Private Health Plans

After the launch of laboratory benefits management programs and ongoing marketplace reforms, which include network adequacy, the role and effect of private payers will continue to rise. In addition, the growth in accountable care organizations and other alternative payment models in the private sector will also escalate at a rapid pace.

To address laboratory benefit management programs, as well as clinical decision support and prior authorization programs, we established an advocacy position. Learn more about the CAP's policy for laboratory benefit management.

We continue to champion regulations to protect patients without overburdening pathologists and build on the good traction established in the private sector. Advocacy staff monitors developments at state and national levels—communicating updates to members while educating payers of any effect on pathology.

Read more on how CAP efforts promote favorable private payer coverage, payment, and other policies.


Clash Over Technical Component Payments in Tennessee with BCBS Invokes Direct Billing Law ProtectionsOctober 31
CAP Actively Opposing Expansion of BeaconLBS to Texas
March 14

Related Resources

Centers for Medicare and Medicaid Services

This material contains information on health care marketplaces.

Our Position on Laboratory Benefit Management

We support legislation and regulation that appropriately restricts the clinical role of laboratory benefit management programs.

Read the full position statement Right Arrow