AMCNO board of directors meets with new medical director of United HealthCare for the Northern Region

This week the AMCNO board of directors had an opportunity to meet and talk with Dr. Giesele Greene, the new medical director of UHC for the Northern Ohio region. Among the topics discussed with Dr. Greene were UHC’s practice to require participating providers to refer lab services to a participating lab network. The intent of this program is that after March 1, 2007 continued referrals to non-participating labs may, after appropriate notice, subject the referring physician to one or more of the following actions: 1.) a financial penalty of $50, 2) a decreased fee schedule 3) a change in eligibility for the Premium Designation program or 4) termination of network participation.

The AMCNO is of the opinion that UHC should remove the economic sanction until such time that any questions that have arisen regarding these new rules have been addressed and reviewed. It is our opinion that our members should not be subject to a change in rating or a penalty by an insurance company if the patient makes a decision to use a non-network lab. In addition, the AMCNO questions whether or not UHC even has the authority to require such financial penalties. Last, the AMCNO expressed concern as to whether or not the imposed rules to use only in-network labs would in some way impact existing referral contracts with UHC.

Dr. Greene also briefly discussed the UHC radiology notification program. Beginning April 16th, UHC will require prior notification for the following defined set of outpatient imaging procedures: CT scans, MRIs, PET scans and nuclear medicine studies, including nuclear cardiology. Dr. Greene noted that UHC is calling this process prior notification and the program contains different requirements than prior authorization or pre-certification. In addition, failure by a practice to notify UHC prior to performing the procedure can result in not getting paid for the service. Physicians and their staff may obtain additional information regarding the Radiology notification program at http://www.unitedhealthcareonline.com  If any AMCNO members have specific issues with either of these programs, please email your comments to ebiddlestone@amcnoma.org