How Does This Program Affect You?

We are dedicated to ensuring your patients receive the highest quality laboratory testing at the most reasonable cost. We can only accomplish this if we effectively manage the network of laboratory providers and if your practice accesses the laboratories that have been accredited for participation in the health plan.

  • Sometimes patients may need a specialized test. BlueCross has considered this issue and has included specialty labs and centers of excellence within the network of laboratory providers. The centers of excellence are staffed by qualified clinical pathologists and genetic counselors prepared to answer your inquiries both before and after you perform testing.
  • We do not qualify all laboratories. If an out-of-network laboratory services you or you have outpatient testing performed by a hospital, your patients' out-of-pocket cost may be significant. To ensure the lowest cost to your patients, please send BlueCross and BlueChoice HealthPlan members' testing to in-network laboratories only.
  • Certain laboratory procedures require prior authorization. You can submit requests to Avalon for prior authorization by fax or by phone. Avalon will promptly review your request and provide a timely, written decision.
  • Please note that Avalon doesn't manage services in an emergency room or hospital inpatient setting. This change does not alter the available member benefits, but using these participating providers will result in a lower out-of-pocket cost for your BlueCross and BlueChoice®-covered patients.

Read more about the goals of our Laboratory Medical Benefits program our relationship with Avalon Healthcare Solution.

If you have questions or would like to learn more, you can contact the Provider Education department by using the Provider Education Contact Form. You can also request training by using the Provider Advocate Training Request Form.

What other resources are available to assist me in learning more about Avalon?

Here are reference materials about Avalon:

BlueChoice HealthPlan is an independent licensee of the Blue Cross and Blue Shield Association. Avalon is an independent company that provides benefits management service on behalf of BlueCross and BlueChoice HealthPlan of South Carolina.