UHC seeking to renegotiate legacy contracts in Texas

May 21, 2020

It appears another major payer is now seeking to rein in payments to pathologists and labs with long-standing “legacy” contracts as UHC recently began issuing letters to providers in Texas informing them of upcoming fee schedule cuts.

Last month, UHC began sending the letters to providers, which say in part that, “This new fee schedule is part of a larger effort to support community-based physicians. The commercial fee schedule reimbursement is based on 2019 CMS RVUs and geographically adjusted, and account for Site of Service differentials based on location of services performed, similar to CMS methodology.”

The letter goes on to state that anyone who does not agree to the new contract must notify UHC within 30 days of receipt of the notice.

The exact amount of the cut depends on the provider’s existing contract. While we can’t disclose the exact numbers we’ve seen at this time, we can say those we have reviewed so far have been substantial.

While we have so far only been able to confirm providers in Texas have received these notices, the strategy being deployed seems to be similar to the effort Anthem took in 2019 to drastically reduce pathology and lab compensation in the payer’s markets across the nation.

We’re currently discussing strategic options for those looking to push back against these cuts. As always, if you are concerned about these reductions, a good first step is to reach out to your state pathology societies to coordinate a response.

In the meantime, if you have questions about these drastic rate adjustments, don’t hesitate to reach out to us at 517-486-4262 for a free consultation.

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