Use a Par Lab to Avoid Unexpected Expenses

United Healthcare’s (UHC’s) network of participating laboratory (par lab) service providers for The Empire Plan Medical Program includes a combination of LabCorp, as the only national provider, plus other local, regional and hospital-owned labs and draw stations.  Enrollees who are not familiar with how the Plan works, may find that their out-of-pocket costs for lab services are higher than they expected.

Specimens collected at a physician’s office

As long as your physicians use par labs, you pay a $20 copayment for covered tests.  However, you may not always know which lab service provider your physician uses.  In most cases, specimens are collected in a physician’s office and picked up by a courier.  To minimize your out-of-pocket costs, it is important that you ensure your physician sends your samples to an Empire Plan par provider for testing.

Specimens collected at a hospital-owned lab

In other cases, your physician may write you an order for lab services and allow you to choose where to have the specimen collected.  With one exception, you should know that your out-of-pocket cost may be substantially higher if you use a hospital-owned lab.  The exception is the list of hospital-owned labs that are subcontracted by LabCorp to serve as LabCorp draw sites.  These labs are listed in the directory of Empire Plan par providers with “LCA subcontracted” before the name of the facility.

If you are physically present at the outpatient department of a hospital or at a hospital-owned extension clinic that is not an LCA subcontracted facility, the lab services you receive may be covered under the Empire Plan Hospital Program.  As such, benefits will be subject to the Plan’s outpatient hospital services copayment.  You will pay a $35 copayment for each visit to a network facility, or the greater of 10 percent of charges or $75 at a non-network facility.

Stellaris Health Network (SHN) Hospital Labs

UHC’s directory of Empire Plan par lab service providers includes the labs based in the following non-network hospitals:  Lawrence Hospital Center, Northern Westchester Hospital, Phelps Memorial Hospital Center, and White Plains Hospital Center.  These hospital-based labs are included in the directory because you will only pay the Medical Program par provider copayment if your physician sends your sample(s) to one of these hospital labs for testing.

However, if you are physically present at one of these hospitals, then benefits will be subject to the outpatient hospital services copayment.  Since these hospitals are currently not in the Hospital Program network, you will pay the greater of 10 percent of charges or a $75 copayment.

List of Par Lab Providers

To find the most current listing of par lab providers in the Medical Program, visit the NYS Department of Civil Service web site at www.cs.state.ny.us.  On the home page, click on “Benefit Programs” and follow the instructions to access NYSHIP Online.  Then, click on “Find a Provider.” You can also obtain a list of par labs by calling UHC at 1-877-7NYSHIP (1-877-769-7447) and selecting the prompt for United Healthcare.