About Avalon and lab benefit management

HMSA has partnered with Avalon Healthcare Solutions as its lab benefit manager for routine lab tests as of July 1, 2024. Avalon is a lab benefit manager with expertise and an evidence-based approach to administering and evaluating lab services.

The overuse of lab benefits is high, which contributes to the rising cost of health care. HMSA is always working on solutions to improve the affordability of health care for our members. This partnership will help HMSA continue to ensure that patients get the right test at the right time while managing health care costs effectively. In addition, having a lab benefit manager allows HMSA to consult with lab testing experts and helps providers understand current guidelines and best practices.

HMSA will continue to pay for all medically necessary routine lab tests ordered by your health care providers.

Routine lab policies

Your provider should review the applicable policy for routine lab tests before ordering them and can contact HMSA if they have questions about routine lab policies.

If a lab requests that you sign a financial responsibility form or waiver, you may be responsible for paying the lab fees if HMSA doesn’t pay for the test. However, the financial responsibility form must comply with various requirements designed for your protection, including that it must identify specific services you’re receiving and be meaningfully discussed with you. Providers may find more information at https://prc.hmsa.com/s/article/Acknowledgement-of-Financial-Responsibility-Medical.

You may want to contact your provider directly to check that they ordered your tests properly and in accordance with HMSA’s lab policies before you sign any form or waiver accepting financial responsibility.

Filing an appeal

If you received a bill for a routine lab test, but think HMSA should have paid for it, you may file an appeal. Please visit Appeals & Grievances to learn more. The appeals process varies depending on what type of health plan you have.