Lab Tests & X-Rays

Eligible lab services are covered only if you use in-network clinical laboratory providers for members enrolled in Horizon HMO Access:

• Laboratory Corporation of America (LabCorp)
• Quest Diagnostics (Quest)
• AtlantiCare Clinical Laboratories

When you need clinical laboratory tests, your PCP may collect specimens at his or her office for testing by an in-network lab, or send you to a LabCorp, Quest or AtlantiCare patient service center.

• If you go to an in-network patient service center, be sure to bring your member ID card, as you may be asked to complete forms. If you get a bill from LabCorp, Quest or AtlantiCare Clinical Laboratories, please contact Member Services.

• If you use a testing facility other than LabCorp, Quest or AtlantiCare Clinical Laboratories, your tests will not be covered and you will have to pay the total cost of the lab services.

We work with eviCore healthcare for non-emergency outpatient radiology and diagnostic imaging services. eviCore healthcare will help schedule and manage your outpatient radiology and diagnostic imaging, determine whether a service is medically necessary and confirm a location for the service.

If your PCP decides that you need an X-ray or scan, they will ask you to call eviCore healthcare’s Scheduling Line at 1-866-969-1234. Representatives are available weekdays, from 7 a.m. to 7 p.m., ET.

The eviCore healthcare scheduling staff will coordinate with the in-network imaging center of your choice to schedule your exam and provide you with a confirmation number. You won’t need a referral for most radiology services.

However, if you schedule radiology services at a hospital outpatient department, your PCP must provide you with a referral form. You can use eviCore healthcare’s Scheduling Line to make an appointment at a hospital outpatient department, but eviCore healthcare cannot issue a confirmation number as a referral to a hospital outpatient department.

Advanced imaging services

Your PCP must call eviCore healthcare before you get these services:

• CT/CTA scans
• Diagnostic left-heart catheterization
• Echo stress tests
• Echocardiograms
• MRIs/MRAs
• Nuclear medicine studies (including nuclear cardiology)
• PET scans

For more information about X-rays and imaging, please refer to your SPD or Benefit Booklet for coverage details.