Reminder: Refer lab services in-network

As you’ve read before, independent laboratories must file claims with the Blue Cross plan in the state where the specimen is drawn, which is determined by where the referring (or ordering) physician is located. That’s why health care practitioners shouldn’t send samples to a lab unless they’ve first verified that the lab participates in the member’s applicable Blue Cross network. These rules apply regardless of whether a Blue Cross plan provides primary or secondary coverage.

Keep in mind that Blue Cross Blue Shield of Michigan doesn’t have participation agreements with most labs located outside of the state. You can determine if a lab outside of Michigan participates with Blue Cross by going to bcbsm.com and doing the following:

• Click on Find a Doctor.
• Click on Get Started.
• Click on I want to find doctors or hospitals.
•  Type in your ZIP code.
• Using the drop-down menu, select PPO Plans – Group Enrollees.
• Type in Out-of-State Independent Laboratories.
• Click on Go.

If practitioners don’t refer such services to Blue Cross network providers, members may be responsible for additional out-of-network cost-sharing. They may also be subject to balance billing by the out-of-state labs that aren’t participating or in-network with Blue Cross.

As a reminder, Blue Cross PPO practitioner agreements require practitioners to refer services to in-network providers. We regard referring laboratory services to non-participating out-of-state laboratories as a violation of the Participating Provider Agreement and the TRUST Network Agreement. If you do not meet our program requirements for participating laboratory services, you may be subject to corrective action and potential termination from the TRUST Network.