical society executives say they can't think of a case in which plans bluntly assessed financial penalties on physicians for their patients' decisions.