Non-participating lab referrals
Not only does your Anthem agreement obligate you to refer to participating labs where available, but members will only receive their full benefits from participating providers. As a result, referring your patient and our member to a non-participating lab may expose them to a greater financial responsibility. As a reminder, Quest Diagnostics is a non-participating laboratory for all lines of business in Colorado.
Unfortunately, there are certain non-participating labs that are offering to waive or cap co-payments, coinsurance or deductibles to our members in order to increase their overall revenue. These practices undermine member benefits and may encourage over-utilization of services.
These billing practices are also questionable in their legality. Such a practice may present violations under state or federal anti-kickback laws, and may constitute abuse of health insurance under the Colorado criminal code.
For a listing of Anthem participating laboratories, please check our online directory. Go to anthem.com. Choose Select Providers, and Providers Overview. Select Find Resources in Your State, and pick Colorado. From the Provider Home tab, select the enter button from the blue box on the left side of page titled Find a Doctor.
Note: When searching for laboratory, pathology, or radiology services, under the field “I am looking for a:” select Lab/Pathology/Radiology; and then under the field “Who specializes in:”, select Laboratories, Pathology, or Radiology as appropriate for your inquiry.
LabCorp is our preferred lab provider and offers a Single Source Solution to your testing needs:
LabCorp is capable of providing services that range from routine testing, such as basic blood counts and cholesterol tests, to highly complex diagnosing of genetic conditions, cancers, and other rare diseases. LabCorp has specialized laboratories which cover the following areas of testing:
· Allergy Program
· Cancer Testing
· Cardiovascular Disease
· Companion Diagnostics
· DNA Testing
· Endocrine Disorders
· Esoteric Coagulation
· Genetic Testing
· Genetic Counseling
· HLA Lab for National Marrow Donor Program
· Infectious Disease
· Liver Disease
· Kidney Disease
· Medical Drug Monitoring
· Molecular Diagnostics
· Newborn Screening
· Pain Management
· Pathology Expertise w/range of Subspecialties
· Preimplantation Genetic Diagnosis
· Reproductive Health
· Obstetrics / Gynecology
· Whole Exome Sequencing
· Women’s Health
Note: This relationship with LabCorp does not affect network hospital-based lab service providers, contracted pathologists, or contracted independent laboratories.
December 2019 Anthem Provider News and Important Updates - Colorado