On April 25, the CAP wrote a letter to Horizon Blue Cross Blue Shield of New Jersey opposing a policy that limits the ability for pathologists to be reimbursed for diagnostic services performed on patients. The letter follows an April 3, 2024, meeting between Horizon representatives and CAP leaders where the CAP stressed that it should be up to the patient and their doctor to determine where diagnostic services occur, with the common goal of delivering the healthiest outcome. The CAP had also written Horizon in November 2023 with similar concerns and a request for clarification around the policy update. In its most recent letter, the CAP has called on Horizon to reverse its decision to enforce this policy, and to revise it so that clinicians can continue to choose local pathologists who are part of their model of coordinated care, which is an essential element in quality patient care. The CAP explained that differentiating where specimens are sent, and which pathologists are “credentialed,” based only on place of service results in fractured care that by its nature disrupts health care quality and adds unnecessary burden for patients and their physicians. In situations where the diagnostic biopsy leads to further hospital-based care (for example, an office-based fine-needle aspiration to diagnose cancer), the current requirement that patient samples be sent outside the local health system or care team prevents the local pathologist from participating in care coordination at the time of initial diagnosis or correlating these critical initial findings with subsequent surgical specimens obtained in the hospital. The CAP also emphasized the potential for delay in diagnosis and treatment, as well as logistical challenges and risks that are involved in this kind of policy. The CAP will continue to engage with Horizon to ensure insurer-imposed policies do not disrupt care coordination, add patient burdens, or compromise quality care. For more on the CAP’s advocacy in the private sector, visit www.cap.org/advocacy/payments-for-pathology-services/private-sector-advocacy.