Effective January 1, 2022 United Healthcare (UHC) rolled out a scaled back version of its Designated Diagnostic Provider (DDP) program in 21 approved states for commercial members only. UHC expects to expand the program to additional states once state approval is received. Previously the program was set to deny any outpatient lab tests or pathology services as non-covered when performed by a non-DDP provider (whether in or out-of-network), holding members financially responsible. Under the new version of the program, UHC is focused on promoting the lower patient out of pocket financial liability on claims performed by a Designated Diagnostic Provider, because these providers have lower fee schedules.
The program covers clinical lab tests and pathology services provided to non-hospital patients in an outpatient setting, that are not bundled or a part of the global surgical package.
UHC argues that using a DDP lab helps ensure high quality care at a lower out of pocket cost. CAP is however urging UHC to end the program. CAP is concerned it could potentially cause patients to put financial interest ahead of a treating provider’s professional judgement. CAP also has concerns the program could adversely impact smaller independent labs and pathology groups that cannot qualify for DDP approval, which could cause a disruption in long-standing professional referral relationships between ordering providers, patients and performing providers.
Please click here for the original APS white paper information on this topic.