Allergen Testing Referral Form Page 2

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Texas Managed Medicaid Plans and corresponding lab providers
(Pharmacist: Please indicate the plan in which the patient is enrolled by checking the corresponding box)
Plan
Lab Provider
Aetna
Quest, CPL
Aetna Better Health
Quest
Amerigroup
Quest
BCBS TX
Quest
CHRISTUS Health Plan
Quest
Community First Health Plans
Quest
Community Health Choice
Quest
Cook Children’s Health Plan
Quest
Driscoll Children’s Health Plan
Quest
El Paso First Premier
Quest
FirstCare STAR
Quest
HealthSpring
Quest
Molina Healthcare
Quest
Parkland Healthfirst
Quest
Right Care from Scott and White Health Plan
Quest
Sendero
Quest
Seton
CPL
Superior Health Plan
Quest
Texas Children’s Health Plan
Quest
United Healthcare Community
LabCorp
Other: _______________________________
Information is current as of 1/8/14; please verify coverage before referring patient to lab.
This is not an exhaustive list.
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