IBC has become aware that potentially misleading information about member cost-sharing (e.g., copayment, coinsurance, deductible) is being distributed on documents that display the Quest Diagnostics name and logo. The information indicates that members can continue using Quest Diagnostics after July 1 without additional member financial impact or cost-sharing. Please be assured that Quest Diagnostics will be an out-of-network provider effective July 1, 2014.

Waiving member cost-sharing has long been prohibited under the federal anti-kickback laws when used in connection with federally funded programs, such as Medicaid and Medicare, which may now include Qualified Health Plans on the Federally Facilitated Marketplace. In addition, routine waiver of cost-sharing may be a violation of the Federal False Claims Act, subject to investigation by the Office of Inspector General and/or any applicable state insurance department?s fraud division.

Use an in-network laboratory provider

Your Professional Provider Agreement with IBC requires you to direct members and/or their lab specimens to a participating laboratory, except in an Emergency, as otherwise described in the applicable Benefit Program Requirements, or as otherwise required by law. The ordering physician shall obtain preapproval before referring a member to a non-participating provider.

If you have any questions about this information, please email us.