Lab Wars and the Doctor-Patient Relationship

From a somewhat threatening form letter I received from Peter McCauley, MD, Midwest Marketing Specialist, CIGNA, dated 1 August 2010:

Dear Westby Fisher,

By using a CIGNA in-network laboratory, including two of the largest national laboratories, Laboratory Corporation of America (LabCorp) and Quest Diagnostics, Inc., as well as other regional and niche laboratories, you and your patients can have a greater choice and access to an extensive list of patient service center and quality service at competitive rates.

As highlighted below, using a non-participating laboratory has important implications:

Patients

• Individuals, depending on the nature of their health benefits, face the potential of higher costs and avoidable impacts on their deductibles or health savings accounts.
• Individuals with no out-of-network benefits may have no coverage at all.
• Use of non-participating laboratories will decrease the amount of maximum lifetime benefits available to individuals.

Physicians

• Under your contract with us, you agreed to refer your CIGNA patients to contracted in-network laboratories, unless otherwise authorized by CIGNA. It is important that this agreement be honored.
• Unwarranted use of non-participating laboratories may adversely affect our business relationship

And the letter goes on to describe why I must transition my patients to CIGNA's labs.

What will I tell my employer whose lab services I use because they're integrated with our electronic medical record?

Let's see. Soon I will have to call one insurer to get an authorization to implant an emergent pacemaker and now I find I have to call another insurer's laboratory chain to obtain my patient's lab tests, even though that chain is not integrated with our EMR system.

Looks like it's time to add every patient's insurance provider to their medical problem list.

There is simply no way doctors can keep all of these insurance gymnastics straight AND provide health care, yet here we are with yet another example of how third parties are creating an adversarial relationship between doctors and their patients while actually decreasing the efficiency and quality of patient care.

-Wes