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Analysis

Health Plans Should Scrutinize Lab, Genetic Testing for Unneeded Expenses

By Gregory A. Freeman  
   January 31, 2018

No physician has the time to study a policy like that, so the policy becomes irrelevant, Kaufman says.

Physicians use their best judgment to determine whether they think the test is appropriate, and the health plan has lost the opportunity to guide that decision, he says.

Policies should be simple enough that the clinician can quickly determine what parameters determine whether the health plan will pay for it, he says.

"That improves the efficiency of the process because clinicians aren't ordering tests that are going to be rejected, appealed, and re-appealed. All that takes time and carries an expense," Kaufman says. "Many times the patient is caught up in the middle of all this. If policies can be clear, accessible, and transparent, it improves the system for everyone."

Gregory A. Freeman is a contributing writer for HealthLeaders.


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