UnitedHealthcare, Aetna, BCBS Plans Implement Lab Testing and Provider Reimbursement Policy Changes
Six major health insurers implemented reimbursement policy changes effective September 1, 2026. UnitedHealthcare is tightening lab testing reimbursement across commercial, Medicare Advantage, and Medicaid plans, with Medicaid rollouts staggered by state from August through December. Changes include caps on allergen testing (20 allergens per year for patients 20+), limits on hepatic fibrosis testing to once every six months, and vitamin B12 testing restrictions to once every three months. BCBS Michigan is phasing out incident-to billing starting September 1, requiring enrollment-eligible clinicians to add modifier SA; by March 2027, clinicians with their own NPI must bill directly or face 80% fee schedule reimbursement. Molina Healthcare of Ohio is implementing new specialty medication administration site-of-care policies and revised buy-and-bill pharmacy policies for several drugs.