Bcbs Lab Services and Coverage

Blue Cross Blue Shield (BCBS) lab services and coverage can be a bit confusing, but don't worry, we've got you covered.

BCBS has a network of over 90,000 laboratory locations across the US, which means you have access to a wide range of testing services. Most BCBS plans cover lab services, but the specifics can vary depending on your plan and location.

You can expect BCBS to cover routine lab tests, such as blood work and urinalysis, with little to no out-of-pocket costs. Some lab services, like genetic testing and specialized testing, may require prior authorization or have different coverage rules.

We're dedicated to ensuring your patients receive the highest quality laboratory testing at the most reasonable cost. This is achieved by effectively managing the network of laboratory providers and accessing in-network laboratories.

BlueCross BlueShield of South Carolina has considered the need for specialized tests and has included specialty labs and centers of excellence within the network of laboratory providers.

These centers of excellence are staffed by qualified clinical pathologists and genetic counselors who are prepared to answer your inquiries before and after testing.

Certain laboratory procedures require prior authorization, which can be submitted to Avalon for review by fax or phone.

Avalon will review your request and provide a timely, written decision.

To ensure the lowest cost to your patients, please send BlueCross and BlueChoice HealthPlan members' testing to in-network laboratories only.

To ensure your patients receive the highest quality laboratory testing at the most reasonable cost, it's essential to use in-network laboratories. This will help minimize out-of-pocket costs for your patients.

BlueCross BlueShield of South Carolina has a network of laboratory providers, including specialty labs and centers of excellence, staffed by qualified clinical pathologists and genetic counselors. These centers are prepared to answer your inquiries before and after testing.

Some laboratory procedures require prior authorization, which can be submitted to Avalon for review. Avalon is an independent company that provides laboratory network management on behalf of BlueCross and BlueChoice.

To determine which laboratory services require prior authorization, you can reference the Avalon Prior Authorization List or view the list through Avalon's PAS portal on their website.

Here are some resources to help you navigate lab coverage policies: