A Cautionary Tale for All Labs

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Anonymous said:
So after the S/S article, the stock price rises over 10% and company get upgraded to buy. Ha! Ha! Mission (Un)Accomplished S/S.
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You look at the stock charts, and it appears to just meander along with the general sentiment of the market. I'd wager you big money that the vast majority of investors in the stock have not seen the report and haven't the vaguest idea what is going on there.
 






Anonymous said:
You look at the stock charts, and it appears to just meander along with the general sentiment of the market. I'd wager you big money that the vast majority of investors in the stock have not seen the report and haven't the vaguest idea what is going on there.
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You all are idiots. This is simply how BCBS is going to get a handle on all the out of network labs. They just are not going to continue to pay. It doesn't apply to Quest or LCA because they have the capitated contracts.
 






Anonymous said:
You all are idiots. This is simply how BCBS is going to get a handle on all the out of network labs. They just are not going to continue to pay. It doesn't apply to Quest or LCA because they have the capitated contracts.
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Come now! We're not all idiots..;)

Speaking as a rep for a Blues plan, here's the skinny: the BCBS' enforcement of the lab billing rule is a big, big help for us plans to control our spend on the Millenniums and Genotpix of the world. Those questionable labs have been skirting the system by billing all of their Blues business through the 1 or 2 Blues plans that were foolish enough to contract with them.

Those fun and games came to an end in Oct 2012, when all us Blues plans agreed to only accept lab claims for which the specimen was drawn in our territory.

Quest and LabCorp are in the catbird's seat now, as they both had the foresight to contract directly with as many Blues plans as possible.

The questionable labs had no such strategy, and now they're begging us for contracts. We're turning them away, as none of them are offering medically necessary testing that we can't already get through Quest, LabCorp, or a sprinkling of specialty labs in our network.

Y'all can whine and moan about how much it may suck to work for one of the behemoth labs, but the Big 2 are as well positioned as any labs can be in the era of Obamacare...
 






The majority of Blues lives are PPO and or self-insured and have out of network benefits. So what will happen, is the Blues will pay more for lab services (with less control), then become LabCorp and Quest's bi-ach when the ask the network person to call an account. So what are you really accomplishing?
 






Anonymous said:
The majority of Blues lives are PPO and or self-insured and have out of network benefits. So what will happen, is the Blues will pay more for lab services (with less control), then become LabCorp and Quest's bi-ach when the ask the network person to call an account. So what are you really accomplishing?
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To say the least, this post is bizarre and hard to understand. I think the poster is saying BCBS will pay whatever Labcorp or Quest demand. Au Contraire, LC and Quest will take whatever they can get, ie. whatever BCBS pays. CMS is the premier cost-setter. Do you think they're just going to bend over and take it from labs? What universe are you from?
 






Anonymous said:
The majority of Blues lives are PPO and or self-insured and have out of network benefits. So what will happen, is the Blues will pay more for lab services (with less control), then become LabCorp and Quest's bi-ach when the ask the network person to call an account. So what are you really accomplishing?
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1) True - most Blues lives have OON benefits, but those benefits are signficantly less than if a member goes to an INN lab. Doc's ain't gonna send their lab reqs to an OON lab and screw over their patient.

2) Check with your lab's health plan reps - they'll tell you that the LabCorp/Quest rates are among the lowest rates paid by a health plan. In addition, the hospital labs are charging 3-4 times as much as LabCorp/Quest. Speaking for my plan, I can tell you that we're wanting as much business as possible to go to LabCorp/Quest.
 






The doctor will send to specimen to whatever lab the hospital tells him/her to. Hospital owns the practice. Within 5 years 75 percent of physicians will be hosptial employees they are saying.
 






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